Introducing Gluten to the Baby At-Risk for Celiac Disease

IMG_3038 copy

This is Claire. She is my fourth baby, my “last” baby, and one of the greatest gifts of my life. She is the first baby I’ve had since being diagnosed with Celiac Disease and going gluten free. Because of this, I spent a lot of time during the postpartum period obsessing/fretting/freaking out about if/when I should expose my dear baby to gluten. I felt that I needed to do everything that I could to protect her from developing celiac disease. As usual, my husband was much more laid back and calm about the whole situation!

I researched my question and discovered the following:

1. Based on the best available information, gluten should be introduced to the “at risk” baby between 4 and 6 months of age. This runs counter to the current notion that infants should be exclusively breastfed for 6+ months and not have solids introduced until after 6 months.

2. Babies should be breastfed when gluten is first introduced and should continue to receive breast milk for at least 2-3 months after the first introduction to gluten.

Here is some of the science behind what I discovered:

-Anti-gliadin antibodies (antibodies against the major gluten protein) are present in breast milk of all women. The highest antibody titers are in colostrum, or early breastmilk, and levels decrease with time. It is hypothesized that these antibodies, which are passed from mother to baby, provide immunity to babies when gluten is introduced. Please refer to my post from November 2012 for additional information.

-Norris, et al. followed a large cohort of infants (>1500) in the U.S. who were at risk of developing celiac disease between the years 1994 and 2004. Feeding practices were analyzed and their research showed a much higher risk of celiac disease if gluten was introduced between 1 and 3 months of age or after 6 months of age.

- The rates of celiac disease skyrocketed in Sweden between 1984 and 1996; 3% of children born during this time developed celiac disease. This epidemic coincided with a nationwide change in feeding practice recommendations from starting solids between 4-6 months until after 6 months of age. This led to many infants having gluten introduced after being weaned from breastfeeding. See link for more information.

- The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) recommends avoiding both early (<4 months) and late (>7 months) introduction of gluten and to introduce gluten while the infant is still being breastfed. This mirrors the advice given by the University of Chicago Celiac Center (see website). The American Academy of Pediatrics emphasizes the importance of introducing gluten while breastfeeding in their 2012 “Breastfeeding and the Use of Human Milk” policy statement.

Overall, there seems to be a current consensus for an optimal “window” for introducing gluten to the “at-risk” baby between 4 and 7 months.

Back to sweet, little Claire. We started her on wheat-contaminated baby oatmeal at 4.5 months one time/day for about 4 weeks. She received exclusive breast milk for the next 2.5 months and is now a gluten-free baby. We’ll see what develops with time, but at if she develops Celiac Disease, at least I will know that I tried my best to prevent it!

Happy New Year and thank you for reading!

PLEASE NOTE THAT THERE HAS BEEN ADDITIONAL RESEARCH INTO THIS TOPIC SINCE I WROTE THIS POST IN DECEMBER 2012. PLEASE SEE MY OCTOBER 2014 POST FOR DETAILS. THANK YOU!

*Also, a quick reminder that this is a blog. I am summarizing medical literature, but also adding in my own thoughts and opinions on what I have read. I am not trying to tell anyone what they should do for their own health, nor am I giving medical advice through this page. Thank you!

6 thoughts on “Introducing Gluten to the Baby At-Risk for Celiac Disease

  1. Dana

    Oh, I can totally relate to this post. Great info, by the way. We took my son to our daughter’s celiac doctor close to 6 months (exclusively breastfed at that point) and he rec’d introducing gluten while continuing to breastfeed. I love how you wrote, “wheat contaminated” cereal – because it really does feel strange (to me, anyhow) to handle gluten in my home and feed it to my child. It was actually hard for me to follow through because I was concerned about cross contamination in my home. A few months in I stopped and he is gluten free. I wonder what the future will be for him and hope he doesn’t have celiac. One child is enough for me. When I was pregnant, I used to think I’d rather both had the same disease, maybe for company/solidarity, but not anymore.

    1. Jess Post author

      Hi Dana,
      It is often so difficult to know the right thing to do for our kids. I really hope that the breast milk during gluten exposure helps both of our babies. I wish that there was a good way to prevent all of our children (and everyone else’s) from developing this disease! Perhaps in the future everyone will be gluten free and it will be a non-issue….
      Jess

  2. Pingback: The Prevent CD Study | The Patient Celiac

  3. Sally

    Hi Jess, I just happened upon your blog in my search of when,what and how to introduce GF solids to my 6 month old. She’s my 5th baby, and I’ve chosen the gluten free diet only since being pregnant with her. I was able to eat more nutritious grains like teff,quinoa etc and not pick up a ton of weight like I did in my 4 previous pregnancies. I haven’t gotten tested nor had any of my kids tested, but we all enjoy the gluten free foods I cook up. We do eat wheat(organic) but very seldom. I want to keep my baby GF, so I’ve decided not to feed her regular grain. I haven’t introduced any foods yet, she is exclusively nursed. I did not understand what you wrote about feeding your baby. So you introduced baby oatmeal cereal at 4.5 months while also nursing her, and fed her this way for the next 4 weeks? Then you stopped and nursed her exclusively for the next 2.5 months? During this 2.5 months you fed her nothing else? What GF foods did you feed her after that 2.5 months?
    I nursed all my kids for 2 years, so am intending the same with my baby. I just want to feed her healthier and GF.
    I’d appreciate any advice on this.
    Thanks

    1. Jess Post author

      Hi Sally,
      Thank you so much for stopping by. I feel like I wrote this post ages ago, because Claire, by baby, is now almost 19 months old! It sounds like you also have a big family. Your question is very timely because I just returned from the International Celiac Disease Symposium in Chicago, where infant feeding practices were discussed. The general consensus, based on actual research studies, is that gluten should be introduced to an infant in small amounts between the ages of 4 to 6 months while breastfeeding is still occurring. This pretty much mirrors what I did with Claire. I started her on baby oatmeal when she was about 4 1/2 months old (not GF, standard Gerber which is cross contaminated with wheat) and stage 1 fruits and veggies. I gave her the oats once a day for about a month. Then I transitioned her to rice cereal as her only grain after this 4 week period of oats, along with other baby foods liked pureed fruits and veggies. Her only milk source until she was about 8 months old was breast milk. I hope this makes sense. I realize now that when I said exclusive breastfeeding, that I really meant she received no formula, so I am sorry about the confusion.
      Jess

  4. Pingback: Introducing Gluten to the Baby At-Risk for Celiac Disease (2014 update) | The Patient Celiac

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>