Newborn Formula - infant celiac risk

[Dencar]

Hi,

I have no personal experience of Celiacs, and about to work with a new family
and their NB who will arrive by CSect this week.

There is a family history of Celiacs. I have done some online research regarding formula hoping to find some insight into what may be a suitable
formula to suggest/use.

From what I can find, with the exception of "hungier" formulas, NB formulas
are gluten free.

Does anyone have any experience or thoughts as to which formula/s
may be "more" suited to a newborn who may have a risk of Celiacs?

Thank you for any thoughts and ideas

PS-The decision has already been made by the parents this baby(#2) WILL be formula fed. Baby number one was EBF and unfortunately suffers excemia, severe asthma, celiacs and numerous other allergies.

best bet speak to a gp or support group

Unfortunately they have been passing the buck....

speak to GP...> speak to health visitor...> speak to MW/doctor......etc
just goes round in circles

BF only reduces the chances of a child suffering any on these things it's no magic cure. However a baby who's family have such a heavy history of allergies, would be best to BF there could be a risk of cows milk protien intolerances then baby would need prescition formula.

Maybe better informing the family about the risk's would be a good idea.

Babies that are breastfeeding are less likely to suffer from atopic illness (allergies) however, this does not mean that they definitely won't

Babies and children with coeliac disease who are bf tend to have milder symptoms while still receiving breast milk. the symptoms of coeliac disease will not present until exposed to gluten. If their first child has coeliac disease, they should be seeing a paediatrician (if not a paediatric gastroenterologist) and have had input from the dietician. They would be the best people to ask (particularly the dietician)

Good luck

Exclusive bf is a protection against the development of coeliac disease. I agree - the decision not to breastfeed and to choose a formula is something the parents should discuss with someone qualified in specialist paediatric nutrition - prob a dietitian with further training.

Coeliac disease is an autoimmune disorder, it's not an allergy to gluten. In fact, it's a byproduct of a healthy immune system in that it is the body basically overreacting to a non-toxic substance (gluten) by treating it as a pathogen and attacking it. In that context, I really don't see why bf / ff would make a difference. Bf is supposed to support the newborn immune system better but coeliac disease is not caused by weak immunity so there's no reason to assume bf is best in this case as some posters have suggested. If the family have chosen ff then that's their choice.

One thing to be aware of is that coeliac children are often lactose intolerant as well as coeliac but this should only manifest after weaning because the lactose intolerance is caused by the damaged villi in the gut which is caused by ingestion of gluten. It could be worth checking the baby for lactose intolerance and using a lactose-free formula if that is the case (depending on medical advice).

I am coeliac by the way so am basing my opinion on my knowledge of the disease and advice given to me regarding nutrition of my own son.

www.annualreviews.org/doi/abs/10.1146/annurev.med.57.051804.122404?journalCode=med

www.pediatric.theclinics.com/article/S0031-3955%2805%2970289-3/abstract

www.nursingcenter.com/prodev/ce_article.asp?tid=699660

That exclusive breastfeeding, and especially breastfeeding at the time gluten is introduced, is important in reducing the incidence of coeliac disease, is not really controversial - surprised you have been advised differently, NapaCab. Formula feeding is not about making the immune system 'weaker' but different ....I don't have the knowledge to explain why in detail but the issue of coeliac risk and infant feeding has been well-researched, I would say - see my links above.

Of the studies you link to, tiktok, only the last one is available without subscription. I was only able to read the abstracts of the other two so can't evaluate these, I'm afraid. Do you have a subscription to those publications to put up some extracts from them?

The third article mentions three papers from the early 2000s that demonstrated delayed onset of symptomatic coeliac disease in children that were EBF and then further evidence from Sweden that children that were EBF and had gluten introduced later than 4 months had reduced risk of coeliac disease. It also mentions a small study in Malta that showed that incidence of coeliac disease reduced when WHO guidelines on infant weaning and bf were introduced. This to me is all about when gluten is introduced to infants rather than bf itself and I agree that weaning is important for risk of developing coeliac disease so no argument there. The study does then try to link bf and its benefits to these reduced risks or delayed onset of coeliac disease but also admits that there is no biological reason why bf would protect against coeliac disease and that the mechanisms are poorly understood - yes bf does help develop the epithelium and protect against microbes but that shouldn't make a difference to the development of coeliac diseases as it is an autoimmune disease, as I say in my comment above, not an allergy. In general obviously 'bf is best' so it's no harm to recommend it but there's no specific reason why it should reduce risk of coeliac disease.

