Celiac Disease: Children vs. Adults

Celiac disease isn’t one-size-fits-all. How it presents, how quickly people heal, and what challenges arise differ significantly between children and adults.

Here’s what we know about those differences.

Presentation Differences

In Children

Classic presentation (historically):

• Failure to thrive
• Growth delays
• Distended belly
• Chronic diarrhea
• Irritability

Modern presentation:

• May be subtler
• Short stature
• Delayed puberty
• Iron deficiency
• GI symptoms
• Behavioral changes

In Adults

Common presentation:

• GI symptoms (but less specific than children)
• Anemia
• Fatigue
• Bone problems
• Neurological symptoms
• Depression/anxiety
• Infertility

Often:

• Diagnosed after years of symptoms
• Previously diagnosed with IBS
• Multiple doctor visits before diagnosis

Diagnostic Considerations

In Children

Blood tests:

• Same tTG-IgA testing
• Usually quite accurate in children

Biopsy:

• Traditional approach: required for diagnosis
• Newer guidelines: may skip biopsy if tTG-IgA is very high (>10x normal) and EMA positive
• This no-biopsy approach is more accepted in children than adults

Why different:

• Easier to get clear results in children (less time for complications to develop)
• Strong pediatric guidelines support this approach

In Adults

Blood tests:

• Same tests
• May be more variable

Biopsy:

• Still generally recommended for adults
• More complex medical history to consider
• More comorbidities possible

Healing Differences

Children Heal Faster

Why:

• Younger tissue regenerates more quickly
• Less accumulated damage
• Generally better response to diet

Timeline:

• Many children achieve mucosal healing within 6-12 months
• Some faster

Adults Heal Slower

Why:

• Older tissue regenerates more slowly
• Often more accumulated damage by diagnosis
• May have had undiagnosed celiac for decades

Timeline:

• May take 1-2+ years for mucosal healing
• Some adults never achieve complete histological recovery
• Symptom improvement may precede intestinal healing

Complications

In Children

Short-term:

• Nutritional deficiencies
• Growth impairment
• Dental enamel defects
• Developmental delays (in severe cases)

Long-term if untreated:

• All adult complications possible
• Most reversible with early treatment

In Adults

Often present at diagnosis:

• Osteoporosis or osteopenia
• Anemia
• Other autoimmune conditions

If diagnosed late:

• More accumulated damage
• Higher risk of complications
• More work to reverse problems

Compliance Challenges

In Children

Challenges:

• Not understanding why
• Social pressure at school
• Birthday parties and events
• Other children eating tempting foods
• Adolescent rebellion

Advantages:

• Parents control most food
• School can be managed with plans
• Adapting is easier with less established habits

In Adults

Challenges:

• Established eating habits to change
• Social and professional eating situations
• Personal responsibility for every food choice
• Years of food memories and preferences

Advantages:

• Understanding the “why”
• Ability to research and advocate
• Control over own food environment

Family Screening

When a Child Is Diagnosed

• Screen first-degree relatives (parents, siblings)
• Parents may discover they’re celiac too
• Siblings have ~10% chance

When an Adult Is Diagnosed

• Screen children
• Screen parents and siblings
• Children of celiacs have ~10% chance

Psychosocial Impact

In Children

Challenges:

• Feeling different from peers
• Not understanding why they can’t eat things
• School social dynamics

Support needs:

• Age-appropriate education
• Help explaining to friends
• Comfortable advocating for themselves

In Adults

Challenges:

• Identity disruption
• Grief for lost foods
• Social and professional eating
• Possible depression/anxiety

Support needs:

• Processing the diagnosis
• Learning to navigate adult life GF
• Possible therapy support

Fertility and Pregnancy

Women with Celiac

Undiagnosed:

• Higher rates of infertility
• Higher rates of miscarriage
• Higher rates of pregnancy complications

Diagnosed and treated:

• Fertility typically normalizes
• Normal pregnancy outcomes expected
• Must maintain GF diet during pregnancy

Children’s Development

Maternal celiac (treated):

• Normal fetal development expected
• Breastfeeding supported
• Introduction of gluten to child: follow pediatric guidelines

What This Means for You

If You’re an Adult

• Don’t expect healing as fast as you might read about
• Your path may be different from a child’s
• Patience is required
• Full healing is still the goal

If You Have Celiac Children

• They may heal quickly
• Focus on normalization and adaptation
• School and social support matter
• Screen as they grow (symptoms can be subtle)

If You’re Screening Family

• Both children and adults can have celiac
• Both can be asymptomatic
• Screening catches disease early, improving outcomes

The Bottom Line

Celiac disease is one disease with different faces:

• Different symptoms at different ages
• Different healing timelines
• Different challenges
• Same treatment: strict GF diet forever

Whether you’re a child or adult, the path forward is the same: remove gluten, let the body heal, live your life.