One of my baby's favorite first foods, alongside steamed broccoli and fruit puree, was bread. The toasted sandwich variety or sourdough ciabatta, she seemed to love it all. Armed by the research findings linking a lower risk for Celiac disease to early introduction to gluten while still breastfeeding, I felt comfortable feeding my baby gluten-containing grains like wheat, rye and barley. But was it a good decision?
Since the prevalence of Celiac disease, an autoimmune disorder affecting about 1 percent of the population, has quadrupled in the last few decades, it is not surprising that parents are looking for ways to reduce their babies's chances of developing it in the future.
Until recently, all we had was data from some observational (not experiment-based) research suggesting that there was a window of opportunity somewhere between four and seven months when babies were more likely to develop tolerance to gluten.
But in October 2014 two respectable journals published intriguing results of two experimental, randomized controlled studies. The studies were performed independently in different parts of the world and reached very similar conclusions.
One of them looked at 700 infants in Italy who were at risk for Celiac disease due to family history. The infants were randomized into two groups, one of which received gluten-containing foods at six months and the other at 12 months. The groups were followed up periodically over a period of 10 years. Children who were introduced to gluten at six months were more likely to have Celiac disease at two years of age but there was no difference between the groups at the five-year check up. At 10 years, those children who had higher genetic risk for Celiac disease were more likely to have it, regardless of when gluten was introduced. Breastfeeding while introducing gluten did not play any role in reducing the risk.
For the other randomized study, Dutch researchers enrolled just under 950 infants at high risk for Celiac disease from seven countries and divided them into two groups. Parents from both groups were instructed to start gradually introducing gluten at six months of age. Infants from one of the groups were also receiving 100mg of gluten every day from four months while the other group was getting placebo. By the three-year follow up, about same number of children from both groups developed Celiac disease and researches found that breast-feeding was not protective.
So it looks like neither introducing gluten between four and six months nor breastfeeding seems to be protective from Celiac disease for babies at high-risk. And while delaying gluten till 12 months does not help to prevent Celiac disease it may delay its onset for a few years.
If you are feeling a little confused, you are not alone. It does not look like we will be getting definitive answers to this question very soon, at least not until more randomized controlled studies are conducted. But the good news is that nutritional research is moving forward and we are now learning more about Celiac disease prevention than ever before.
To summarize, here are some points to consider when deciding when to introduce gluten to your baby's diet:
- There is no conclusive research on the best time to introduce gluten in order to reduce risk for Celiac disease in the future.
- If your baby is at high risk and you can wait until she is 12 months before introducing gluten, you may delay the potential onset of celiac disease. Talk to your doctor to determine your baby's genetic predisposition for this disorder.
- No solids including those containing gluten should be introduced before four months.
- Allow 2-3 days before introducing a new food to allow time to spot signs of a possible allergic reaction.
- In the case of a strong history of Celiac disease in family, consult with your doctor before giving your baby gluten containing foods
- If you are breast-feeding, continue as long as you can, preferably until your baby is at least one year old. Even though breastfeeding does not seem to help reduce risk for Celiac disease, it has many other benefits to mother and baby.
Know though that if your baby isn't at high risk for celiac disease there's no evidence at this point that delaying the introduction of gluten will be beneficial in any way.
To answer my own question whether or not I should have waited to introduce gluten to my baby until she was older, I think I made the decision that worked for me.
Our family has no history of Celiac disease so her risk of developing it was pretty low to begin with. Also, we like the baby to share meals with us and since we are a family of bread lovers, trying to come up with alternatives would have been more work for me. And finally, seeing her happy face gnawing with gusto on a piece of toast first thing in the morning was too precious to miss!
Natalia Stasenko MS, RDN is a registered dietitian and recognized pediatric nutrition expert. A mother of three, she uses evidence-based and always practical strategies to foster parents' confidence and skills in feeding their children right. To read more of Natalia's articles, visit her website, or follow her on Facebook, Twitter or Pinterest.
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Image: Homemade bread via Shutterstock