Midwifery
Council
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Idaho Midwifery Council |
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Copyright 2005-2010 |
Breastfeeding with Celiac Disease
Very committed to breastfeeding, J.B. had breastfed all of her children:
a 15 year old daughter born 1994, a 14 year old son born 1995, a 5 year
old daughter born 2003 and twin boys born 2006. When introducing grains
as infants, all had varying signs of intolerance, namely colic. J.B.
made her own whole wheat bread and provided healthy vegetarian meals to
everyone. Both daughters
were lactose intolerant from infancy, with the youngest daughter
manifesting more serious symptoms of “colic” such as writhing on the
floor in pain. J. B. continued to treat children for “colic” and visited
a dietitian at one time without being referred for allergies. “What
mother would not do everything in her power to help their children?”
Once J.B. was diagnosed, she scheduled all of her children to have a
blood test. They were all positive for celiac. J.B. stated, “I was
furious.” Very upset that there was not very much information available,
she took all children off of gluten. The oldest daughter had struggled
at school with learning problems and had eczema. School work has
improved but the skin lesions have taken longer to heal.
The 2 ½ year old twin boys are just now being weaned from breastfeeding.
J.B. was going to wean the twins at 15 months, then found out they had
celiac, so she decided to not have another diet change at that time.
Also, one twin had to have hydrocele surgery, so she decided to continue
to provide the added comfort.
J.B. provided words of wisdom for those reading this article: “If you
suspect your children have a problem, get them tested…I can’t tell you
how glad I am that they were tested young. It has been life changing for
us.”
Celiac Disease (CD)
is a lifelong, digestive disorder affecting children and adults. The
disease is thought to be a genetic disorder causing either an inborn
error of metabolism or an immune system disorder.¹ When people with CD
eat foods that contain
gluten,
it creates an immune-mediated toxic reaction that causes damage to the
small intestine and does not allow food to be properly absorbed. Even
small amounts of
gluten in foods can affect those with CD and cause
health problems. Damage can occur to the small bowel even when there are
no symptoms present.
Duration of Breast Feeding From the ADA
evidence library, we read about two studies (one cohort and one
case-control) that showed patients with untreated or undiagnosed celiac
disease may have a shorter duration of breast-feeding. In the
aforementioned neutral-quality cohort study by
Ciacci et al (2005),
number of months of breast-feeding was significantly lower among the
newly diagnosed women (4.50 +/- 2.1 months for gluten-free diet
adherers, 2.56 +/- 1.3 months for the transient diet adherers, and 1.77
+/- 0.5 months for newly diagnosed, P < 0.001). In the aforementioned
neutral-quality case-control study in Italy by
Ciacci et al (1996),
the duration of breast-feeding was 2.54 times shorter (p < 0.001) in
untreated mothers (2.77 +/- 0.52 months vs. 7.03 +/- 1.17 months, p <
0.0003).³ Certainly the common symptoms associated with celiac disease
would be suspected of influencing duration of breast-feeding.
Protective nature of breast
feeding Sweden had a dramatic
increase in celiac cases in children under the age of two due to a
change in infant feeding practices, “...namely: the amount of gluten
given; the age at introduction of gluten; and whether breast-feeding was
ongoing or not when gluten was
introduced.” The
data, throughout an 18 year period, provided the following evidence when a
mother regularly breast-fed while introducing gluten-containing foods:
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Reduction by 40% that a child would develop celiac when compared to a weaned
child.
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Risk of developing celiac fell 65% when mothers breast-fed greater than one
month beyond the infant’s introduction of gluten-containing food. The mechanism and duration of
protection is unknown and needs further study. 4 It should be emphasized
that the total number of cases of diagnosed celiac did not decrease, but the
age of presentation did when infant feeding practices were changed as
indicated above. In Jan Riordan’s text,
Breastfeeding and Human Lactation,
many studies are sited that support the evidence that formula-feeding
and the early introduction of solids accelerate the appearance of symptoms
of celiac disease. Infants with the disorder are asymptomatic until gluten
containing foods are introduced. Symptoms indicate poor absorption of fat
manifested by stools that are frothy appearing, foul smelling and excessive.
The “PDR” of Breastfeeding a child
with Celiac disease 1.
Prevention: teach the families
with a history of celiac disease
that childbearing age women should breastfeed for a longer period of time
and delay the introduction of solid foods (about 5-6 months of age).
Remember, asymptomatic lactating women may be a carrier of the disease.
2. Duration:
If you choose to
breastfeed a baby or toddler with a
diagnosis of celiac disease, you will need to follow a gluten-free diet.
Continue breastfeeding at least one month past introduction of solid foods. 3.
Response:
There is a chance that exposure to gluten in breast milk from a
mother without a confirmed case of celiac disease to her celiac-free baby
may help the baby develop a normal immune response to gluten. 5
1. Riordan J.
Breastfeeding and Human Lactation.
Jones and Bartlett Publishers, 2005. 2.
www.celiac.org State sites listed for
local group support 3. American Dietetic
Association Evidence Library.
www.eatright.org 4. Canadian Celiac
Association. “Celiac News. March 2004.
Does Breast feeding protect against
celiac disease?” Butzner, Sarkadas.
www.celiac.ca/Articles/PAB%20breast%20feeding.html 5.
“Gluten free baby “
http://celiacdisease.about.com/od/raisingaglutenfreechild/a/Breastfeeding_2.htm
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