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 The testing recommendations, published in the journal Pediatrics,
mirror guidelines for diagnosing the disorder in adults. Because
children may have a harder time eliminating gluten from their diets,
they may also require long-term follow-up to support good nutrition
habits and check for complications that can develop when the disease
isn’t well managed.
To effectively treat children with the disease, doctors and parents
need to be sensitive to the unique problems young patients may face,
such as difficulty understanding what’s in their food and drink,
peer pressure to eat and drink what their friends do, and a fear of
ridicule and being singled out, said study co-author Dr. J. Decker
Butzner of the University of Calgary in Canada.
“One main take away is that children can learn to manage their
diet,” Butzner said by email. “They need to be involved in grocery
shopping, menu planning, restaurant assessment, food ordering and
trip organization in regards to a gluten free diet.”
“Second, children need to be periodically assessed by a health care
professional for the management of their celiac disease,” Butzner
added.
About one in 100 people have celiac disease, an autoimmune disorder
that damages the small intestine and interferes with the absorption
of nutrients from food. People with celiac disease can't tolerate
gluten, a protein in wheat, rye and barley. Left untreated, the
condition can lead to complications such as malnutrition, low bone
density, lactose intolerance and infertility.
To craft the diagnosis and treatment recommendations laid out in the
current paper, Butzner and colleagues reviewed previously published
research on celiac disease. Then, they anonymously voted on proposed
guidelines.
In addition to age-appropriate education about how to follow a
gluten-free diet, children with celiac disease also need close
monitoring to make sure their growth in height and weight is
appropriate for their age, the doctors argue. They should also be
checked for nutritional deficiencies that could hamper growth, such
as an insufficient amount of iron in their diet.
Sometimes, children with celiac disease also have type 1 diabetes,
another chronic autoimmune condition that results in the pancreas
producing little or no insulin, a hormone needed to allow blood
sugar, or glucose, to enter cells and produce energy.
People with type 1 diabetes typically have to test their own blood
sugar levels throughout the day and inject insulin to manage them.
Getting the insulin dose right requires patients to count carbs
correctly, and kids with celiac disease need to do this in addition
to juggling a gluten-free diet.
At the same time, children need to be monitored
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for proper bone health because celiac disease can lead to
osteoporosis, a thinning of the bones that can lead to fractures and
is more typically seen in old age.
Doctors also need to monitor kids’ heart health because celiac
disease is associated with an increased risk for clots, which have
the potential to contribute to strokes and other life-threatening
problems.
Down the line, these children are also at an increased risk for
liver damage, particularly if their gluten-free diet isn’t well
managed. For this, too, doctors need to watch closely for early
warning signs and keep tabs on how children are eating to minimize
the odds of complications.
Parents and children need to understand as well that celiac disease
isn’t a one-size-fits-all diagnosis, said Dr. Tracy Ediger, a
researcher at Ohio State University and Nationwide Children’s
Hospital in Columbus who wrote an editorial accompanying the study.
“Celiac disease presentations are highly variable and should be at
least considered with many different symptoms, including abdominal
pain, failure to thrive/weight loss and diarrhea, constipation,
anemia, canker sores, arthritis, tooth enamel defects, distinct
rashes, behavioral issues, headaches, delayed puberty and
infertility,” Ediger told Reuters Health by email.
“Close follow-up with the primary care provider and pediatric
gastroenterologist are also important to monitor growth parameters,
symptoms and blood work to assure normalization,” Ediger added.
SOURCE: http://bit.ly/2bG5cbl and http://bit.ly/2buPRr0 Pediatrics,
published online
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reserved.] Copyright 2016 Reuters. All rights reserved. This material may not be published,
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