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The current accepted approach is aggressive case finding with vigilance for the many potential manifestations of coeliac disease and a low threshold for serological testing. Perhaps the group of most concern is young children with a first-degree relative with coeliac disease, as the approximate 7% risk of coeliac disease is considerable and delayed diagnosis has the potential to lead to a permanent loss in growth potential. For this reason serological testing may be considered before the onset of symptoms in at-risk children. Well-designed, randomised clinical trials do not suggest that either breastfeeding or timing of gluten introduction into the diet alter the risk of coeliac disease in children with a family history of coeliac disease. [61] Vriezinga SL, Auricchio R, Bravi E, et al. Randomized feeding intervention in infants at high risk for celiac disease. N Engl J Med. 2014 Oct 2;371(14):1304-15. http://www.nejm.org/doi/full/10.1056/NEJMoa1404172 http://www.ncbi.nlm.nih.gov/pubmed/25271603?tool=bestpractice.com [62] Lionetti E, Castellaneta S, Francavilla R, et al. Introduction of gluten, HLA status, and the risk of celiac disease in children. N Engl J Med. 2014 Oct 2;371(14):1295-303. http://www.nejm.org/doi/full/10.1056/NEJMoa1400697 http://www.ncbi.nlm.nih.gov/pubmed/25271602?tool=bestpractice.com [63] Pinto-Sánchez MI, Verdu EF, Liu E, et al. Gluten introduction to infant feeding and risk of celiac disease: systematic review and meta-analysis. J Pediatr. 2016 Jan;168:132-43. http://www.jpeds.com/article/S0022-3476%2815%2901045-8/fulltext http://www.ncbi.nlm.nih.gov/pubmed/26500108?tool=bestpractice.com
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