Coeliac disease is pretty poorly understood still and while infant weaning and risk of coeliac disease has been well-researched, I wouldn't say that the pre-weaning period and links to coeliac disease has been well-researched at all actually. Most of the advice I've been given has focused on that issue of weaning and coeliac disease. No information I could find mentioned anything about ff/bf and risks of coeliac disease apart from just now and that one article you've provided

Actually my son's seeing his pediatrician on Friday so I'll ask her then if there's any medical advice on this as obviously it's a big concern for me. He's 4 months so I was going to ask her about weaning and gluten anyway.

The biggest growth in coeliac disease in recent years as been in adult onset and adult diagnosis of coeliac disease so maybe that's why there is not much focus on pre-weaning feeding and the disease. I was diagnosed at 19 myself although had it for most of my childhood undiagnosed. I was bf for six weeks by the way.

My older brother and sister were not bf but were fed cows milk fortified with iron (apparently that was OK in the 1960s?!?)but they're not coeliac. The plural of anecdote is not data though of course...

Sorry, NapaCab, not really intending to argue the toss here. If you want to read the whole articles and not just the abstract you'll need to seek 'em out. No use putting extracts up - you still would not be able to fully evaluate and there would be a risk of copyright breaching, too.

It was just to show that the idea formula feeding increases the risk of developing celiac is not a way out or extreme one, and that it has been researched.

Clearly, if continuing to bf when gluten is introduced appears to be a factor in reducing the risk (the Swedish study), the baby has to be breastfed from the start.

Does anyone know if partial breastfeeding confers any protection?

For various reasons my Dts were mixed fed since birth, first with EBM and now bf, plus prem formula/comfort milk as they were 10 weeks prem.

The guidelines for weaning premmies seem to be wean at 6 months actual, not corrected, and Bliss advise continuing to bf whilst introducing gluten, but exclusive bf has never really been an option.

My initial plan was to drop the Bfs as I start weaning at 6 months, and to introduce gluten closer to 8 as my dm is cealiac. Maybe I should be looking to bf a few weeks longer (if we can, my supply is pretty feeble and dtd is on a semi-permanent boob strike!) and introduce gluten sooner? Anyone have any knowledge that's relevant?

Bumpier bump

One more shout out for the experts...?

Peeling, I don't think anyone can give you a definite answer on this. I looked into it a bit before because it runs in my family. Because celiac disease itself is not that well understood, its relationship to bfing isn't well understood either, let alone its relationship to partial bfing. Then you have the added complication of yours being prem. There is an argument that the reason why bfing was protective of celiac disease in Sweden is that babies who were not bfed while being weaned were often being fed a gluten-containing infant formula instead, which upped their intake of gluten massively. The bfed babies were getting much smaller amounts of gluten because they weren't getting it in the formula on top of weaning foods. So there seems to be some evidence that it's not just the age at which gluten is introduced that matters, it's also the amounts that are given daily and the regularity of it. Small amounts given regularly seems to be the better option. In the absence of definitive evidence, I'd expect most experts to say that continuing bfing, partial or otherwise, while introducing gluten can't do any harm, and it might help.

In terms of when to introduce gluten, there's some suggestion out there that there's a 'window' in which to do so. Earlier than 4 months certainly seems to be a risk. However, 6 months or later may also be a risk. The Swedes (where celiac is a major problem and therefore there's quite a few studies from there) have changed their recommendation on when to introduce gluten from 6 months to 4 based on that school of thought.

If I were you, I'd try to find both a paediatrician and a gastroenterologist (maybe your dm's?) who are familiar with the research on early infant feeding and go with their advice. Those are the kind of experts you need, that and maybe a really expert dietician.

Thanks sioda, I will go back to the paediatrician but just wondered if anyone with particular awareness of latest bf guidelines knew any more.