What is coeliac disease?
Coeliac disease is a permanent condition arising from an abnormal immune response to the gluten protein found in grains such as wheat, barley and rye. This response damages the small finger-like structures (villi) lining the small intestine that are responsible for nutrient absorption. As a result, even with adequate intake, the absorption of vitamins, minerals and energy is impaired — which can affect many processes, including growth.
Coeliac disease is not merely a “food sensitivity” but an autoimmune disease, and its only treatment is lifelong gluten-free eating. It develops on a background of genetic predisposition, so a family history of coeliac raises the risk.
Its effect on growth
In children, coeliac can present with growth problems alone, even without classic digestive symptoms (bloating, diarrhoea, constipation). Because absorption is impaired, the child may fail to gain weight despite adequate intake, growth velocity may slow, and short stature can emerge. So coeliac is among the causes of short stature and growth faltering that should be investigated.
A typical clue is the child leaving their own percentile channel — often with weight affected first, then height. Iron or other nutrient deficiencies (e.g. anaemia not responding to treatment), fatigue, dental enamel problems or delayed puberty may also accompany. When these are seen together, coeliac should come to mind.
How is it diagnosed?
Coeliac is not diagnosed by guesswork but by clinical evaluation. The first step is usually special blood tests (coeliac-related antibodies); if positive, the diagnosis is often confirmed with small tissue samples taken from the small intestine (biopsy). An important point: for the tests to be reliable, the child must continue eating gluten before testing — families should not cut gluten on their own, as this can hide the diagnosis.
So the right path when coeliac is suspected is not online tests or trial-and-error diets, but a paediatrician. Early, accurate diagnosis matters both for getting growth back on track and for long-term health.
Treatment and catch-up growth
The single, effective treatment for coeliac is lifelong gluten-free eating. Once gluten is removed, the gut begins to heal, absorption improves, and growth markedly recovers in most children. A “catch-up growth” is often seen in this period: the child compensates for lost growth and returns to their genetic channel — a strong sign that the diagnosis was correct and the diet followed.
Gluten-free eating, although it seems daunting at first, can be applied in a balanced, sustainable way with dietitian support. Strict adherence is needed for both growth and long-term health. If there is unexplained growth slowing or short stature, a paediatrician is the right step for an assessment that also covers the possibility of coeliac.