Celiac disease is an autoimmune disorder that causes the body to react adversely to gluten, a protein found in wheat, barley and rye. The immune system responds to the gluten as a foreign invader and attacks the small intestine causing inflammation which damages the small intestine and prevents the body from absorbing nutrients properly. Children with Celiac Disease often have slow or stunted growth and development. Treatment requires a lifelong gluten-free diet to manage symptoms and further intestinal damage. If left untreated, celiac disease can lead to other, serious conditions including ADHD, epilepsy, diabetes, intestinal cancer and infertility.
The primary component of gluten, called gliadin, is what triggers the immune system to attack the lining of the small intestine (villi). When this lining is damaged, nutrients cannot be absorbed. This abnormal immune response is thought to be primarily a genetic trait as it tends to run in families and affects approximately 1 out of every 100 people worldwide.
Patient will maintain adequate nutrition; patient will maintain adequate fluid balance; patient will appropriately meet all developmental milestones
Assess mouth and skin
Oral ulcerations and sores may be present.
Teeth may have areas of discoloration or patches of thinning enamel, often caused from nutritional deficiencies and chronic vomiting.
An itchy, blistery rash may occur on the elbows, knees and buttocks in severe cases called dermatitis herpetiformis.
Obtain history from parents; symptoms, frequency, known triggers; family history
Celiac disease is thought to be hereditary, so there may be other family members with the same disease. Note if any family members have developed complications such as diabetes or epilepsy.
Monitor labs and diagnostic tests
Blood tests may be run to determine the presence of antibodies for celiac disease or genetic testing
Address vomiting and/or diarrhea as appropriate
Excessive vomiting and diarrhea can cause severe fluid & electrolyte imbalances and should be addressed as appropriate to prevent long-term complications or circulatory collapse
Assess for growth and developmental milestones
Children with celiac often have delays in meeting developmental milestones, especially if diagnosed later in childhood.
Patients may have slow or stunted growth due to malabsorption issues.
Patients may have previously been treated for failure to thrive
Patients may have delays in puberty
Administer medications and supplements as required
Calcium and vitamin supplements may be given orally or by injection for better absorption
Provide nutritional education for patient and parent
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