How to Identify and Treat Celiac Disease in Infants

Risk factors for celiac disease

While celiac disease can occur in anyone and can show up at any age, some people are at higher risk for developing it. This includes those with (1):

• family history of celiac disease
• other autoimmune disorders, including type 1 diabetes and autoimmune thyroid or liver diseases
• Down syndrome
• Turner syndrome
• Williams syndrome
• selective IgA deficiency
• systemic lupus erythematosus
• juvenile chronic arthritis

Between 10–20% of people with a first-degree relative, such as a sibling, parent, or child, with celiac disease will also develop celiac disease (1).

Another risk factor for celiac disease is the presence of genes known as human leukocyte antigen (HLA) DQ2 and DQ8. While not everyone who has those genes have celiac disease, nearly everyone with celiac disease has one of those two genes (4).

Do breastfeeding or introducing gluten too early play a role?

Other environmental risk factors, such as whether a baby is breastfed and when gluten is introduced into a baby’s diet, have been explored.

However, the development of celiac disease doesn’t seem clearly connected to either breastfeeding or introducing gluten at a certain age.

For example, one study tested delaying gluten introduction to 12 months instead of the traditional 6 months of age among babies at higher risk for developing celiac disease.

While it did appear to delay the age at which kids developed celiac disease, ultimately, there was no difference in whether or not they did develop it by age 10 (5).

In addition, the evidence is inconclusive about introducing gluten earlier than four months of age. In general, it’s not recommended to give babies solid foods before they reach four months of age (5).

That said, one study did find that delayed introduction past 12 months increased risk, so while more research is needed, there appears to be no reason to delay gluten introduction and possibly good reason to introduce gluten between 6–12 months (6).

There may also be a “sweet spot” amount of gluten to give to kids that are genetically at higher risk for developing celiac disease. One study showed that higher gluten consumption in the first five years of life was linked to higher risk (7).

Still, more research is needed to determine whether there is an ideal amount of gluten to consume in early years.

Although breastfeeding appears to have a protective benefit against autoimmune disorders like type 1 diabetes, breastfeeding duration or breastfeeding during the introduction of gluten doesn’t appear to affect risk of developing celiac disease (5).

How and when does celiac develop in babies/children?

Celiac disease can develop at any point in a person’s life from the time gluten is introduced into a baby’s diet all the way through later adulthood.

Symptoms are triggered by eating gluten, though for some, it can take years for symptoms to arise.

Celiac disease in breastfed babies

There has been little research done on the gluten content of breastmilk. However, a few small, older studies have shown that gliadin, which is a component of gluten, is present in human breast milk (8, 9).

It’s actually been hypothesized that the presence of gliadin in breast milk could reduce risk of celiac disease, but further studies haven’t shown that to be true (5, 6, 8).

Though studies show very high levels of gliadin being produced in breast milk, the overall amount produced is still less than what the U.S. Food and Drug Administration (FDA) considers as the limit for gluten-free foods (9, 10).

Therefore, it’s not likely that an exclusively breastfed baby who has not started foods with gluten in them yet will develop symptoms of celiac disease.

It’s unclear whether breastfeeding influences the risk of developing celiac disease overall.

Signs and symptoms of celiac disease in babies

If your baby has celiac disease, it’s much more likely to come about after introducing gluten into the diet via solid foods.

Symptoms of celiac disease in babies and young children can include both digestive and non-digestive symptoms (3, 11, 12).

Early signs may include:

• chronic diarrhea
• chronic constipation and gas
• nausea and vomiting
• abdominal distention
• weight loss or slowed growth
• reduced appetite or food intake
• sad mood

If not diagnosed early enough, other symptoms might include:

• failure to thrive (slowed growth that can lead to developmental delays)
• elevated liver enzymes
• anemia
• irritability
• chronic fatigue

Because the signs and symptoms of celiac disease are similar to those of other food intolerances and health conditions, it’s important to work closely with a healthcare professional to determine if your baby should be tested for celiac.

In addition, there are “silent” or asymptomatic cases of celiac disease, which appear most common among people with a risk factor like family history or another autoimmune disease (4).

