Understanding Autoimmune Disease in Children
Autoimmune diseases can affect people of all ages. While they are more common in adults during their reproductive years (20-40), some autoimmune diseases can appear in childhood. Early diagnosis and treatment are crucial for improving the lives of children and teens living with these conditions.
What Causes Autoimmune Diseases in Children?
The specific causes of autoimmune diseases in children are unclear, but genetics and environmental factors likely play a role (1). Dr. Robyn Tiger, radiologist and certified Lifestyle Medicine physician, says, “Stress has a dual role in impairing immune system function.” She notes that stress increases the production of certain pro-inflammatory hormones, which can worsen autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematous.
What Are the Key Differences Between Autoimmune Diseases in Children and Adults?
Children and teens are not little adults. Autoimmune disease may look quite different in youth than in their adult counterparts.
Youth may experience many of the generalized symptoms associated with autoimmune disorders as part of normal immune maturation.
Dr. Chinwe Efuribe, a pediatrician and owner of Centered Youth Clinic and Consulting in Austin, TX, notes, “Because of normal expectations that young people will experience frequent immune responses as their systems mature, early identification of autoimmune conditions may be more challenging during this period compared to during adulthood.”
Dr. Efuribe, acknowledges the challenges in recognizing autoimmune diseases in youth, saying, “Symptoms can be non-specific, attributed to isolated inflammatory responses or develop gradually with no early symptoms to identify. For example, fatigue, joint pain, and swelling are most associated with injuries or transient inflammatory conditions [like] infections in young people and do not always warrant initial blood testing.”
Additionally, youth with certain autoimmune diseases, like celiac disease (2), juvenile idiopathic arthritis (3), and type 1 diabetes (4), are more likely to develop other autoimmune diseases.
What Are the Most Common Autoimmune Diseases in Children and Teens?
While autoimmune diseases are uncommon in youth, some are seen more frequently than others. Recognizing how these diseases may present differently in youth can help improve diagnosis and management.
Celiac disease (CD)
Triggered by consuming gluten, CD in children can cause various symptoms, including diarrhea, constipation, weight loss, delayed growth, iron deficiency anemia, and abdominal pain. Younger children often present with vague, unexplained symptoms such as chronic diarrhea, poor appetite, abdominal distension, and abdominal pain (5).
Systemic lupus erythematosus (SLE)
SLE is a rare disease in children (only 10% of cases) that affects multiple organs. Compared to adults, children with SLE are more likely to have kidney, blood, and brain involvement (6).
Juvenile idiopathic arthritis (JIA)
JIA encompasses various conditions causing inflammation in joints, eyes, skin, and internal organs. Symptoms appear before age 16 and last for at least six weeks. Pain, eye problems, and rashes are potential symptoms (7).
Type 1 diabetes mellitus (T1D)
T1D typically first appears in childhood. It affects the pancreas, causing low insulin and high blood sugar. Children with T1D often experience excessive thirst, urination, and weight loss. Diabetic ketoacidosis, a serious complication of high blood sugar, can be the first presentation in about a third of children (8).
What Should You Do If You Suspect Your Child Has an Autoimmune Disease?
Having an autoimmune disease in childhood comes with unique challenges. Dr. Efuribe recognizes the diagnostic dilemma: “Compared to adults, children and teens may experience non-specific symptoms without notifying their caregivers/parents, so identifying onset or duration of symptoms may be difficult to pinpoint during history-taking.”
If you’re concerned that your child or teen might be experiencing symptoms suggestive of an autoimmune disorder, take them to see a healthcare provider.
Autoimmune diseases diagnosed in childhood can show worse outcomes both because of the duration of the disease and long-term treatment. Families have an important role in helping youth manage their disease.
Dr. Efuribe also stresses the importance of supporting older children and teens’ self-advocacy.
She advises that families and youth track concerning symptoms. She says, “Families and youth can use calendars, diary, or notes section in a phone app to document symptoms by when they occur, how frequently they occur, what body parts are involved, and any associated factors that alleviate or aggravate the symptoms.
Additional Tips to Consider for Managing Autoimmune Diseases in Children
Education: Families can help a youth living with an autoimmune disease understand their condition. Explaining what’s happening to their bodies can help ease anxiety. They can also learn to recognize symptoms, actively engage in treatment, and make informed decisions about their care.
Medical care: Autoimmune diseases are complex and can be even more challenging to diagnose, understand, and manage in youth. These diseases are often missed in young people and can require the involvement of various specialties, such as endocrinologists, rheumatologists, or neurologists. Families must also consider the potential side effects of long-term treatments with medications such as corticosteroids. Families can be advocates for their children and teens, helping them get the most appropriate care.
Lifestyle: The choices we make can play a significant role in preventing and managing autoimmune diseases. Dr. Tiger stresses the importance of the basics, such as choosing healthful foods, getting nourishing sleep, and moving your body. She also emphasizes the importance of having a supportive network of family and friends. In addition to helping with loneliness, she notes, “Social connection increases the binding hormone, oxytocin, which decreases stress and anxiety and enhances immune system function.”
What’s on the Horizon for Understanding and Treating Autoimmune Disease in Children and Teens?
Research is ongoing to improve the early detection of autoimmune diseases in children. Early diagnosis allows prompt treatment, potentially slowing disease progression and improving long-term outcomes. Additionally, the development of more targeted therapies holds promise for better management in the future.
About the Author
Tracy Asamoah, MD, is a writer, child and adolescent psychiatrist, and leadership coach based in Austin, Texas. She completed her medical education at the University of California, San Francisco, and her general psychiatry residency and child and adolescent fellowship at the David Geffen UCLA School of Medicine. Tracy has served on the faculty of the University of New Mexico School of Medicine and the Texas A&M School of Medicine. Tracy’s journey into the world of autoimmune diseases began when she experienced sudden onset symptoms of multiple sclerosis early in her medical career. This personal experience, combined with her intense curiosity, has informed her work and writing in the field. As a writer, Tracy has contributed to various books and written articles related to mental health. She’s also written on various medical topics regularly contributing to publications such as GoodRx, Psychology Today, and Psychotherapy.net
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