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Celiac Disease in Children

Dr. Alkalay explains celiac disease risk factors in children.
Celiac Disease in Children
Featured Speaker:
Michelle Alkalay, MD
Michele Alkalay, M.D., earned her medical degree from the Sackler School of Medicine. She completed her internship and residency in pediatrics and her fellowship in pediatric gastroenterology, hepatology and nutrition at UT Southwestern Medical Center and Children's Healthâ„ . She is also an assistant professor of pediatrics at UT Southwestern.

After her fellowship, she practiced in New York and was recognized as a top physician in the Brewster area; acquired the certificate of a Leading Physician of the World and Top Health Care Professional from the International Association of HealthCare Professionals; was published in The World Wide Leaders in Health Care; was named in Cambridge Who's Who Doctors of America; and received top patient satisfaction in patient AMGA surveys.

Dr. Alkalay's clinical interests include celiac disease, inflammatory bowel disease, fatty liver disease, gastroesophageal reflux disease, eosinophilic esophagitis, chronic abdominal pain, irritable bowel syndrome (IBS), constipation and encopresis.

Bill Klaproth: You're listening to Children's Health Checkup where we answer parent's most common questions about raising healthy and happy kids. I'm Bill Klaproth and on this episode we'll talk about celiac disease in children. How common is it? What are the signs and how is it treated with our expert, Dr. Michelle Alkalay, Pediatric Gastroenterologist and Director of the Pediatric Celiac Program at Children's Health and Assistant Professor at UT Southwestern Medical Center. Dr. Alkalay, thank you so much for your time. So first off, what is celiac disease and what causes it?

Dr. Alkalay: Well, celiac disease is an abnormal immune reaction to gluten. This is the protein found in wheat, rye, and barley. When we eat this, it causes damage to the small intestine and those people who are genetically susceptible.

Host: Okay, so genetically susceptible. Those kids are at higher risk. So how common is celiac disease in kids?

Dr. Alkalay: It's actually quite common. It occurs in approximately one in 100 children.

Host: So it is fairly common. And then what are the signs of celiac disease parents should watch for?

Dr. Alkalay: Parents should watch for chronic abdominal pain, changes in their bowel habits, and slow growth.

Host: So when those symptoms become chronic, that's when you should reach out to your doctor. How long of a timeframe is that? Generally?

Dr. Alkalay: Yes, so chronic meaning at least three weeks or so. Usually they get screened by the pediatrician and then referred to the gastroenterologist.

Host: Okay, so let's talk about screening. Who and when should a child be screened for celiac disease and what does a screening consist of?

Dr. Alkalay: So children who have an increased risk of celiac disease should be screened. These are kids who have family members with celiac disease, children who have type one diabetes, autoimmune thyroid disease, IGA deficiency, Downs, Turners and Williams syndrome. Also kids should be screened for celiac who have digestive symptoms such as the ones we talked about, stomach pain, changes in their bowel habits. And also think about those kids with non digestive tract symptoms like short stash or delayed puberty or even if they have iron or B12 deficiency. And a screening test is actually quite simple. It's just a simple blood test and they look for specific celiac antibodies.

Host: And when does celiac disease generally occur? Early on in a child's life or later after the child has grown for several years?

Dr. Alkalay: So actually you have to be exposed to gluten that's ingested. So this doesn't usually occur until about six months of age when the kids are fed cereals that have gluten in it. So we usually do not screen for celiac disease before six months of age.

Host: So very early on as six months. So can kids grow out of this or is this something they have to manage their entire life?

Dr. Alkalay: So unfortunately it is a chronic disease, meaning that you never grow out of it. So the minute that you reintroduce gluten into that diet, this will re damage the small intestine. It is usually reversible once you take the gluten out of the diet, but unfortunately you can't grow out of it.

Host: Okay. So if celiac disease is diagnosed, how is it generally treated?

Dr. Alkalay: So we treat this by a lifelong gluten free diet. The diet is quite difficult. So you should have access to a dietician who can educate you about the diet.

Host: So Dr. Alkalay as we ramp up, do you have any advice for patient families who are facing a celiac disease diagnosis?

Dr. Alkalay: Yes. Being diagnosed with celiac initially could be very overwhelming. It not only affects the child but affects the entire family. Eliminating the gluten rarely requires a major lifestyle change for everybody, but it does become easier with time and practice, so it's really helpful if you have a very good nutritionist or dietician and a good gastroenterologist to help guide these families one step at a time. There's also a lot of free Smartphone apps. Applications such as find me gluten free and this helps locate gluten-free restaurants. They even have free scanners to scan groceries and that'll check if they have gluten content or not. It's also really great for the families to get involved in local support groups. We have one here at Children's, at UT Southwestern and then they also have national groups as well, like the Celiac Disease Foundation and a gluten intolerance group. There's also a lot of good sources of information out there, such as Beyond Celiac or,, GI kids,, and Beyond the Basics.

Host: Well, that's great to know. There are many resources available for families dealing with celiac disease. Dr. Alkalay, thank you so much for your time. This has really been informative.

Dr. Alkalay: Thank you.

Host: That's Dr. Michelle Alkalay. And for more information, please visit, that's And if you found this podcast helpful, please rate and review or share the episode and please follow Children's Health on your social channels. This is Children's Health Checkup, a podcast from Children's Health. Thanks for listening.