New guidelines for pediatric celiac disease

June 9, 2016 Uma Pisharody, MD, FAAP

Wouldn’t it be great if there were a way to prevent infants and children from developing celiac disease (CD)?Previously, based on 2008 guidelines, it was thought that by introducing gluten to an infant between the ages of 4 and 7 months, especially if an infant was still being breastfed, there might be a “window of opportunity” to prevent the disease.

Unfortunately, the results of two large international, randomized controlled trials, both published in the New England Journal of Medicine in 2014, found that this wasn’t the case.

It turns out that if a child is genetically predisposed to developing CD, it doesn’t matter whether he or she is introduced to gluten sooner rather than later.

In light of these studies, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition recently published new guidelines and key points about introducing gluten to an infant’s diet: 

Gluten may be introduced to an infant's diet anytime between 4 and 12 months of age.

To avoid bringing on the symptoms of celiac disease more rapidly and severely, infants shouldn’t receive relatively large amounts of gluten in the first weeks after its introduction. This go-slow approach is advised to avoid risking harm during the first year of a child’s life, a period of crucial growth and development. 

While breastfeeding should be encouraged for its well-established health benefits, the practice – including during the time of gluten introduction – doesn’t reduce the risk of celiac disease. While it’s disappointing to know that there’s little parents can do to prevent their children from developing celiac disease, it’s also reassuring to know that we have a definitive answer that is proven by scientific data. Genetics seems to be the biggest risk factor for celiac disease, and since genes can’t be changed, neither can the threat of CD.

It’s important to remember that only a small fraction of people who carry genes linked to celiac disease will actually ever develop the condition. While as many as 4 in 10 people carry the genes, the disease actually only occurs in about 1 in 100 people.

If you have questions about celiac disease and your child’s health, our pediatric gastroenterology team is here to help. To make an appointment, call 206-215-6005.

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