Dear Lisa,
I brought my daughter to the doctor’s because she was having a lot of stomach aches. She has been having diarrhea and has lost weight. The doctor ordered some tests and told me that she needed to be tested for Celiac Disease. What is Celiac Disease and how do you get it?
“Need to know more about Celiac Disease”,
Dear “Need to know more about Celiac Disease”,
Celiac Disease or gluten-sensitive enteropathy is an autoimmune disease that is brought on by the ingestion of gluten. Gluten is the major protein found in wheat, rye and barley. Celiac Disease is also considered a malabsorption disorder because gluten ingestion causes intestinal inflammation which leads to inadequate absorption of nutrients. Therefore, children with Celiac Disease develop problems when they eat foods with gluten.
The symptoms of Celiac Disease vary from person to person. Celiac Disease can appear any time in life in genetically susceptible individuals. It can be triggered by surgery, a viral infection, severe emotional distress, and childbirth. In children, the symptoms tend to start between 6 months and 2 years old and include diarrhea or constipation, abdominal distention, signs of malnutrition, failure to thrive, lack of appetite, short stature, irritability, lack of energy and developmental delay (1).
The development of symptoms can develop weeks to months after consuming products that contain gluten. Earlier symptoms usually include poor weight gain which eventually leads to weight loss. Older children may present with less typical symptoms which include recurrent abdominal pain, nausea, vomiting, bloating, constipation, short stature, delay in puberty, iron deficiency, dental enamel defects and abnormalities in liver function tests. (2) The long term effects of untreated Celiac Disease include recurrent miscarriages, infertility, osteoporosis, seizures, hair loss, dental abnormalities, anemia and malignancy.(3)
Celiac Disease is thought to be an inherited disorder since 5-15% of first degree relatives- parents, siblings or children of a person who has biopsy-proven Celiac Disease also test positive for the disease (4) People with other autoimmune disorders such as Type 1 diabetes mellitus, thyroid disease, systemic lupus erythematosus, liver disease, collagen vascular diseases and rheumatoid arthritis have an increased risk of developing Celiac Disease. Between 5-10% people with Down’s syndrome will be diagnosed with Celiac Disease. (3)
The treatment for Celiac Disease is a gluten free diet. Eliminating gluten from the diet stops intestinal inflammation, stops tissue damage and allows the lining of the intestines to heal. Once the proper diet is adhered to, the small intestine typically heals within 6 months. (3) Removing gluten from a child’s diet seems like a very simple solution to what can be a very serious health condition, but this diet is sometimes hard to maintain.
Gluten can often be a hidden ingredient of many products such as herbal supplements, vitamins, minerals and as an inactive ingredient in common medications. (5) Besides this, most of the popular children’s food such as cereal, bread, bagels, pasta, cookies, waffles, pizza, hotdog and hamburger rolls and snack bars all contain gluten. Children with Celiac Disease are also not supposed to eat oat even though it does not contain gluten. The problem is cross-contamination, or accidental mixing of oat with wheat, rye and barley in the plants that commercially prepare oats in the United States. (5)
Children with Celiac Disease should maintain a diet including plain meat, fish, rice, potatoes, fruits and vegetables. Potato, rice or soy flour can be substituted for wheat flour in recipes. If your daughter is diagnosed with Celiac Disease, be assured that it is treatable with the proper dietary modifications. A consult with a nutritionist can assist you with meal planning, choosing the appropriate foods and giving you information about the types of foods that tend to have gluten as hidden ingredients.
For more information about Celiac Disease contact The National Institute of Diabetes and Digestive and Kidney Diseases:
http://www.digestive.niddk.nih.gov.
References:
(1)Leffler D, Saha S, Farrell RJ. Celiac Disease. Am J Managed Care. 2003;9:825-831.
(2) Gelfond D, Fasano A. Celiac Disease in the Pediatric Population. Pediatric Annals 35(4):275-279.
(3)Rewers M. Epidemiology of Celica Disease: What are the prevalence, incidence and progression of Celiac Disease? Gastroenterology. 2005;128(suppl):47-55.
(4)National Digestive Disease Information Clearinghouse. Celiac Disease. Available @ www.digestive.niddk.nih.gov/ddiseases/pubs/celiac. Accessed July 2006.
(5)Kupper C. Dietary guidelines and implementation for celiac disease. Gastroenterology. 2005;128(suppl):121-127.
Lisa Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner
Pediatric Advice Website
Monday, July 10, 2006
Friday, July 07, 2006
Infant Feeding
Dear Lisa,
My baby is constantly eating. He takes 3 to 4 ounces of formula every 3 hours and always seems to look for more. How do I know if I am feeding him the right amount of formula?
“How much formula should I give?”
Dear “How much formula should I give?”,
Most babies will give their mother cues when they are finished with a feeding. Usually a baby will turn his mouth away or fall asleep when he is full. If your baby is content after feeding and he has 6 to 8 diapers wet with urine in a 24 hour period, then he should be drinking enough. Your doctor can track your baby’s weight gain at regular intervals during infancy at his well baby examinations. As long as your baby gains weight at regular intervals and maintains his percentile curve on the weight growth chart he is eating enough.
It is important to remember that infants have a normal need to suck. It is a normal part of their development during the first 6 months of life. In infancy, a baby feels with his mouth the way that an adult feels with their fingers. Therefore the mouth and sucking are central to all of an infant’s activities and learning. In the first 6 months, sucking is the most satisfying activity performed by an infant. It is through sucking that an infant gains nutrition, satisfies hunger and learns. Infants need a minimum of 2 hours of sucking per day, including feeding time. (1) This sucking can be fulfilled through feeding and by allowing an infant to suck on a pacifier.
