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Coeliac disease in children: signs, testing and support at school

A UK parent's guide to coeliac disease in children: signs to look out for, how children are tested and diagnosed, and getting support at nursery and school.

Published Last reviewed 4 min read

Coeliac disease can start at any age, including in babies and young children once they’re eating gluten. If you’re worried about your child, or they’ve just been diagnosed, this guide explains the signs, how testing works for children in the UK, and how to get the support they’re entitled to at nursery and school.

This is general information, not medical advice. If you’re concerned about your child’s health, speak to your GP.

Signs to look out for

Symptoms vary a lot. The NHS says they can range from mild to severe and often come and go, and some people have no noticeable symptoms at all. Common signs include:

  • diarrhoea, tummy pain, bloating and wind
  • constipation or being sick
  • tiredness and a lack of energy
  • unexpected weight loss

In children, untreated coeliac disease can lead to malnutrition, which the NHS says can mean not growing at the expected rate in height and weight, and delayed puberty.

When NICE says a child should be offered a test

NICE guidance (recommendation 1.1.1) says a coeliac blood test should be offered to people, including children, with:

  • persistent unexplained tummy or bowel symptoms
  • faltering growth
  • prolonged tiredness
  • unexpected weight loss
  • severe or persistent mouth ulcers
  • unexplained iron, vitamin B12 or folate deficiency
  • type 1 diabetes or autoimmune thyroid disease, at diagnosis

It should also be offered to first-degree relatives of people with coeliac disease. So if a parent, brother or sister has coeliac disease, it’s worth talking to your GP about testing your child, even if they seem well.

How children are tested and diagnosed

Keep gluten in their diet until testing is finished

This is the most important point. NICE says any test is only accurate if gluten is eaten during the diagnostic process, and advises eating some gluten in more than one meal every day for at least six weeks before testing. Don’t start a gluten-free diet until a specialist has confirmed the diagnosis, even if the blood test is positive.

NICE also says infants shouldn’t be tested before gluten has been introduced into their diet. The NHS advises not introducing gluten before 6 months.

The blood test

For children, NICE recommends that laboratories test total IgA and IgA tissue transglutaminase (tTG) antibodies first, with IgG-based tests if the child is IgA deficient. Our guide to the coeliac blood test and diagnosis explains the tests in more detail.

Seeing a specialist

If the blood test is positive, NICE says children should be referred to a paediatric gastroenterologist or a paediatrician with a specialist interest in gastroenterology for further investigation.

Some children won’t need a biopsy. Coeliac UK explains that, under European paediatric (ESPGHAN) guidelines, a child whose IgA tTG level is more than 10 times the upper limit of normal, with a positive EMA blood test, may be diagnosed without a biopsy. This isn’t offered to children with IgA deficiency, and the decision is made with the specialist.

After diagnosis

The treatment is a strict gluten-free diet for life. The NHS says you’ll be referred to a dietitian to help with the change, and NICE recommends an annual review, including measuring weight and height and checking how the diet is going.

A few things that help families:

Nursery, school and the law

Coeliac UK suggests meeting the person in charge, teaching staff and catering staff before your child starts. Explain that:

  • coeliac disease is not an allergy and isn’t contagious, so it won’t cause anaphylaxis, but even small amounts of gluten cause harm
  • your child needs a strict gluten-free diet, including at snack time, in cookery lessons, at parties and on trips
  • the most common symptoms if gluten is eaten by mistake are diarrhoea, nausea, tummy ache and wind
  • cross-contamination matters as well as ingredients

In England, section 100 of the Children and Families Act 2014 requires state-funded schools (including academies and free schools) to make arrangements to support pupils with medical conditions. The Department for Education’s statutory guidance, Supporting pupils with medical conditions at school, includes templates for an individual healthcare plan (IHCP), which sets out what your child needs and who is responsible.

Coeliac UK says children with coeliac disease shouldn’t be excluded from school meals or activities because of their condition, and that a child entitled to free school meals shouldn’t lose out because they need gluten-free food. Scotland and Wales have their own guidance on supporting pupils with healthcare needs, which Coeliac UK links to from the same page.

Looking after the whole family

A coeliac diagnosis can feel overwhelming at first, for children and adults. Plan ahead for birthday parties (sending a gluten-free treat is often easiest), and involve your child in shopping and cooking so they build confidence. For eating out together, see our guide to eating out safely in the UK.

If you’re new to coeliac disease yourself, start with what coeliac disease is.

Frequently asked questions

What are the signs of coeliac disease in a child?

Signs can include ongoing tummy problems such as diarrhoea, pain or bloating, tiredness, and not growing or gaining weight as expected (faltering growth). NICE recommends offering a coeliac blood test to children with these and some other signs, and to children who have a parent, brother or sister with coeliac disease. Some children have mild symptoms or none.

Should my child keep eating gluten before a coeliac test?

Yes. NICE says tests are only accurate if gluten is eaten during the diagnostic process, and advises eating some gluten in more than one meal every day for at least six weeks before testing. Don't start a gluten-free diet until a specialist confirms the diagnosis.

Do children always need a biopsy to diagnose coeliac disease?

Not always. Coeliac UK explains that, under European paediatric guidelines, some children with a very high tTG antibody level (more than 10 times the upper limit of normal) and a positive EMA test can be diagnosed without a biopsy. The decision is made by a paediatric specialist.

Do schools have to support a child with coeliac disease?

In England, state-funded schools have a legal duty to make arrangements to support pupils with medical conditions, under section 100 of the Children and Families Act 2014, and Department for Education guidance says pupils should have an individual healthcare plan where appropriate. Scotland and Wales have their own guidance.

Sources

  1. Coeliac disease: symptoms, NHS. Accessed 4 October 2026.
  2. Coeliac disease: treatment, NHS. Accessed 4 October 2026.
  3. Coeliac disease: recognition, assessment and management (NG20), recommendations, NICE. Accessed 4 October 2026.
  4. Testing children for coeliac disease (for healthcare professionals), Coeliac UK. Accessed 4 October 2026.
  5. Nursery, playgroup and school, Coeliac UK. Accessed 4 October 2026.
  6. Coeliac disease, schools and the law, Coeliac UK. Accessed 4 October 2026.
  7. Free NHS prescriptions, NHS Business Services Authority. Accessed 4 October 2026.
  8. Children and Families Act 2014, section 100, legislation.gov.uk. Accessed 4 October 2026.
  9. Supporting pupils with medical conditions at school, GOV.UK (Department for Education). Accessed 4 October 2026.