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Clinical Pediatrics, Vol. 44, No. 3, 249-258 (2005)
DOI: 10.1177/000992280504400309
© 2005 SAGE Publications

Presentation of Pediatric Celiac Disease in the United States: Prominent Effect of Breastfeeding

Michael A. D’Amico, MD

Departments of Medicine and Pediatrics, and the Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY

Jessica Holmes, PhD

Department of Economics, Middlebury College, Middlebury, VT

Stavros N. Stavropoulos, MD

Departments of Medicine and Pediatrics, and the Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY

Marisa Frederick

Departments of Medicine and Pediatrics, and the Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY

Joseph Levy, MD

Departments of Medicine and Pediatrics, and the Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY

Amy R. DeFelice, MD

Departments of Medicine and Pediatrics, and the Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY

Philip G. Kazlow, MD

Departments of Medicine and Pediatrics, and the Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY

Peter H. R. Green, MD

Departments of Medicine and Pediatrics, and the Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY

Childhood celiac disease (CD) is considered rare in the United States. Consequently there are few data concerning its clinical presentation. A validated questionnaire was distributed to families of children with CD. One hundred forty-one children with biopsy-proven CD were included in the study. We found significant differences in the clinical spectrum of children based on their infant feeding history. Exclusively breastfed children were significantly less likely to report failure to thrive (69% vs 88%, p<0.05) and short stature (37% vs 62%, p<0.05), and had a higher rate of "atypical" symptoms (p<0.01). Breastfeeding alters the presentation and contributes to atypical presentations of CD and diagnostic delay. Pediatricians need to be aware of the diverse manifestations of celiac disease to reduce diagnostic delay.


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P. H.R. Green and C. Cellier
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N. Engl. J. Med., October 25, 2007; 357(17): 1731 - 1743.
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