Some parents interpret an infant’s need to suck as hunger. Therefore if a baby starts sucking on his hand or rooting (turning his head to the side with his mouth open) and it is not time for a feeding it is a good idea to allow the baby to suck. It is normal for parents to question, how do I know if it’s time for a feeding or if my baby just wants to suck? The normal time interval between feedings is 2 to 3 hours for breastfed babies and 3 to 4 hours for bottle fed babies. When you measure the time interval between feedings, you should start from the beginning of the feeding not the end. Therefore if a breastfed baby begins to eat at 6 a.m. and finishes eating at 6:20 a.m. the time for the next feeding should be at 8 a.m.
Some parents feel better knowing the exact number of ounces of formula they should give their baby. There is a calculation that healthcare professionals use to determine if an infant is receiving the sufficient amount of calories. Babies need 50 calories per pound of body weight per day. If you have an 8 pound baby boy, he needs 50 calories X 8 pounds = 400 calories per day. Regular baby formula has 20 calories per ounce therefore you need to divide 400 by 20 to determine how many ounces of formula the baby needs in a 24 hour period. 400 divided by 20 = 20 ounces. The results show that an eight pound baby needs 20 ounces of formula per 24 hours or 2 ½ ounces per feeding if a baby eats every 3 hours. If you are concerned that your baby is not getting the correct amount of baby formula, you can input your child’s weight into this formula and discuss the results with your Doctor or Nurse Practitioner.
Premature and low birth weight babies have special requirements and their calorie intake should be closely monitored by a healthcare professional. A low birth weight baby is defined as one with a birth weight of less than 2,500 grams( or less than 5 pounds, eight ounces). In this situation, many times the Doctor or Nurse Practitioner will prescribe special infant formula with more calories per ounce (24 to 27 calories per ounce). Low birth weight and premature babies also typically require more calories per day as compared to a full term baby; approximately 110 to 150 calories per kilogram per day.
(1)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York: Delmar Publishers Inc. 1984: 283-284.
Lisa Kelly RN., P.N.P.,C.
Certified Pediatric Nurse Practitioner
Pediatric Parenting Advice
My baby is constantly eating. He takes 3 to 4 ounces of formula every 3 hours and always seems to look for more. How do I know if I am feeding him the right amount of formula?
“How much formula should I give?”
Dear “How much formula should I give?”,
Most babies will give their mother cues when they are finished with a feeding. Usually a baby will turn his mouth away or fall asleep when he is full. If your baby is content after feeding and he has 6 to 8 diapers wet with urine in a 24 hour period, then he should be drinking enough. Your doctor can track your baby’s weight gain at regular intervals during infancy at his well baby examinations. As long as your baby gains weight at regular intervals and maintains his percentile curve on the weight growth chart he is eating enough.
It is important to remember that infants have a normal need to suck. It is a normal part of their development during the first 6 months of life. In infancy, a baby feels with his mouth the way that an adult feels with their fingers. Therefore the mouth and sucking are central to all of an infant’s activities and learning. In the first 6 months, sucking is the most satisfying activity performed by an infant. It is through sucking that an infant gains nutrition, satisfies hunger and learns. Infants need a minimum of 2 hours of sucking per day, including feeding time. (1) This sucking can be fulfilled through feeding and by allowing an infant to suck on a pacifier.
Some parents interpret an infant’s need to suck as hunger. Therefore if a baby starts sucking on his hand or rooting (turning his head to the side with his mouth open) and it is not time for a feeding it is a good idea to allow the baby to suck. It is normal for parents to question, how do I know if it’s time for a feeding or if my baby just wants to suck? The normal time interval between feedings is 2 to 3 hours for breastfed babies and 3 to 4 hours for bottle fed babies. When you measure the time interval between feedings, you should start from the beginning of the feeding not the end. Therefore if a breastfed baby begins to eat at 6 a.m. and finishes eating at 6:20 a.m. the time for the next feeding should be at 8 a.m.
Some parents feel better knowing the exact number of ounces of formula they should give their baby. There is a calculation that healthcare professionals use to determine if an infant is receiving the sufficient amount of calories. Babies need 50 calories per pound of body weight per day. If you have an 8 pound baby boy, he needs 50 calories X 8 pounds = 400 calories per day. Regular baby formula has 20 calories per ounce therefore you need to divide 400 by 20 to determine how many ounces of formula the baby needs in a 24 hour period. 400 divided by 20 = 20 ounces. The results show that an eight pound baby needs 20 ounces of formula per 24 hours or 2 ½ ounces per feeding if a baby eats every 3 hours. If you are concerned that your baby is not getting the correct amount of baby formula, you can input your child’s weight into this formula and discuss the results with your Doctor or Nurse Practitioner.
Premature and low birth weight babies have special requirements and their calorie intake should be closely monitored by a healthcare professional. A low birth weight baby is defined as one with a birth weight of less than 2,500 grams( or less than 5 pounds, eight ounces). In this situation, many times the Doctor or Nurse Practitioner will prescribe special infant formula with more calories per ounce (24 to 27 calories per ounce). Low birth weight and premature babies also typically require more calories per day as compared to a full term baby; approximately 110 to 150 calories per kilogram per day.
(1)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York: Delmar Publishers Inc. 1984: 283-284.
Lisa Kelly RN., P.N.P.,C.
Certified Pediatric Nurse Practitioner
Pediatric Parenting Advice
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