Gluten intolerance, also known as celiac disease, is an autoimmune disorder that can affect people of any age. It is caused by an abnormal immune reaction to gluten, a protein found in wheat, barley, and rye. In celiac disease, eating gluten triggers damage to the small intestine, leading to an inability to properly absorb nutrients from food.
Key Points
- Yes, a 2 year old can be gluten intolerant or have celiac disease.
- Symptoms in a toddler may include diarrhea, abdominal pain, bloating, constipation, vomiting, pale stools, poor weight gain, and irritability.
- Celiac disease is diagnosed through blood tests and an intestinal biopsy. Gluten must be consumed for the tests to be accurate.
- The only treatment is a strict lifelong gluten-free diet to control symptoms, promote healing, and prevent complications.
- Undiagnosed or untreated celiac disease in a child can lead to malnutrition, stunted growth, other autoimmune disorders, and long-term health problems.
- Early diagnosis and gluten-free diet increases the chances of normal height and development.
Symptoms of Celiac Disease in Toddlers
Celiac disease symptoms can vary greatly from person to person and occur at any age after first exposure to gluten. Many children develop symptoms between 1-3 years old, after starting solid foods containing gluten.
Common celiac symptoms in a 2 year old may include:
- Chronic diarrhea: Frequent loose, watery stools.
- Abdominal pain and bloating: Intermittent stomach aches and distension.
- Constipation: Hard, dry stools.
- Nausea and vomiting: Frequent nausea and throwing up.
- Pale, foul-smelling stools: Stools may have a particularly bad odor and appear greasy or fatty.
- Weight loss or poor weight gain: Falling off growth curves despite normal or increased appetite.
- Failure to thrive: Inability to gain weight and grow properly.
- Irritability or behavior issues: Increased fussiness, tantrums, mood swings.
- Tooth discoloration or enamel defects: Permanent teeth come in weak, discolored.
Some toddlers may have milder or atypical symptoms like constipation, chronic anemia, fatigue, joint pain, skin rashes, or headaches. Many show no symptoms at all but still develop intestinal damage.
When to Test a Toddler for Celiac Disease
The American Academy of Pediatrics recommends screening for celiac disease in children beginning around 2-3 years old if they show any concerning symptoms or have a first-degree relative with celiac. Testing at a younger age is needed if severe symptoms appear.
A toddler should be tested for celiac disease if they have any of the following:
- Chronic gastrointestinal symptoms like diarrhea, constipation, abdominal pain, vomiting
- Unexplained faltering growth
- Failure to gain weight or loss of weight
- Tooth discoloration, tooth enamel defects
- Unexplained iron deficiency anemia
- Irritability or behavior issues
- Muscle wasting
- Known family history of celiac disease
- Associated condition like Down syndrome or type 1 diabetes
Since celiac can be asymptomatic, testing may be considered between 2-3 years old even without obvious symptoms, especially if a first-degree relative has celiac.
Diagnosing Celiac Disease in Toddlers
Diagnosing celiac disease in a toddler involves blood testing and an intestinal biopsy. For accurate results, children must be on a gluten-containing diet when undergoing testing.
Blood Tests
Serologic blood tests check for antibodies related to celiac disease:
- Tissue transglutaminase IgA (TTG-IgA): Elevated levels confirm gluten intolerance. The most sensitive test for celiac disease.
- Endomysial antibody IgA (EMA): Presence indicates likely celiac disease.
- Deaminated gliadin peptide IgG (DGP): May be used for screening. Elevated in celiac disease.
- Complete blood count: May show vitamin and mineral deficiencies signaling malabsorption. Anemia commonly occurs.
If the toddler tests negative but symptoms continue, serology should be repeated in the future while still eating gluten. Antibody levels fluctuate and children under 3 may not yet show abnormalities.
Intestinal Biopsy
An intestinal biopsy from the small intestine is needed to confirm celiac disease in a child. Several tissue samples are taken during an upper endoscopy procedure while sedated. The biopsy shows characteristic damage to the intestinal villi lining if celiac is present.
Biopsy results are graded based on the amount of villous atrophy seen:
- Marsh score 1: Increased immune cells infiltrating the villi
- Marsh score 2: Additional presence of hyperplasia with elongated crypts
- Marsh score 3a: Partial villous atrophy
- Marsh score 3b: Subtotal villous atrophy
- Marsh score 3c: Total villous atrophy with flattened lining
A score of 3 indicates confirmed celiac disease. Lower scores may suggest early developing celiac that will worsen without treatment. Repeat biopsy may be needed after a gluten-free diet if the initial score is equivocal.
Treating Celiac Disease in Toddlers
The only treatment for celiac disease is strict adherence to a gluten-free diet to avoid further damage to the small intestine. Gluten is completely removed from all foods and beverages in the child’s diet.
