Coeliac testing in children

Testing is generally recommended for children with persistent digestive symptoms (such as bloating, diarrhoea, or abdominal pain), unexplained poor growth or weight gain, unexplained anaemia, or a first-degree relative (parent or sibling) with coeliac disease, even without symptoms in some guidelines. Testing may also be considered in children with other autoimmune conditions such as type 1 diabetes, given the increased association. A doctor can advise on the specific indications relevant to your child.

Testing typically starts with a blood test looking for specific antibodies (most commonly anti-tTG antibodies), which needs to be done while the child is still eating gluten normally, since a gluten-free diet beforehand can affect results and lead to a missed diagnosis. If the blood test is positive, further testing, often a small intestine biopsy taken during endoscopy, is usually needed to confirm the diagnosis, though in some cases with very high antibody levels and specific genetic testing, biopsy may sometimes be avoided in children. Your paediatrician or paediatric gastroenterologist will advise on the most appropriate pathway.

Starting a gluten-free diet before testing can cause the antibody levels and any gut lining changes to normalise or improve, potentially leading to a false-negative result and a missed or delayed diagnosis. If a gluten-free diet has already been started, your doctor may recommend a supervised 'gluten challenge' (reintroducing gluten for a period before retesting) to ensure accurate results. This is an important practical point to discuss with your doctor before making any dietary changes if coeliac disease is suspected.

A positive result, particularly if confirmed by biopsy or very high antibody levels combined with supportive genetic testing, means your child will need to follow a strict, lifelong gluten-free diet, ideally with support from a paediatric dietitian to ensure balanced nutrition during growth and development. Regular follow-up monitors growth, symptom improvement, and gut healing over time. Most children respond very well to dietary treatment, with symptoms and growth improving significantly.

Yes, siblings and other first-degree relatives of a child diagnosed with coeliac disease are generally recommended for testing, even without symptoms, given the significantly increased risk within families due to shared genetic predisposition. This is usually straightforward to arrange alongside your child's own diagnosis and follow-up care. Discuss this with your paediatrician when your child is diagnosed.

See a doctor if your child has persistent digestive symptoms, poor growth, or a relevant family history, to discuss whether testing is appropriate, and importantly before making any dietary changes. NHS paediatric gastroenterology referral can take several weeks; a private paediatric consultation is typically available within about 2 weeks for earlier assessment and testing.