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The cel-pro subscribers have been discussing the issue of whether an
infant who has a sibling with Celiac Disease should have a gluten free
diet during the first year(s) of life.

In the interest of reducing List traffic, I ask that you think about the
content of all replies to this message.  By this I mean:  Does it
either further the subject under discussion or demonstrate developmental
problems with an undiagnosed child?  If in doubt, send it to my ID, not
the List, and I will summarize appropriate posts in a future message.

As you can see from this discussion, there is no clear cut answer.
Please do not use this issue for medical professional bashing.

The following post by Dr. Ivor Hill is being re-posted with permission:

----
Michael Jones ([log in to unmask]) Orlando, FL USA
One of the Celiac & Cel-Kids Listowners

~~~~~~~~~~~~

I think [name withheld] has raised a very important issue here.  The
question is not whether delaying gluten intake will protect the
individual from later developing celiac disease.  I think we all now
believe that this is not the case and this question would seem to have
been adequately addressed in the study by Luigi Greco et al (J Pediatr
Gastroenterol Nutr 1988;7:395-399).

Rather it is a question of whether early introduction of gluten into the
diet of an individual predisposed to develop celiac disease may be doing
some harm.  There are numerous reports of infants who show regression of
developmental milestones before the diagnosis of celiac disease is
recognized.  We anticipate that after commencing a gluten free diet
these milestones will be regained.  However, a more difficult question
to answer is whether any permanent damage may have occurred which could
result in much more subtle findings such as learning disorders.

More than once a parent of a child with celiac disease has raised this
question when the next child in the family is born.  Their concern is
for the first two years of life when brain growth is most rapid and
nutrient deficiencies are most likely to have an adverse effect.  I do
not have an answer for the father who asked me how I can be sure that
subtle micronutrient malabsorption is not going to occur long before the
clinical signs of celiac disease become manifest, and what the long term
consequences of such malabsorption may be.

Obviously we are not in a position to prevent any such potential
problems in an individual who has no family history of celiac disease.
However, when there is a family history of celiac disease I personally
do not have a problem if the parents want to keep their child on a
gluten free diet for the first two years of life.  I do not subscribe to
the opinion recently expressed that by delaying gluten introduction we
might make it more difficult to diagnose celiac disease later in life
because patients are more likely to present with "atypical" symptoms.
With the knowledge we have today, we should no longer regard the host of
non-gastrointestinal complaints that occur with celiac disease as
"atypical".  More liberal use of serological tests for screening should
be employed particularly if there is a family history of celiac disease.

... I am pleased to find that I am not alone in agonizing over some very
tough questions posed by knowledgeable parents.

Ivor D. Hill, MB, ChB, MD.
Professor of Pediatrics
Chief, Pediatric Gastroenterology & Nutrition
Bowman Gray School of Medicine, Wake Forest University