{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T23:35:51Z","timestamp":1779924951019,"version":"3.53.1"},"reference-count":25,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2005,12,1]]},"abstract":"<jats:p>Objectives. We sought to characterize the clinical features at presentation as well as the associated disorders, family history, and evaluation of compliance with a gluten-free diet in children with celiac disease from across Canada.<\/jats:p>\n               <jats:p>Study Design. All members (n = 5240) of the Canadian Celiac Association were surveyed with a questionnaire. Of the 2849 respondents with biopsy-confirmed celiac disease, 168 who were &amp;lt;16 years old provided the data reported here.<\/jats:p>\n               <jats:p>Results. The mean age when surveyed was 9.1 \u00b1 4.1 years, and 58% were female. Median age at diagnosis was 3.0 years with a range of 1 to 15 years. Presenting symptoms included abdominal pain (90%), weight loss (71%), diarrhea (65%), weakness (64%), nausea\/vomiting (53%), anemia (40%), mood swings (37%), and constipation (30%). Almost one third of families consulted \u22652 pediatricians before confirmation of the diagnosis. Before the recognition of celiac disease, other diagnoses received by these children included anemia (15%), irritable bowel syndrome (11%), gastroesophageal reflux (8%), stress (8%), and peptic ulcer disease (4%). A serological test was performed to screen for celiac disease in 70% of those in this population. Eight percent had either type 1 diabetes mellitus or a first-degree relative with celiac disease. Almost all respondents (95%) reported strict adherence to a gluten-free diet, and 89% noted improved health. Reactions after accidental gluten ingestion developed in 54% of the children between 0.5 and 60 hours after ingestion with a median of 2.0 hours. Reactions included abdominal discomfort (87%), diarrhea (64%), bloating (57%), fatigue (37%), headache (24%), and constipation (8%), and most displayed &amp;gt;1 symptom. Although most adjusted well to their disease and diet, 10% to 20% reported major disruptions in lifestyle. Twenty-three percent felt angry all or most of the time about following a gluten-free diet. Only 15% avoided traveling all or most of the time, and during travel, 83% brought gluten-free food with them all of the time. More than half of the families avoided restaurants all or most of the time. Twenty-eight percent of the respondents found it extremely difficult to locate stores with gluten-free foods, and 27% reported extreme difficulty in finding gluten-free foods or determining if foods were free of gluten. Sixty-three percent of the respondents felt that the information supplied by the Canadian Celiac Association was excellent. Gastroenterologists provided excellent information to 44%, dietitians to 36%, and the family physician to 11.5%. When asked to select 2 items that would improve their quality of life, better labeling of gluten-containing ingredients was selected by 63%, more gluten-free foods in the supermarket by 49%, gluten-free choices on restaurant menus by 49%, earlier diagnosis of celiac disease by 34%, and better dietary counseling by 7%.<\/jats:p>\n               <jats:p>Conclusions. In Canada, children with celiac disease present at all ages with a variety of symptoms and associated conditions. Delays in diagnosis are common. Most children are compliant with a gluten-free diet. A minority of these children experience difficulties in modifying their lifestyles, and gluten-free foods remain difficult to obtain.<\/jats:p>","DOI":"10.1542\/peds.2005-0904","type":"journal-article","created":{"date-parts":[[2005,12,1]],"date-time":"2005-12-01T20:44:17Z","timestamp":1133469857000},"page":"e754-e759","source":"Crossref","is-referenced-by-count":157,"title":["Celiac Disease: Evaluation of the Diagnosis and Dietary Compliance in Canadian Children"],"prefix":"10.1542","volume":"116","author":[{"given":"Mohsin","family":"Rashid","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Nutrition, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada"},{"name":"Professional Advisory Board, Canadian Celiac Association, Mississauga, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Cranney","sequence":"additional","affiliation":[{"name":"Department of Medicine and Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada"},{"name":"Department of Medicine, Queen's University, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Zarkadas","sequence":"additional","affiliation":[{"name":"Professional Advisory Board, Canadian Celiac Association, Mississauga, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian D.","family":"Graham","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Ottawa, Ottawa