Ask Dr. Weir – April 2021

Dr. Dascha Weir

Dr. Dascha Weir

This month’s “Ask the Expert” features Dr. Dascha Weir, MD, Associate Director, The Celiac Disease Program, Boston Children’s Hospital. Dr. Weir answers questions about going back to school and persistent celiac disease related symptoms.

Question – With kids getting ready to go back to school in person, I expect more incidences of colds, stomach bugs and those other ailments that kids pass around at school. Is my child more susceptible to these illness because of his celiac disease?

Dr. Weir – No. Celiac disease does not compromise a child’s immune system. Kids with celiac disease are not more susceptible to the common viral or bacterial infections of childhood (or to COVID-19 fortunately) than kids without celiac disease.

Hopefully, with all the expected protective measures in place (such as social distancing, frequent hand washing and mask wearing) we will be seeing fewer infectious illnesses this year – even as the kids get back to school.

Question – My child was diagnosed with celiac disease 2 years ago. At first we saw a lot of improvement in her health but then she plateaued and continues to have issues. We are confident that her diet is gluten-free. Why has she stopped getting better?

Dr. Weir – Most children with celiac disease feel better on a gluten diet. However, unfortunately, approximately 15% of kids with celiac disease continue to have symptoms after diagnosis for a variety of reasons.   The most common symptoms that continue to bother children on a gluten free diet are abdominal pain, hard stools, nausea, diarrhea, poor weight gain or growth or fatigue.

I recommend discussing your child’s ongoing issues with your gastroenterologist so that she/he can help sort it out.   Consultation with a dietitian who specializes in celiac disease is important because unrecognized gluten exposure is a frequent cause of ongoing or recurrent symptoms.  Constipation, a common side effect of the gluten free diet because it tends to be lower in fiber than the standard diet, is another leading cause of ongoing symptoms. Some children with celiac disease may have concurrent lactose intolerance and oat sensitivity.  Other causes include gastro-esophageal reflux and irritable bowel syndrome. Another frequently seen cause of abdominal pain in children is functional abdominal pain, a condition related to heightened sensitivity to the normal functioning of the gastrointestinal tract that causes pain in the absence of inflammation, infection or anatomic abnormalities.

The specific intervention or treatment that will help your child, depends on what is triggering the symptom.

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