Can I reduce my child’s risk of celiac disease?

Celiac disease is an autoimmune condition in which the body is unable to tolerate gluten, a protein found in grains such as wheat, barley, and rye. When individuals with celiac disease eat gluten, it triggers an immune (inflammatory) response in the small intestine. Over time, this inflammation damages the lining of the small intestine until it’s unable to absorb nutrients. People with celiac disease may also be more susceptible to other disorders and autoimmune conditions.

What are the symptoms of celiac disease? 

The symptoms of celiac disease can include irritability, slow growth for children, poor weight gain or weight loss, chronic diarrhea or constipation, vomiting, and pale or foul-smelling stools. Symptoms may appear after a baby first starts eating cereal (grains).

How common is celiac disease? 

Celiac disease is said to affect 1 in 100 to 120 adults and 1 in 80 to 300 children. But a 2017 study of a Colorado population showed a higher rate among children: Celiac disease was found to affect 3 percent of the study population by age 15. Its prevalence seems to be on the rise globally in what one 2017 article termed a “celiac surge.”

What causes celiac disease? 

Scientists aren’t sure what causes celiac disease. But given the upward trend of celiac disease incidence and the potential for developing celiac disease throughout the course of a lifetime, some researchers are investigating environmental factors.

Genetics are known to play a role in the development of celiac disease. For those with a first-degree relative (parent, sibling, or child) with the condition, the risk of developing celiac disease is 7 to 20 percent. If an individual is found to share genes like HLA-DQ2 and HLA-DQ8 with the first-degree relative, the risk is even higher. A pair of large-scale studies (see this and this) found genetics to be significantly associated with the diagnosis of celiac disease in early childhood. 

Does delaying gluten make a difference? 

Research is mixed on whether exclusive breastfeeding followed by introduction (at about 4 to 6 months of age) of foods containing gluten can help reduce a child’s risk of celiac disease. There may be a “window of opportunity”—an optimal time to introduce gluten to the digestive system that might reduce the risk of an autoimmune response. According to this theory, introducing gluten too early (before 4 months) or too late (after 6 months) may increase the likelihood of a child developing celiac disease.

But in a randomized controlled trial of nearly 1,000 children in Europe, those not introduced to gluten until later had better outcomes. Among those children with gluten delayed until age 12 months, significantly fewer were diagnosed with celiac disease at age 2. Although similar numbers of children in the study went on to develop the disease by age 5, researchers suggest that any delay in celiac disease onset can be beneficial to a child’s brain development during toddlerhood and to his overall health.

What else can I do? 

With so much uncertainty about the development and prevention of celiac disease, it’s challenging for parents to determine the best nutritional course for their child. The following steps can help support optimal growth and development: 

  • Breastfeed your child. Breastfeeding is still a good choice for many reasons, all of which benefit children—even those who have been diagnosed with celiac disease. Click here to learn about the many benefits of breastfeeding. 
  • Consider celiac disease testing. While celiac disease can develop at any age, studies suggest that the vast majority of children who develop celiac disease do so within the first 3 years of life. Identifying children with celiac disease is an important first step in preventing long-term health problems. If there’s a family history of celiac disease, talk with your child’s doctor about early signs of the disease and whether your child should be tested. 
  • Don’t eliminate gluten from your child’s diet before testing. If you eliminate gluten from your child’s diet prior to testing, blood tests can appear normal even in children with celiac disease.

Last updated February 26, 2018

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