Background:
Celiac disease (CD) in early childhood often presents with non-specific symptoms, delaying diagnosis. Although extraintestinal manifestations and developmental or neurological associations have been described, little is known about healthcare and developmental service utilization before diagnosis.
Objective:
To examine relationships between the timing of CD diagnosis and patterns of healthcare utilization, developmental service utilization, and developmental concerns during early childhood.
Methods:
A retrospective cohort study was conducted using anonymized data from the Maccabi Healthcare Services database. The sample included 5,215 children aged 6–17 years with CD and matched controls. Healthcare utilization was compared between CD and control groups. A subgroup analysis included children diagnosed with CD before age 6 years who were referred to child development services, comparing those diagnosed before referral with those diagnosed afterward. Physiotherapy, occupational therapy, and physician visits were examined from birth to age 6 years. Nutritional consultations were analyzed separately because the available data included visits during the three years before and after diagnosis.
Results:
No differences were found between the overall CD and control groups. Among children diagnosed before age 6 years, different patterns were observed. Children referred to child development services before CD diagnosis had significantly greater utilization of physiotherapy and physician services than those diagnosed before referral. Nutritional consultations were also more frequent; however, because they included visits before and after CD diagnosis, they are not directly comparable to the other healthcare services. Occupational therapy utilization was higher among children diagnosed before referral, although the reasons remain unclear.
Conclusions:
Children with undiagnosed CD may first present with non-specific developmental or physical concerns, resulting in increased early healthcare utilization before diagnosis. Recognizing these patterns may contribute to earlier identification of CD. The associations with occupational therapy utilization and nutritional consultations raise new questions regarding their roles in the healthcare pathway to CD diagnosis.