Is your child at risk for Celiac Disease?

Is your child at risk for Celiac Disease?

Below is a 15 question screening tool to help identify if your child is at high risk for celiac disease. It takes less than 5 minutes to complete and score but can make a lifetime of difference in the health of your child and your family’s quality of life.

How accurate is the screening questionnaire?

Research has concluded that the questionnaire is 87% effective in identifying children at high risk for celiac disease. However, the questionnaire results are not a medical diagnosis and the screening program does not replace a comprehensive exam by a trained physician.

Does the questionnaire recommend treatment?

No, the celiac disease screening questionnaire only identifies children who are at high risk for the disease.  If a child is identified at high risk it is recommended you consult a local and knowledgeable health care professional for further medical evaluation and testing.

Questionnaire for Celiac Disease Screening

Age: _____

Sex: _____

Please tell us how often your child has any of the following by circling the best answer.

Does your child have …?

Total Score:____________

Scoring: Never=1; Seldom= 2; Frequent=3; A Lot=4; Don’t Know=0; No=1; Yes=2

1. Abdominal pain, gas or bloating? (STOMACH)

Never        Seldom           Frequent          A Lot        Don’t Know

2. Diarrhea, constipation, vomiting or nausea? (INTESTINAL)

Never        Seldom            Frequent          A Lot      Don’t Know

3. Allergies or asthma? (ALLERGIES)

Never        Seldom            Frequent          A Lot       Don’t Know

4. Short stature, growth delay, or weight loss? (GROWTH)

Never        Seldom           Frequent          A Lot       Don’t Know

5. Fatigue, weakness, anemia or other nutrient deficiencies? (ANEMIA)

Never          Seldom          Frequent          A Lot       Don’t Know

6. Unexplained mood swings, depression, anxiety or stress? (MENTAL)

Never          Seldom         Frequent          A Lot         Don’t Know

7. Unexplained headaches, joint aches or body aches? (ACHES)

Never         Seldom          Frequent            A Lot          Don’t Know

8. Dental enamel defects (vertical or horizontal grooves in permanent teeth that are chalky white) or recurring canker sores in mouth? (MOUTH)

Never         Seldom          Frequent           A Lot         Don’t Know

9. Skin rashes such as eczema, psoriasis, or dermatitis herpetiformis (itchy, blistering skin) (SKIN)

Never      Seldom           Frequent          A Lot           Don’t Know

10. Any autoimmune syndrome such as IgA deficiency or autoimmune thyroiditis (AUTOIMMUNE)

No                   Yes                  Don’t Know

11. Type I diabetes  (DIABETES)

No                   Yes                  Don’t Know

12. Down’s syndrome, Turner’s syndrome, or William’s syndrome (SYNDROME)

No                   Yes                  Don’t Know

13. Autism, hyperactivity, learning disabilities or attention deficit disorder (COGNITIVE)

No                 Yes                  Don’t Know

14. A first degree relative with diagnosed celiac disease (RELATIVE)

No                  Yes                  Don’t Know

15. Higher than normal absenteeism due to sickness (more than 15 days)  (ABSENTEEISM)

No                   Yes                  Don’t Know


A score greater than 24 indicates a child at high risk for celiac disease.

>24 indicates a child at high risk for celiac disease

Categories in parentheses indicates factors for risk. For example abdominal pain, gas or bloating correlate to stomach symptoms.

Vancouver Health Coach