With the advent of effective screening tests and knowledge of high-risk patients, the number of children with diagnosed celiac disease in southeastern Wisconsin has risen in recent years, increasing from 1 in 1986 to 93 in 2003. Telega and colleagues discuss changes in the clinical presentation of patients with this disorder. With this increase in frequency of diagnosis, the mean age at diagnosis rose from 5 to nearly 9 years. In children older than 3 years, most presented with extraintestinal manifestations; in this group, 60% had no gastrointestinal symptoms and 11% were overweight. Pediatricians should be aware of the more typical presentation of celiac disease and screen all high-risk children, including those who have Down or Turner syndrome, type 1 diabetes, short stature, thyroiditis, and a first-degree relatives with celiac disease.