Gluten-free food products dot the grocery aisle shelves and for many, adhering to a gluten-free diet is a necessity. Why? Celiac Disease, an immune mediated disease, can affect as high as 1% of the population in North America, according to Dr. Nasha Khavari, is a clinical associate professor and the director of the Stanford Children’s Health Celiac Disease Center. We recently asked Dr. Khavari about Celiac Disease in children and what parents can do to better identify and manage the disease (beyond only going gluten free). If you have a hunch someone in your family may be affected by Celiac Disease or want to learn more regarding proper diagnosis and treatment, read on to hear from Dr. Khavari.

Can you tell us what exactly Celiac Disease is and its instance in children? At what age are kids usually diagnosed?

Dr. Khavari: Celiac Disease is an immune mediated disease in genetically predisposed individuals. It can be triggered by eating/ingestion of gluten-containing foods, including wheat, rye, barley, and oats. The incidence of Celiac Disease may be as high as 1% of the population in North America.

What are the proper steps and procedures for determining a Celiac Disease diagnosis in a young child?

Dr. Khavari: If a child has either symptoms concerning for Celiac Disease or is at risk for Celiac Disease (a family history of a first-degree relative or other related disease), we ask that they are screened for Celiac Disease. The disease can present and range from no symptoms at all to significant malabsorption, failure to thrive and weight loss. Our Stanford Children’s Health Celiac Disease care team would begin with an initial visit, followed by the diagnostic work up with laboratory testing. If this testing results are concerning, diagnosis is usually confirmed with a procedure called an upper endoscopy.

My five-year-old complains about tummy aches. Is this a sign of Celiac Disease? Is there anything I can look out for to know if this is normal or if there’s a reason to be concerned?

Dr. Khavari: Abdominal pain can be a sign of Celiac Disease. It can also be very common symptom in children without Celiac Disease. However, some of the more traditional ways Celiac Disease presents include symptoms of abdominal pain, diarrhea, bloating, and problems with gaining weight or height.

With that said, some children with Celiac Disease have no symptoms at all making it very important to be tested if your child is in a higher risk category.

With the New Year, I want my family to eat healthier and am considering cutting out gluten our diet. Is this a good idea for my family’s overall health? What are the negative factors to consider before we eliminate gluten from our child’s diet?

Dr. Khavari: As pediatricians, we really like to encourage healthy, diverse diet, with minimally processed foods and significant fruits and vegetables. Many of the naturally gluten free foods, for example, fruits and vegetables, are important to incorporate into a child’s daily diet.

Unnecessary exclusion of foods from a child’s diet can be stressful and detract from their overall quality of life. Negative factors to consider before eliminating gluten from your child’s diet include the possibility of missing a diagnosis of Celiac Disease as laboratory testing may not be accurate once you have eliminated gluten from your child’s diet, quality of life effects on the child, and the higher cost of purchasing some of the processed gluten-free foods. It is also important to keep in mind that many of the more highly processed gluten-free foods are higher in sugar content which can have adverse effects on children.

If we find out our child does have Celiac Disease, what are our options and what sort of care will she need to receive?

Dr. Khavari: We recommend that your child see a pediatric gastroenterologist, as well as nutritionist with expertise in navigating the gluten free diet.

Are there medications they can take?

Dr. Khavari: There are no current medications for the treatment of Celiac Disease.

Is this something they’ll live with her whole life?

Dr. Khavari: Celiac Disease is thought to be a lifelong autoimmune disease in most diagnosed individuals.

How important is nutritional coaching/training for my child post-diagnosis?

Dr. Khavari: This is probably among the most important aspects of Celiac Disease after making the diagnosis. Providing your child with the proper nutritional support and education is key to their success in managing this disease. Our Celiac Disease team supports patient care specific to Celiac Disease, from the newly diagnosed through ongoing lifestyle maintenance, offering families the resources and valuable steps to ensure your child’s overall health and well-being.

My five-year-old son has Celiac Disease. What are some useful tips to help us navigate school snacks and lunches once he enters Kindergarten?

Dr. Khavari: We usually recommend sending a letter to the teacher and school staff explaining what Celiac Disease is, and why a student needs to eliminate gluten from their diet. We also recommend a stash of gluten-free foods for the classroom for those days when other children in the class may bring a gluten containing treats to share with the class.

What is the best way to manage this when he is away from our home, and for example, on playdates or at birthday parties?

Dr. Khavari: If you are close with the families of playdates and others having a conversation with the family about what foods they are able to eat is really helpful. Sometimes packing a gluten-free snack for your child, or for them to share with friends, can also be really helpful. While the gluten free diet is the most important aspect of treatment of Celiac Disease, balancing this with a good quality of life for children and allowing them to socialize, interact and eat (in a safe, gluten-free manner with others) is also a very important aspect of treatment.


Dr. Nasha Khavari is a clinical associate professor and the director of the Stanford Children’s Health Celiac Disease Center. She received her medical degree from University of Minnesota Medical School in 2003 and has been in practice for 16 years. Dr. Khavari completed her pediatrics residency at Stanford Children’s Health followed by a fellowship in pediatric gastroenterology at Harvard’s Boston Children’s Hospital. Dr. Khavari specializes in treating conditions in children like chronic stomach pain, ulcers, diarrhea, reflux, cancer, Crohn’s disease and Celiac Disease.

Find a Stanford pediatrician in your neighborhood.

Do you have questions about picky eating in kids? Read here for more information from Stanford Children’s Health.


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