Because repeated exposure to gluten can lead to long-term complications in those with celiac, if your child has a known risk factor, you may want to discuss testing with a healthcare professional, even if there are no obvious symptoms (4).

Summary

Celiac disease can develop at any point in a baby’s life after introducing gluten-containing foods. Early symptoms are mostly related to digestion, though slowed growth or weight loss can also be early signs.

Diagnosing celiac disease in babies

Whether or not your baby has a higher risk for celiac disease, if they exhibit any signs or symptoms, it’s essential that you contact a healthcare professional.

Your healthcare provider will want to do a full exam of your baby and may want to rule out other health concerns before testing for celiac disease. However, none of these symptoms should go untreated.

If your healthcare provider suspects that your baby has celiac disease, they may recommend a simple blood test to test for antibodies to gluten (12).

Traditionally, a provider would then conduct a biopsy of the small intestine to confirm diagnosis. However, studies have shown that may not be necessary, and that a blood test may be enough, especially in children and teens (12).

If diagnosed with celiac disease, your baby will need to follow a gluten-free diet.

If your baby is still breastfed, work closely with their healthcare provider to determine if the breastfeeding parent needs to eliminate gluten as well.

Summary

Always contact a healthcare professional if your baby shows any signs of celiac disease or other illness. In most cases, celiac disease can be diagnosed through a simple blood test.

What to do if your baby eats something containing gluten

If your baby is diagnosed with celiac disease, following a gluten-free diet is essential. That means avoiding any foods that contain or are made with wheat, barley, and rye or derivatives of those foods.

However, even foods that don’t obviously contain gluten can be cross-contaminated with gluten. This may happen during processing (in packaged foods) or during cooking (in restaurant or prepared foods) (13).

Certified gluten-free products are the safest option, as studies have shown they are far less likely to be contaminated (13).

If your baby is accidentally exposed to gluten, don’t panic. The best thing you can do is to offer your baby comfort, manage their symptoms, and ensure they remain hydrated.

If your baby is vomiting or having diarrhea, you may also need to provide some electrolytes though a drink like Pedialyte (14, 15, 16).

It’s also recommended that you contact a healthcare professional, especially if symptoms are severe.

Summary

If your baby accidentally consumes something with gluten, manage symptoms, keep them hydrated, and call a healthcare provider if symptoms are severe or if you’re unsure how to manage them.

Celiac-friendly meal ideas

Even if your baby can’t eat gluten, there are plenty of nutrient-rich foods that they can enjoy to meet their energy and nutrient needs.

Here are some ideas to get you started.

Breakfast ideas:

• plain yogurt with strawberries
• certified gluten-free oatmeal with nut butter and banana
• scrambled eggs with avocado and raspberries
• egg, banana, and chia seed “pancakes” with melon
• chia pudding with raspberries

Lunch ideas and dinner ideas:

• fish with roasted or steamed broccoli and mashed sweet potato
• quinoa with lentils, butternut squash, and mashed avocado
• certified gluten-free chickpea pasta with pesto and cauliflower
• ground turkey or beef burger with rice and cinnamon-roasted carrots
• millet with cannellini beans, sautéed zucchini, and fresh mozzarella

Snack ideas:

• yogurt with certified gluten-free Cheerios
• almond flour carrot and apple muffins
• unsweetened applesauce
• fresh fruit like raspberries, bananas, or melon
• hummus or mashed avocado
• chia pudding
• certified gluten-free baby food pouches

The bottom line

Celiac disease can develop anytime in life, from infancy to adulthood. In babies, it typically emerges after gluten is introduced through solid foods.

It’s important to know the signs and symptoms of celiac disease, though they are similar to many other health conditions seen in babies. Reach out to a healthcare professional if your baby has any digestive issues or other health concerns.

If celiac is suspected, whether because your baby has symptoms or is at high risk for developing it, your healthcare provider can test for it through a simple blood test. Some may require additional testing.

After diagnosis, it’s important to follow a gluten-free diet. Remember, it is possible to feed your baby all of the nutrients they need on a gluten-free diet.