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This article originally appeared in the Autumn 2012 edition of Celiac.com's Journal of Gluten-Sensitivity. Celiac.com 11/25/2014 - As a celiac patient or relative of a celiac patient, many have come to understand the mental and physical symptoms of celiac disease directly or indirectly. Now the time has come for your infant to delve into the world of eating solid foods, most of which happen to contain gluten, especially the first baby cereals. If you’re like most mothers, it’s understandable that you would be nervous. In my gluten-free advocacy work and as a child of a celiac mother, I understand these concerns and am pleased to inform others of the fruits of celiac disease research regarding infants at risk for the disease, introducing gluten, and breastfeeding. These studies indicate that there may be a way to lower the risk of developing the disease and reveal signs to look out for in your infant to determine whether indeed she/he may be celiac. An important question which has been addressed in research across the globe is when to introduce solids, usually gluten-containing baby cereal. First, after guidelines were issued regarding the benefits of exclusive breastfeeding for six months, many countries, including the United States, United Kingdom, and Australia, found that the rate of food allergies and intolerances increased. In Sweden it was revealed that celiac disease rates sharply increased after the guidelines were followed, and these rates declined again after compliance with the guideline was dropped. The question then arose regarding the introduction of gluten before four months of age with a 2005 study published in the Journal of the American Medical Association. According to Nancy Lapid in her article titled Gluten-Free Baby? Facts About Breastfeeding, Gluten, and Celiac Disease, “the babies who ate gluten before four months of age had a five-times-higher risk of developing celiac disease in childhood compared with babies who started on gluten between four and six months. Babies who first ate gluten at age seven months or older also had a higher risk compared with babies introduced to gluten between four and six months, but the increase in risk was small.” In the end, it seems that research indicates that the optimum time to introduce gluten into your baby’s diet is between the ages of four and six months, yet carefully and in small amounts. Now let’s look at one of my favorite subjects, breastfeeding. As far as breastfeeding is concerned, several studies have shown risk of celiac disease to be reduced when still breastfeeding in the recommended “window” of four to six months, with an even lower risk if breastfeeding is continued for a longer period. Nancy Lapid shares, “If neither the baby nor the mother has confirmed celiac disease, the mother should continue to eat gluten, even if there is a history of celiac disease in the family, because there is a chance that exposure to gluten in breast milk will actually help the baby to develop a normal immune response to gluten.” If your child is diagnosed with celiac disease, you’ll need to eliminate gluten from your own diet due to the fact that gluten can be passed from your system via your breast milk to your baby. If you have reason to suspect that your child has a genetic predisposition to celiac disease, you’ll want to be on guard for a variety of celiac disease symptoms during the process of introducing gluten. Some common symptoms, which are visible in adults as well as in infants and young children, are gastrointestinal or bowel issues such as severe chronic diarrhea with floating voluminous stools, extreme weight loss to the point of wasting, and growth issues. Should you observe abnormal physical or mental symptoms in your baby, you may try eliminating gluten from the diet and note changes, but do make sure to consult with a pediatrician or other qualified medical practitioner before you begin making major changes to his diet. It’s important to note that it doesn’t necessarily indicate that introducing gluten during the optimum window will eliminate a child’s risk of developing celiac disease, but it could reduce risk or at least delay disease onset. As gluten-free awareness and research continues, however, we can assuredly look forward to more helpful information regarding reducing celiac disease in young children.

Celiac.com 04/12/2013 - A number of studies have suggested a connection between infant feeding patterns and the development or clinical expression of celiac disease. However, until recently, it remained unclear whether infant feeding actually affects the occurrence and/or the clinical presentation of celiac disease. A recent study that shows important differences in celiac disease rates between two groups of 12-year-olds indicates a possible strategy for preventing celiac disease. The notable difference between the two groups was simple infant feeding practices. The study findings suggest that gradual introduction of gluten in small amounts during ongoing breastfeeding provides protection against celiac disease. The study was conducted by Anneli Ivarsson, MD, PhD; Anna Myléus, MD, PhD; Fredrik Norström, PhD; Maria van der Pals, MD; Anna Rosén, MD, PhD; Lotta Högberg, MD, PhD; Lars Danielsson, MD; Britta Halvarsson, MD, PhD; Solveig Hammarroth, MD; Olle Hernell, MD, PhD; Eva Karlsson, MD; Lars Stenhammar, MD, PhD; Charlotta Webb, MD; Olof Sandström, MD, PhD; and Annelie Carlsson, MD, PhD. They are variously affiliated with the Departments of Public Health and Clinical Medicine, Epidemiology and Global Health, Medical Biosciences, Clinical and Medical Genetics, and Clinical Sciences, Pediatrics at Umeå University in Umeå, Sweden; the Department of Pediatrics in Clinical Sciences at Skånes University Hospital at Lund University, in Lund, Sweden; the Pediatric Clinic of Norrköping Hospital in Norrköping, Sweden, the Department of Clinical and Experimental Medicine in the Division of Pediatrics at Linköping University in Linköping, Sweden; the Pediatric Clinic of Norrtälje Hospital in Norrtälje, Sweden; the department of Pathology and Cytology of Aleris Medilab in Täby, Sweden; and the Pediatric Clinic of Växjö Hospital in Växjö, Sweden. To accomplish their goal, the team crafted a 2-phase cross-sectional screening study of 13,279 children from two separate birth groups: the first born during the Swedish celiac disease epidemic of 1993, and the second born in 1997, after the epidemic ended. The team investigated and compared the overall rates of celiac disease in the two groups, each at twelve years old, and compared the results against each group's ascertained infant feeding patterns. To report and confirm all previously diagnosed cases of celiac disease, they analyzed blood samples for serological markers of celiac disease, and referred all children with positive values for small intestinal biopsy. The team used questionnaires to determine infant feeding practices for both groups. They expressed prevalence comparisons as prevalence ratios, and found that the total prevalence of celiac disease was 29 in 1000 for the 1993 group, and and 22 in 1000 1997 group. Children born in 1997 substantially less likely to develop celiac disease compared with those born in 1993 (prevalence ratio: 0.75; 95% conï¬dence interval: 0.60–0.93; P = .01). Again, the difference between the groups was in infant feeding patterns. Specifically, the groups differed in the percentages of infants introduced to dietary gluten in small amounts during ongoing breastfeeding. Many more children in the 1997 group had gluten introduced into their diets in small amounts during ongoing breastfeeding, as compared to the 1993 group. Overall, the signiï¬cantly lower rates of celiac disease in the 1997 group indicate that gradual introduction of gluten-containing foods from 4 months of age, preferably during ongoing breastfeeding, offers a possible way to prevent or lower celiac disease risk. Source: Pediatrics 2013;131:e687–e694. doi: 10.1542/peds.2012-1015