Celiac disease is a chronic autoimmune condition that can appear even in infancy or toddlerhood. It is triggered by the ingestion of gluten, a protein found in wheat, barley, and rye. When someone with celiac disease consumes gluten, their immune system mistakenly attacks the lining of the small intestine, impairing nutrient absorption and potentially leading to long-term complications. In very young children, symptoms can be subtle and are often mistaken for general fussiness or unrelated issues.

Recognizing Symptoms in Babies and Toddlers

Babies and toddlers may start to show symptoms of celiac disease shortly after being introduced to foods containing gluten. However, these symptoms can often be hard to distinguish from normal developmental issues or common digestive upsets.

Some of the signs to look out for include:

  • Failure to thrive: The child does not gain weight appropriately, or may even lose weight after previously showing normal growth.

  • Persistent digestive issues: Chronic diarrhea, constipation, or alternating between the two.

  • Distended or bloated abdomen: A noticeable swelling of the stomach that is more pronounced than the typical infant belly.

  • Irritability and fussiness: This can stem from abdominal discomfort, though it may not always be obvious what’s causing the distress.

  • Fatigue or low energy: The child may appear more tired or sluggish than peers of the same age.

In some cases, celiac disease may present primarily as developmental delay. A baby who previously met developmental milestones may slow down or regress. For example, delays in rolling over, sitting, crawling, or walking may appear, along with slower social or cognitive development.

Causes and Risk Factors

Celiac disease occurs when the body mounts an immune response to gluten, causing damage to the intestinal villi—tiny structures in the small intestine responsible for absorbing nutrients. Over time, repeated exposure to gluten causes these villi to flatten, reducing the body’s ability to absorb essential nutrients like iron, calcium, and vitamins.

Genetics play a key role in the likelihood of developing celiac disease. Children who carry specific gene variants, such as HLA-DQ2 or HLA-DQ8, are at higher risk. However, carrying these genes alone is not sufficient to develop the condition—other environmental triggers, such as the amount and timing of gluten exposure, may also contribute.

Family history is a strong risk factor. If a parent or sibling has celiac disease, the child has a significantly higher chance of developing it. Other autoimmune conditions, like type 1 diabetes or thyroid disorders, may also increase the risk.

Diagnostic Process for Young Children

If a pediatrician suspects celiac disease, they will likely begin with a blood test to look for specific antibodies that indicate an immune reaction to gluten. However, these tests are not definitive and cannot confirm the condition on their own.

To achieve a definitive diagnosis, a pediatric gastroenterologist may recommend an upper endoscopy with a biopsy of the small intestine. This procedure allows doctors to directly assess whether there is villous atrophy, a hallmark sign of celiac disease. While this may sound invasive, it is the current gold standard for diagnosing celiac disease.

Importantly, it is critical that the child continues to consume gluten in the days and weeks leading up to testing. Eliminating gluten before testing can result in false-negative results, potentially delaying an accurate diagnosis.

Gluten-Free Diet for Infants and Toddlers

Once diagnosed, the only effective treatment for celiac disease is a strict, lifelong gluten-free diet. For young children, this requires careful planning, especially as they transition from breast milk or formula to solid foods.

Parents and caregivers should:

  • Eliminate all sources of wheat, barley, and rye from the child’s diet.

  • Focus on naturally gluten-free foods such as fruits, vegetables, plain meats, fish, poultry, eggs, legumes, and most dairy products.

  • Choose gluten-free cereals, breads, and snacks designed for young children.

  • Avoid cross-contamination by using separate utensils, cutting boards, toasters, and condiments that are not shared with gluten-containing foods.

As children grow and begin eating outside the home, such as in daycare or restaurants, it becomes increasingly important to educate caregivers, teachers, and food preparers about the importance of strict gluten avoidance.

Managing Daily Life With Pediatric Celiac Disease

Although managing celiac disease in infants and toddlers can be challenging, most families adjust well with education and support. Many children experience a dramatic improvement in symptoms within days or weeks of eliminating gluten from their diet. Weight gain and developmental progress often resume, and issues like irritability and fatigue diminish.

Involving a registered dietitian who specializes in pediatric celiac disease can be incredibly helpful. They can guide families on how to read food labels, ensure balanced nutrition, and plan meals that support healthy growth.

As the child gets older, they will need to be taught the importance of their dietary restrictions in an age-appropriate way. Encouraging independence and teaching them how to recognize safe and unsafe foods helps them manage their condition confidently.

When to Talk to a Pediatrician

If your baby is not gaining weight properly, seems excessively tired, has persistent digestive issues, or shows signs of developmental delay, it is essential to consult a pediatrician. Be prepared to discuss any symptoms you've noticed, especially if gluten-containing foods have recently been introduced. A detailed family history, particularly of autoimmune disorders, can also be a valuable part of the diagnostic conversation.

Avoid removing gluten from your child’s diet before testing. Doing so can interfere with accurate results, as the immune response needs to be active for tests to detect celiac markers.

Conclusion

Celiac disease can begin as early as infancy and may present with subtle or easily overlooked symptoms. Recognizing the signs early—such as failure to thrive, persistent digestive issues, and unusual irritability—can lead to timely diagnosis and treatment. With a proper gluten-free diet and medical support, children with celiac disease can go on to thrive and live healthy, active lives. Early identification and dietary management are key to ensuring the child’s development stays on track and long-term complications are avoided.