As a dietitian and the parent of two children with celiac disease, I am often asked questions by moms of newborns about when they should introduce gluten into their infant’s diet. The truth is that I really don’t know the answer. There has been very little conclusive research in this area. And unscientific opinions abound. As if parents of infants don’t have enough to be confused about!
So the basic question is – when should we feed gluten to infants in order to minimize the risk of them developing celiac disease?
Epidemiological studies do support the idea that exposing infants to gluten (e.g. wheat, barley, rye cereals) before 4 months of age does increase the risk of developing celiac disease if the child has genetic susceptibility to celiac disease. There was a prospective, observational study in Denver, Colorado on 1560 genetically susceptible children.
- This study showed that infants who ate gluten containing cereals in the first 3 months of life had a 5 fold increased risk of developing celiac disease compared to infants who ate gluten-containing foods at 4-6 months.
Interestingly, this study also showed a slight increase in celiac disease risk if parents waited until 7 months to feed their children gluten. However, that finding was not duplicated in a similar study on 1511 German babies.
So there is, at this point in time, no conclusive research to determine if gluten should be introduced at 5 months or 12 months or 5 years of age for that matter. The two main schools of thought argue about whether delaying gluten introduction can prevent the onset of celiac disease or merely delay the onset of celiac disease.
The good news is that there are currently at least two large prospective nutrition intervention studies that are underway.
One of these studies is Italian and has been going on since 2004. Genetically susceptible infants have been blindly assigned to one of two groups: gluten at 4-6 months or gluten at 12 months. These babies are then followed for 5 years. The results from the 3 year follow up have been published and are interesting.
- They show that the percentage of infants developing celiac disease is four times higher in the 6 month gluten introduction group than in the 12 month gluten introduction group.
However, follow up is ongoing to see if the delayed gluten exposure prevents celiac disease or merely delays its onset.
So in the next few years, we will hopefully have clearer guidelines for parents. In the meantime, if your infant is genetically susceptible to celiac disease (e.g. has a first degree relative with celiac disease), then it may be prudent to wait until 12 months of age to introduce gluten-containing foods – with doctor supervision. For other infants, gluten introduction at 6 months may be acceptable. Regardless, make sure that you are getting the support of your pediatrician, dietitian or naturopathic physician to make sure that your baby is getting his or her nutrient needs met.
Fasano A. Catassi C. Early feeding practices and their impact on development of celiac disease. Nestle Nutr Workshop Ser Pediatr Program. 2011;68-201-9; Discussion 210-3. Epub 2011 Oct 3.