Benefits of a gluten-free diet include:
- Resolution of symptoms and intestinal inflammation
- Healing of existing intestinal damage
- Correction of nutritional deficiencies
- Prevention of future complications
- Normal growth and development
After starting a gluten-free diet, most children begin to feel better and show catch-up growth within 3-6 months. It may take several years for the intestine to fully heal depending on initial injury severity.
A pediatric gastroenterologist can provide guidance on meal planning, labeling reading, avoiding cross-contamination, and ensuring complete nutrition. Toddlers require frequent intake for adequate calories, protein, vitamins, and minerals to support growth and development.
Parents and caregivers must be diligent about keeping gluten sources out of a toddler’s environment. Teaching young children how to stick to this diet can be challenging.
Foods Allowed in a Gluten-Free Diet
Here are some gluten-free foods and ingredients that are part of a healthy diet for a toddler with celiac disease:
- All unprocessed fruits, vegetables, legumes, nuts, seeds
- Meats, poultry, fish, eggs
- Milk and dairy products
- Rice, corn, quinoa, millet, buckwheat
- Potatoes
- Gluten-free oats
- Beans, lentils
- Gluten-free flours like rice, coconut, almond
- Naturally gluten-free whole grains
Foods to Avoid
These foods containing gluten must be avoided:
- Wheat, barley, rye in any form
- Breads, cereals, baked goods with gluten grains
- Pasta, crackers, pretzels
- Beer
- Malt vinegar
- Soy sauce, teriyaki sauce
- Processed meats containing fillers
- Fried foods coated in batter
- Licorice, candies with barley malt
- Oats, unless certified gluten-free
It is critical to watch for hidden sources of gluten in foods, medications, supplements, and playdough. Cross-contamination from shared kitchen tools, surfaces, and toasters must also be avoided.
Complications of Untreated Celiac Disease
Leaving celiac disease undiagnosed and untreated in a toddler can lead to serious short-term and long-lasting complications.
Potential problems include:
- Malnutrition: Impaired nutrient absorption leads to deficiencies.
- Failure to thrive: Lack of necessary calories and nutrients causes growth failure.
- Delayed puberty: Chronic malnutrition can delay onset of puberty.
- Anemia: Due to iron, folate, vitamin B12 malabsorption.
- Bone disease: Weakened bones from calcium and vitamin D deficiency.
- Tooth defects: Enamel hypoplasia causes permanent discolored spots.
- Other autoimmune disorders: Increased risk of type 1 diabetes, autoimmune thyroiditis.
- Cancer: Linked to increased rates of small bowel lymphoma and adenocarcinoma.
- Neurological issues: Ataxia, epilepsy, migraines, neuropathy.
Adhering to a gluten-free diet and healing intestinal damage promptly improves outcomes and lowers risks. Periodic follow up exams and testing to ensure diet compliance and check for malnutrition are important, especially in a toddler.
Prognosis with Early Celiac Diagnosis and Treatment
When diagnosed and treated early, most children with celiac disease live healthy, normal lives simply by maintaining a gluten-free diet. Many are able to meet growth milestones and avoid long-term complications.
Research shows that adherence to a gluten-free diet beginning in early childhood enables normal height, delays onset of other autoimmune diseases, leads to better bone accrual, and improves outlook compared to later diagnosis.
While transitioning a toddler to a strict diet presents challenges, doing so early establishes the habit before objectionable food restrictions. Families report improved quality of life scores within the first year.
For the toddler to thrive on a gluten-free diet, parents should work closely with a pediatric gastroenterologist and registered dietitian nutritionist. With the right guidance and diligence, living happily gluten-free is achievable.
When to See a Doctor
Consult your toddler’s pediatrician if persistent digestive or behavioral issues are suspected to be celiac-related. Diagnosis and treatment in the early toddler years leads to the best prognosis.
The doctor can check for warning signs, order blood work, and refer to a pediatric gastroenterologist who can evaluate findings, perform an intestinal biopsy, and provide specialized nutritional and follow up care.
Support groups and certified dietitians can also give indispensable guidance on sourcing gluten-free foods, meal planning, avoiding cross-contamination, reading labels, resolving nutritional deficiencies, and adapting to the gluten-free lifestyle.
Conclusion
Yes, a 2 year old can develop celiac disease and be gluten intolerant. When symptoms appear at this young age, prompt testing and diagnosis is essential.
Starting a strictly gluten-free diet early and adhering to it lifelong can enable normal growth and prevent complications of untreated disease. Though challenging at first, with the right medical guidance, substitutions, variety, and creativity, parents can ensure their gluten intolerant toddler thrives.
Early recognition, care team support, and persistence to exclude all gluten sources gives a toddler newly diagnosed with celiac the best chance at living a happy, healthy, normal life.
