Celiac Disease in Babies: Symptoms, Testing, Diet

Diarrhea and constipation aren't the only symptoms

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Babies and toddlers susceptible to celiac disease can begin showing related symptoms as soon as they've been introduced to gluten-containing foods.

But signs of celiac disease in infants and toddlers can be very subtle and easy to miss. Behavior that indicates distress in your baby's tummy region can easily be mistaken for general fussiness.

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Getty Images / Tom Merton

Sometimes celiac disease symptoms can be similar to other conditions, like gluten intolerance. Gluten intolerance is a sensitivity to gluten, while celiac disease is an autoimmune disease in which the immune system attacks the body's own healthy tissues, causing intestinal damage.

It's not unusual for infants to be diagnosed with celiac before their second or even their first birthdays, in some cases. But how can you know if your baby should be tested?

Unfortunately, it may be hard to tell. There are some key celiac symptoms you should discuss with your pediatrician, especially if either parent has a family history of celiac disease. This article covers them, as well as what causes celiac, how it is diagnosed, and what the treatment options are.

Celiac Disease Symptoms in Babies and Toddlers

Symptoms of celiac disease in infants and toddlers include:

  • Failure to thrive, including a failure to gain weight or even weight loss
  • Swollen stomach
  • Diarrhea
  • Constipation
  • Irritability
  • Fatigue

What Is Celiac Disease?

Celiac disease is an autoimmune disease and digestive disorder. Foods with the protein gluten trigger your white blood cells, causing damage to your small intestine lining. Digestive symptoms are more common in children than adults.

Failure to Thrive

When most people think of celiac disease symptoms, they think of diarrhea. Diarrhea is common in children before they're diagnosed, although it's far from a universal celiac symptom. But while some infants and toddlers have diarrhea, they're more likely to have what's called "failure to thrive."

Failure to thrive describes infants and children who don't gain weight or develop as quickly as their peers. Babies with failure to thrive may have a weight that is lower than the 3rd percentile of standard growth charts, or 20% below the ideal weight for their height, and they may have a smaller head circumference.

They also may exhibit normal growth that then slows or even stops, and they may start to lose weight instead of gaining it.

In addition to slowing or stalled growth, infants with failure to thrive may miss developmental milestones for such physical abilities as rolling over, sitting, standing, and walking, and they may exhibit delayed mental and social skills.

A diagnosis of failure to thrive does not mean your baby also has celiac disease—in fact, there are numerous other conditions that can cause delayed growth and poor weight gain. But failure to thrive is often the main sign of celiac in infants and young toddlers, so it's worth considering the possibility and discussing it with your pediatrician if it's not clear what's causing your child's problems.

Swollen, Sore Tummy

In some cases, failure to thrive is the only sign of celiac disease in an infant or very young child. But there are other possible indications, even though not all babies will have these symptoms.

For example, infants and toddlers with celiac disease may also have a swollen stomach—well beyond what would be considered the normal, plump tummy of a happy, thriving baby. They also may have abdominal pain that causes fussiness and crying, although you may find it difficult to determine the exact location or source of that pain.

A baby or toddler who's suffering from celiac disease may also have chronic diarrhea or constipation, although medical studies show these symptoms may be more common in older children and adults than they are in very young children.

Causes

With celiac disease, gluten causes white blood cells to attack the intestinal villi. These are finger-like projections that line the small intestine and absorb nutrients. Celiac disease erodes this lining so the body can't absorb the nutrients that your child needs to grow.

It isn't entirely clear what causes people to have celiac disease. However, genetics do play a role, since celiac disease runs in families.

Celiac disease almost always occurs in those who have a gene variant, either DQ2 or DQ8. Those who don't have one of these gene variants are unlikely to get celiac disease. However, only 3% of people with one of those variants actually get celiac disease.

Researchers are looking into other factors that can cause celiac disease. One study found that higher gluten intake during a child's first five years may increase the risk for those who also have the gene variants.

How Babies Are Tested for Celiac Disease

If your pediatrician agrees that celiac is a possibility, she most likely will refer your child for blood tests that screen for celiac disease.

These celiac disease blood tests can't actually diagnose the condition; they only can tell whether or not it's likely your baby has it. Based on the results of those blood tests, your pediatrician may recommend your child get a procedure called an endoscopy, which is the "gold standard" method for achieving a definitive diagnosis.

In an endoscopy, the gastroenterologist takes samples of the intestinal lining to look for a type of intestinal damage called villous atrophy that's found in celiac disease. Although the blood tests can provide a very good indication of whether celiac is present, an endoscopy is the only way to know for certain.

You should discuss with your pediatrician whether an endoscopy is necessary in your child's case.

Diet for Babies With Celiac Disease

To manage celiac disease, it's important to eliminate gluten from your child's diet. This can be challenging since it's found in many different foods. Your healthcare provider may refer you to a dietitian to help you learn what foods to avoid.

Some general tips for eliminating gluten include:

  • Avoid foods with wheat, barley, and rye.
  • When your child starts eating regular food, opt for naturally gluten-free ones. These include plain meats, fish, chicken, milk, cheese, eggs, fruits, and vegetables.
  • Look for bread, cereals, and baking mixes that are "gluten-free."
  • Watch for cross-contamination when preparing foods. For example, use a fresh knife with butter and spreads to avoid contaminating with regular wheat bread crumbs.
  • As your baby gets older, check before eating at a restaurant to make sure they serve gluten-free meals.

A single exposure to gluten probably won't cause symptoms. The small intestine's lining renews itself every three to four days, and new cells will replace the damaged ones. However, continuous exposure to gluten will start to cause damage to the intestines.

A Word From Verywell

If you suspect your baby or toddler may have celiac disease, the first step should be to talk to your child's pediatrician, who can review growth charts to see if there's truly a problem and when that problem may have begun.

Be ready to describe symptoms and share when you first introduced gluten to your baby's diet. Don't remove gluten from your child's diet just yet, however, as that can invalidate testing results.

If your pediatrician does diagnose your infant or toddler with celiac disease, your child will need to follow a gluten-free diet for life. Fortunately, once your baby starts the diet, it's likely that growth and development will rebound, and any fussiness should diminish markedly.

Frequently Asked Questions

  • Can celiac disease occur in breastfed babies?

    Possibly. Research shows that breast milk does contain gliadin, the part of gluten that's harmful when you have celiac disease. However, it's in very small quantities that aren't likely to cause issues.

  • Does celiac disease cause a rash in babies?

    It's possible, but this usually only happens in older teens and adults.

  • What are symptoms of gluten intolerance in babies?

    Symptoms include constipation, diarrhea, and a distended stomach.

    Check with your healthcare provider if you think your baby may have issues with gluten. They can do tests to find out if it's celiac disease or something else like gluten intolerance.

  • Can a child outgrow celiac disease?

    No. Celiac disease is a lifelong autoimmune disorder. However, your child can lead a normal, healthy life by consistently following a gluten-free diet.

  • Can babies be born with celiac disease?

    No. They can be born with genes that make them susceptible to celiac disease, but the condition doesn't develop until after they've had exposure to gluten.

  • Can a pediatrician diagnose celiac disease?

    A pediatrician can do initial tests, but you will likely need a referral to a specialist to confirm the diagnosis. This usually requires an upper endoscopy and biopsy, performed by a gastroenterologist.

  • Is celiac disease a concern for premature babies?

    Celiac disease often causes issues such as poor appetite, short stature, and weight loss. This can be problematic for kids born prematurely who may

    still be be "catching up" in terms of their growth and development.

    Your healthcare provider will closely monitor your child to ensure that they stay on track.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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