<<Disclaimer: Verify this information before applying it to your situation.>> Dear Kathy, your question about CD and poor growth is one of the most frequent questions that I deal with in my practice and I am more then happy to try to give you more insight on this issue. Children with typical symptoms of the disease (i.e. chronic diarrhea, irritability, distended abdomen, etc.) present poor weight gain or weight loss, while the high is usually not affected, at least in the first stage of the disease. Consequently, they appear dystrophic (weight/high <5 centile). These patients do not offer any problems in terms of diagnosis. More difficult to identify are the cases presenting atypical symptoms. Sometimes the short stature is the only symptom present. In other cases the weight and/or the high may fall off from the growth chart (i.e. weight gain unappropriate for their age, high growth< 6.5 cm/year), but no gastrointestinal symptoms are present. As concern your child, the "drop" in centile at 15 month of age is not unusual and may be due to changes in diet, eruption of teeth, etc. On the other hand, he had a proportional growth since age two, remaining on the same centiles. Based on the previous considerations, it is unlikely that he is affected by CD. Different story would be if he is a first degree relative of a proved CD patients. Since the prevalence of CD among first relatives of celiacs is higher then in the general population, it is now general recommendation to screen them for the presence of antigliadin and antiendomysium antibodies in the blood, despite the presence of symptoms resembling CD. Alessio Fasano, M.D., Director Division of Pediatric Gastroenterology and Nutrition University of Maryland, School of Medicine 22 S. Greene St., PO Box 140 Baltimore, MD 21201