Coeliac disease is an autoimmune condition in which eating gluten — a protein found in wheat, rye, and barley — triggers an immune response that damages the lining of the small intestine. It affects approximately 1 in 70 Australians, yet many cases go undiagnosed for years.

Classic Symptoms

The textbook presentation of coeliac disease in children includes:

Chronic diarrhoea or loose stools

Abdominal bloating and distension

Poor weight gain or weight loss (faltering growth)

Fatigue and pallor (from iron-deficiency anaemia)

Vomiting

Younger children (under 2 years) are more likely to show these classic GI symptoms, particularly after gluten is introduced to their diet.

Non-Classic and Silent Presentations

Older children and adolescents often present differently — or not at all:

Short stature or delayed puberty

Iron-deficiency anaemia that doesn't respond to supplements

Dental enamel defects

Recurrent mouth ulcers

Constipation (less commonly)

Joint pain or fatigue without obvious cause

No symptoms at all ("silent" coeliac disease) — detected only on screening

Who Should Be Screened?

Certain groups have a higher risk of coeliac disease and should be screened even without symptoms:

Children with a first-degree relative (parent or sibling) with coeliac disease

Children with Type 1 diabetes

Children with Down syndrome, Turner syndrome, or Williams syndrome

Children with autoimmune thyroid disease

Children with IgA deficiency (increased risk of a false negative result)

How Is It Diagnosed?

Diagnosis involves:

Blood test: Tissue transglutaminase IgA antibody (tTG-IgA) is the primary screening test. Your child must be eating gluten at the time of the test for accurate results.

Endoscopy with small bowel biopsy: This remains the gold standard to confirm the diagnosis by showing characteristic changes to the intestinal lining (villous atrophy).

Do not start a gluten-free diet before testing — this can produce a false negative result and delay diagnosis.

Treatment

The only treatment for coeliac disease is a strict, lifelong gluten-free diet. With adherence, most children see a significant improvement in symptoms and a return to normal gut health. Regular follow-up with a paediatric gastroenterologist and dietitian is important.

If you suspect your child may have coeliac disease, ask your GP for a referral to Dr Harveen Singh FRACP at our Sydney clinics in Bankstown, Westmead, St Leonards, or Campbelltown.

Last reviewed by Dr Harveen Singh FRACP, Paediatric Gastroenterologist & Hepatologist