The current accepted approach is aggressive case finding with vigilance for the many potential manifestations of celiac disease and a low threshold for serologic testing. Perhaps the group of most concern is young children with a first-degree relative with celiac disease, as the approximate 7% risk of celiac disease is considerable and delayed diagnosis has the potential to lead to a permanent loss in growth potential. For this reason serologic testing may be considered before the onset of symptoms in at-risk children. Well-designed, randomized clinical trials do not suggest that either breastfeeding or timing of gluten introduction into the diet alter the risk of celiac disease in children with a family history of celiac disease.
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