Children frequently experience celiac disease.

Celiac disease frequently impacts children.

"No room for carelessness": The challenge of being overly cautious with food is something that many children with coeliac disease face. They must avoid eating anything with gluten, which limits them from enjoying everyday treats like pasta and sweets like their peers. This condition often develops at a young age and stays with them for life. The only solution is a strict gluten-free diet.

Jan, a ten-year-old boy, has been on a strict diet since early in his life, missing out on many delicious foods. He secretly wishes for a chance to try kebabs or ice cream, both forbidden for him. Eating anything with gluten would result in severe stomach pain, diarrhea, and vomiting.

Coeliac disease is not an ordinary allergy, but a chronic, lifelong autoimmune disease. Without treatment, it can lead to serious consequences for children and adolescents, such as growth retardation, failure to thrive, and developmental issues, as medical professionals mark on World Coeliac Disease Day.

Dr. Jens Berrang, a pediatric gastroenterologist from Dortmund Hospital, performs a thorough exam on Jan. The boy bravely accepts the blood tests, something he has experienced numerous times before. "It can be tough when others have better food," he explains to the doctor. Jan cannot dine at school canteens because gluten is found in grains like wheat, oats, barley, spelt, and rye, and is also secretly present in countless other foods and dishes. Even the smallest traces can be disastrous.

When Jan goes to friends, goes on school trips, or attends birthdays, his parents, Valentina and Robert, ensure he has gluten-free food. They've learned from a dietitian and completely changed their household's eating habits.

One person in 100 may be affected - with many undiagnosed cases

The Coeliac Disease Society (DZG) estimates that around one percent of the population is affected. Many with atypical or milder symptoms remain unaware of their autoimmune disease. The disease's onset can occur at any age, according to the DZG. Due to sometimes mild symptoms, it can go undetected in childhood for years or even decades.

Dr. Berrang from Dortmund explains that coeliac disease most commonly develops between ages one and eight, and between 20 and 50. He mentions that "people often fall ill at ages five or 35 - we don't know why this is the case." Many youngsters in primary school consult his gastroenterology outpatient clinic.

Numerous symptoms - some are subtle

Symptoms of coeliac disease can include diarrhoea, abdominal pain, bloating, nausea, and vomiting, as well as weight loss and chronic fatigue. Sometimes, the disease presents in less obvious ways, like irritability, aggression, and depressive changes, according to the DZG. Smaller amounts of gluten lead to inflammation in the intestinal mucosa, and the body forms antibodies against it, which harm the small intestine's structure and cause various complications.

As a four-year-old, Jan Jonathan experienced severe abdominal pain that lasted several days. He had symptoms like a large swollen belly, sticky stools, and severe diarrhea. However, symptoms may not be so extreme and can often be overlooked or misinterpreted. Another pediatrician, Friederike Stemmann, adds that irritability, aggressive behaviour, and depressive changes are also observed. "Coeliac disease is a chameleon." Nutrient deficiency can occur when the intestine's surface area shrinks. The Pediatricians' Professional Association also mentions rickets, muscle weakness, and damage to tooth enamel as potential complications of untreated coeliac disease.

"It doesn't work without tears"

Carlotta, a first-grader from Düsseldorf, has been on a diet since she was four. "She finds it difficult that she's the only one who can't eat carelessly, that she always has to ask and often has to go without. It's hard without tears," her mother Anna Maria states. "Carlotta has lost the innocent joy of childhood due to her illness, as she's overly cautious for her age and seems almost mature." Her fear is "accidentally eating something with gluten and then vomiting at school or at a friend's house," adds her parent.

Since she was a newborn, Carlotta had an unusual sleeping pattern, ate very little, and weighed less than average. Her family consulted with doctors who eventually diagnosed her with coeliac disease. Carlotta was taken care of in a university hospital. Her mother says, "Now, you can't tell Carlotta is sick anymore. She's at a normal weight, has normal height, and sleeps well." Carlotta is well understood and accepted at nursery, school, and among friends. In addition, more gluten-free products are becoming available in the market. "We try to give her as many alternatives as possible," says Carlotta's mother.

A simple diagnosis with blood tests

From a young age, regular check-ups are essential for coeliac disease. This includes blood tests since it's common for nutrient deficiencies to arise. Doctor Jens Berrang comments that identifying this genetically predisposed illness has become less complicated now with just two blood tests. The knowledge about coeliac disease is also improving among general practitioners. However, there's no medication for this condition yet. Dr. Berrang stresses, "The only solution is to eliminate gluten entirely and for life."

For coeliac disease, there's still much to be discovered regarding its intricate relationships. Research is being done - including, but not limited to, developing a drug that could alleviate the aftereffects of consuming food with gluten unknowingly. Peter Wark from the DZG says over a dozen clinics and research centers are working on this project. The time it'll take for it to be released is uncertain. In the meantime, Jan Jonathan, a student, rummages through a drawer in his home his mother fills with gluten-free food items. And he's gotten accustomed to examining food product labels first. "I always check the ingredients list first."