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Normal growth velocity before diagnosis of celiac disease
H Lejarraga1, S Caíno, A Salvador
1Service Growth and Development, Hospital de Pediatría Prof Dr. J. P. Garrahan, Buenos Aires, Argentina.
Insights
Many children with undiagnosed celiac disease exhibit normal physical growth. This study found normal height velocity in most pediatric celiac disease patients before treatment, challenging growth norms for screening.
Area of Science:
- Pediatric Gastroenterology
- Growth and Development
Background:
- Undiagnosed celiac disease may present in children with normal physical growth.
- Clinical observations suggest a subset of pediatric celiac disease patients remain untreated despite normal growth velocity.
Purpose of the Study:
- To evaluate height velocity in children with confirmed celiac disease prior to diagnosis and treatment.
- To determine if normal growth velocity is a common feature in pediatric celiac disease patients before intervention.
Main Methods:
- Retrospective analysis of anthropometric measurements from 23 pediatric patients with confirmed celiac disease.
- Evaluation of 42 growth periods with velocities measured over 6- to 27-month intervals.
- Data collected by primary care pediatricians before patient referral.
Main Results:
- All 5 patients in the first semester of life displayed normal growth velocity.
- 60% (6/10) of patients in the second semester of life showed normal growth velocity.
- Normal height velocity was observed in most patients aged 1 to 10.66 years, including those up to 8 years old.
Conclusions:
- Pediatricians and specialists should consider celiac disease screening even in children with normal growth rates.
- Normal growth velocity should not exclude a child from celiac disease screening, particularly in growth clinics.
- Findings highlight the importance of considering celiac disease in pediatric patients irrespective of their physical growth trajectory.
Background:
Clinical experience leads us to believe there may be patients with celiac disease who have not yet been treated, with a normal physical growth.
Methods:
To evaluate height velocity of patients with confirmed celiac disease before their diagnosis and treatment, anthropometric measurements taken by the general pediatricians in charge of the primary care of the patients before they were sent to the authors' hospital were studied. Forty-two growth periods (available velocities) were measured at varying intervals (ranging from 6 to 27 months) in 23 patients aged 0.1 to 10.66 years were analyzed.
Results:
All patients studied during the first semester of life (n = 5) showed normal growth velocity, and 6 of 10 patients showed normal growth velocity during the second semester of life. Ten of 12 patients between the ages of 1.0 and 1.99 years of age showed normal height velocity, and 7 of 9 patients aged 2.0 to 10.66 years showed normal height velocity. Normal height velocities were found not only during the first year of life, but also in children aged 1 to 8 years.
Conclusions:
Results should alert pediatricians and those in gastroenterology and growth clinics. In the latter case, norms for studying children who have short stature but are growing at a normal rate should not be a condition for excluding a child from screening for celiac disease.