Diarrhea and constipation aren't the only symptoms

By Jane Anderson 

 Medically reviewed by Lyndsey Garbi, MD

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.

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.1

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.2 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.3

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 stomach4—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.5

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.6

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.7

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.8

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:5

• 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.5

Sources

National Institute of Diabetes and Digestive and Kidney Diseases. Celiac disease.

Giannattasio A, Guarino A, Lo vecchio A. Management of children with prolonged diarrhea. F1000Res. 2016;5. doi:10.12688/f1000research.7469.1

Garnier-lengliné H, Cerf-bensussan N, Ruemmele FM. Celiac disease in children. Clin Res Hepatol Gastroenterol. 2015;39(5):544-51. doi:10.1016/j.clinre.2015.05.024

Celiac Disease Foundation. Does Your Child Have Celiac Disease?

Nemours Foundation. KidsHealth. Celiac disease.

National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & causes of celiac disease.

Andrén Aronsson C, Lee H-S, Hård af Segerstad EM, et al. Association of gluten intake during the first 5 years of life with incidence of celiac disease autoimmunity and celiac disease among children at increased risk. JAMA. 2019;322(6):514. doi:10.1001/jama.2019.10329

Guandalini S. The approach to Celiac Disease in children. Int J Pediatr Adolesc Med. 2017;4(3):124-127. doi:10.1016/j.ijpam.2017.08.002

National Celiac Association. Does gluten transfer to breastmilk?

Children's Hospital of Philadelphia. The signs and symptoms of gluten sensitivity.

Massachusetts General Hospital. What is celiac disease?

Celiac Disease Foundation. Celiac disease in children.

Hill ID, Lee AR. Patient education: Celiac disease in children (Beyond the Basics). UpToDate.

Children's Hospital of Philadelphia. Celiac disease.

Additional Reading

• Kuloğlu Z. et al. Celiac disease: presentation of 109 children. Yonsei Medical Journal. 2009 Oct 31;50(5):617-23. doi: 10.3349/ymj.2009.50.5.617. Epub 2009 Oct 20.

• Medline Plus Medical Encyclopedia. Failure to Thrive. 

• Rubio-Tapia A. et al. ACG clinical guidelines: diagnosis and management of celiac disease. American Journal of Gastroenterology. 2013 May;108(5):656-76; quiz 677. doi: 10.1038/ajg.2013.79. Epub 2013 Apr 23.

• Westerbeek E. et al. Coeliac disease diagnosed at Starship Children's Hospital: 1999-2002. New Zealand Medical Journal. 2005 Aug 12;118(1220): U1613.

By Jane Anderson
Jane Anderson is a medical journalist and an expert in celiac disease, gluten sensitivity, and the gluten-free diet.