Toddler behavioral symptoms may hint at celiac disease

A toddler boy runs across the lawn. (Graham Oliver)

For small kids with a family history of celiac disease, anxiety, aggression, sleep problems and other behavioral issues might signal that it's time to test for celiac, researchers say.

In the study of 3- and 4-year olds at high risk for celiac, mothers of 3-year-olds that had undiagnosed celiac reported more negative psychological symptoms in their children compared to mothers of toddlers with diagnosed celiac or of kids that didn't have the disease.

"This is the first prospective study to be able to answer the question whether children with celiac disease autoimmunity have psychological manifestation symptoms," senior study author Dr. Daniel Agardh of Malmo University in Sweden told Reuters Health by email.

Celiac disease is an autoimmune condition affecting the small intestine. It's triggered by eating a protein called gluten, which is found in wheat, barley and rye. Gastrointestinal symptoms such as loose stools and abdominal discomfort are common.

People with celiac disease autoimmunity, or CDA, also test positive for certain antibodies called tissue transglutaminase autoantibodies or tTGA.

Celiac disease may also associated with depression, cognitive impairment, sleep problems and attention deficits in children.

Previous studies looked at whether parents knowing that their child tested positive for CDA had an impact on their reporting physical symptoms of celiac disease in their child. The current study is the first to examine how psychological symptoms were reported by mothers before they knew their children had CDA, the authors write in Pediatrics.

Agardh and his colleagues analyzed data from an international study designed to examine environmental triggers of type 1 diabetes and celiac disease in children who were at higher than average risk of those conditions because of family history. The current study included more than 4,000 children in the U.S., Finland, Germany and Sweden.

The children were enrolled as infants and visited clinics every three months until age 4 years, and then twice annually until the they were 15 years old. After age 2 years, the children were also screened for tTGA antibodies annually.

In addition to the clinical evaluations, researchers asked whether children were on gluten-free diets, and parents answered psychosocial questionnaires when the kids were between 3 and 4 years old and again when the kids were between 4 and 5 years old.

Overall, there were 66 children who had tested positive for CDA by the time they were about 3.5 years old but their mothers were not yet aware of their child's diagnosis. There were also 40 children who fit this description by age 4.5 years. Another 440 children had tested positive by age 3 years and their parents were aware of it.

Researchers found that mothers who were unaware their children were CDA positive reported more child anxiety and depression, aggressive behavior and sleep problems compared with the mothers of children without CDA.

The mothers who were unaware their children had CDA also reported more child anxiety and depression, withdrawn behavior, aggressive behavior and sleep problems than those who knew their kids had CDA.

By the time kids were about 4.5 years old, however, there was no difference in psychological symptoms reported by mothers regardless of whether they were aware of their child's CDA status.

The authors conclude that the younger, less verbal children may be more likely to act out in response to the physical symptoms of celiac compared to the slightly older kids. And its possible that once mothers know their child is CDA positive, they focus more on the physical symptoms of the disease and are less likely to report the psychological symptoms.

Agardh said celiac disease is often misdiagnosed in young children because the symptoms can be unclear. The study results suggest that physicians should suspect CDA or celiac disease in children with unclear or vague symptoms who are at risk, he added.

Melissa Rifkin, a registered dietitian with Montefiore Medical Center in New York noted that the study found following a gluten-free diet had no association with psychological functioning in the children with celiac disease.

"The findings itself are rare and unexpected. However, factors that may have contributed to this finding is the duration of the gluten free diet that was followed," she said.