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Introducing Gluten for Infants at High Risk for Celiac Disease

To introduce gluten at 4-6 months of age or not to introduce gluten till one year, that is the question?!!!!

I recently wrote a blog about my daughter, who has celiac disease (CD), successfully giving birth to a healthy, happy, thriving baby.  Phew!  That alone was reason to celebrate - a beautiful new life.  The next question is, what can she do to try to reduce her baby’s chance of developing celiac disease since her baby is at higher risk, being a first degree relative to her mom.

The literature has been confusing, at best, but is constantly evolving.  We are still in the very early stages of research for understanding how celiac disease gets triggered. The last 5 years has seen many conflicting reports by some of the leading researchers in CD. The good news is our best and brightest minds are on it.

The two most recent studies (see footnotes for links) published in the New England Journal of Medicine in 2014 contradicted earlier recommendations that we could delay the onset of CD or avoid the risk of getting CD if we introduce gluten between 4 and 6 months, in addition to breastfeeding.

The previous research was based on observation alone. The second two studies used randomized control groups offering a more accurate conclusion. Both studies were performed independently, in two different countries (the Netherlands and Italy) and both had similar results.  The findings are still not engraved in stone, but appear to be more reliable because of using the randomized scientific method. The studies also included a combined subject pool of over 1600 babies.

Both of these current studies used babies as subjects that were identified as being at high risk for CD.  They were randomly assigned to different times of introduction to gluten and were studied for 3 years.  The suspected cases were confirmed or denied by using an intestinal biopsy, the gold standard for diagnosing CD.  High risk was defined as having a genetic predisposition (HLA genotype) or having a first-degree relative (parent or sibling) with CD.

It appeared that it made no difference if gluten was introduced at 4 or 6 months of age or after.  It also was irrelevant whether babies were breastfed before, during or at the time of gluten introduction.  Since breastfeeding has many positive effects on the health of babies, it is still encouraged untill the baby is at least 1 year old.  However, it does not seem to prevent the development of CD.  The results only served to dispel the “introducing gluten window of opportunity” theory.

As of today, the recommendation for  introducing gluten to babies is to wait until the child is 12 months old, even if that just serves to delay the development of CD.  Other points to consider:

  • Talk with your doctor to determine when a good time is to check your baby’s genetic predisposition for CD. 
  • After checking your child’s genetic predisposition, introduce gluten only if and when your doctor suggests it.
  • Do not introduce solid foods, including those with gluten, before 4 months old.
  • After a child is a year old, and you begin introducing solid foods, allow 2-3 days before introducing a new food to allow time to spot signs of a possible allergic reaction or sensitivity to that food.

If your baby is not at high risk for developing CD, there is likely no reason for delaying introduction to gluten.

Remember to try to keep your anxiety to a minimum and enjoy these precious months with your baby.  You will never have them again. 

1.  http://www.nejm.org/doi/full/10.1056/NEJMoa1404172

2.  http://www.nejm.org/doi/full/10.1056/NEJMoa1400697