Health Research Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connie","family":"Switzer","sequence":"additional","affiliation":[{"name":"Professional Advisory Board, Canadian Celiac Association, Mississauga, Ontario, Canada"},{"name":"Division of Gastroenterology and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelley","family":"Case","sequence":"additional","affiliation":[{"name":"Professional Advisory Board, Canadian Celiac Association, Mississauga, Ontario, Canada"},{"name":"Regina, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mavis","family":"Molloy","sequence":"additional","affiliation":[{"name":"Kelowna General Hospital, Kelowna, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph E.","family":"Warren","sequence":"additional","affiliation":[{"name":"Professional Advisory Board, Canadian Celiac Association, Mississauga, Ontario, Canada"},{"name":"Division of Gastroenterology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vernon","family":"Burrows","sequence":"additional","affiliation":[{"name":"Professional Advisory Board, Canadian Celiac Association, Mississauga, Ontario, Canada"},{"name":"Department of Agriculture and Agri-Food, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Decker","family":"Butzner","sequence":"additional","affiliation":[{"name":"Professional Advisory Board, Canadian Celiac Association, Mississauga, Ontario, Canada"},{"name":"Division of Gastroenterology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2005,12,1]]},"reference":[{"key":"2021121003230451100_R1","doi-asserted-by":"crossref","unstructured":"Hill ID, Dirks MH, Liptak GS, et al. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr.\u20082005;40:1\u201319","DOI":"10.1097\/00005176-200501000-00001"},{"key":"2021121003230451100_R2","doi-asserted-by":"crossref","unstructured":"Fasano A, Berti I, Gerarduzzi T, et al. 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Am J Gastroenterol.\u20082001;96:126\u2013131","DOI":"10.1111\/j.1572-0241.2001.03462.x"},{"key":"2021121003230451100_R6","doi-asserted-by":"crossref","unstructured":"Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum. Gastroenterology.\u20082001;120:636\u2013651","DOI":"10.1053\/gast.2001.22123"},{"key":"2021121003230451100_R7","doi-asserted-by":"crossref","unstructured":"Ventura A, Magazzu G, Greco L. Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. Gastroenterology.\u20081999;117:297\u2013303","DOI":"10.1053\/gast.1999.0029900297"},{"key":"2021121003230451100_R8","doi-asserted-by":"crossref","unstructured":"Sategna Guidetti C, Solerio E, Scaglione N, Aimo G, Mengozzi G. Duration of gluten exposure in adult coeliac disease does not correlate with the risk for autoimmune disorders. Gut.\u20082001;49:502\u2013505","DOI":"10.1136\/gut.49.4.502"},{"key":"2021121003230451100_R9","doi-asserted-by":"crossref","unstructured":"Cranney A, Zarkadas M, Graham ID, Switzer C. Canadian Celiac Health Survey: the Ottawa pilot. BMC Gastroenterol.\u20082003;3:8","DOI":"10.1186\/1471-230X-3-8"},{"key":"2021121003230451100_R10","unstructured":"Hamilton JR, Lynch MJ, Reilly BJ. Active coeliac disease in childhood: clinical and laboratory findings of forty-two cases. Q J Med.\u20081969;38:135\u2013158"},{"key":"2021121003230451100_R11","unstructured":"Walker-Smith J, Murch S. Coeliac disease. In: Diseases of the Small Intestine, 4th ed. Oxford, United Kingdom: Isis Medical Media Ltd; 1999:234\u2013277"},{"key":"2021121003230451100_R12","doi-asserted-by":"crossref","unstructured":"Book L, Zone JJ, Neuhausen SL. Prevalence of celiac disease among relatives of sib pairs with celiac disease in U.S. families. 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Accessed March 4, 2005"},{"key":"2021121003230451100_R16","doi-asserted-by":"crossref","unstructured":"Jackson PT, Glasgow JF, Thom R. Parents' understanding of coeliac disease and diet. Arch Dis Child.\u20081985;60:672\u2013674","DOI":"10.1136\/adc.60.7.672"},{"key":"2021121003230451100_R17","doi-asserted-by":"crossref","unstructured":"Kumar PJ, Walker-Smith J, Milla P, Harris G, Colyer J, Halliday R. The teenage coeliac: follow up study of 102 patients. Arch Dis Child.\u20081988;63:916\u2013920","DOI":"10.1136\/adc.63.8.916"},{"key":"2021121003230451100_R18","doi-asserted-by":"crossref","unstructured":"Mayer M, Greco L, Troncone R, Auricchio S, Marsh MN. Compliance of adolescents with coeliac disease with a gluten free diet. Gut.\u20081991;32:881\u2013885","DOI":"10.1136\/gut.32.8.881"},{"key":"2021121003230451100_R19","doi-asserted-by":"crossref","unstructured":"Ljungman G, Myrdal U. Compliance in teenagers with coeliac disease: a Swedish follow-up study. 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