Should Babies at Risk for Celiac Disease Have Gluten?
As more data on when to introduce highly allergenic foods has become available, the question around when and how to introduce gluten frequently comes up.
Gluten is found in grains containing wheat, rye, and barley.
Over the past few decades, there has been an increased interest in celiac disease, wheat allergy, and gluten sensitivity, the different types of conditions associated with gluten intolerance. Here are answers to six commonly asked questions related to introducing gluten to your baby!
When can I begin to introduce solids into my child’s diet?
In general, children are developmentally ready to begin solid foods between 4-6 months old. For most babies, it does not matter what the first solid foods are. Single-grain iron-fortified infant cereals (e.g., oats), fruits, vegetables, and meats are traditionally introduced first.
Once your baby learns to eat a few first foods, you can gradually give him or her other foods—including high-allergy foods like wheat and barley-containing products.
When to introduce wheat for babies at risk for celiac disease?
There is no consistent evidence that waiting to introduce and/or limiting allergy-causing foods such as wheat or other gluten-containing grains (e.g., rye or barley) beyond 4 to 6 months of age prevents food allergy or the onset of celiac disease. Wheat can be introduced most commonly in the form of infant cereal, for example as wheat or multigrain cereal.
How much gluten for babies at risk for celiac disease?
The data is not conclusive. One study in 2019, reported that there was an association in at-risk children being diagnosed with celiac the more gluten they ate before age of 5. A more recent study looked at the amount of gluten given to exclusively breastfed infants. The results showed that those given on average 2.88 g of gluten or the equivalent of 1-2 slices of bread per week of gluten beginning at 4-6 months had a lower prevalence of celiac disease as compared to those given less gluten beginning at 6 months of life. These results need to be further studied to see if early high-dose consumption of gluten may be helpful, at least in exclusively breastfed infants, in the prevention of celiac disease.
Based on this data, the current recommendation for at-risk infants is to consume less than 5 grams of gluten-containing food on average per day beginning at approximately 4-to-6 months and continuing until 2 years of life.
Is early introduction of other high-allergy foods helpful?
An important study in 2015 showed that early introduction (between 4 and 12 months) and regular feedings of foods commonly associated with allergies—particularly with peanuts—may be helpful to prevent an allergy.
It is important to discuss the timing of introduction with your child’s pediatrician as some infants may need to see a pediatric allergist prior to introducing peanuts.
Signs of celiac to look for when introducing gluten to babies
Typical symptoms of celiac disease in infants include abdominal pain, diarrhea, irritability, poor weight gain, and slow growth.
In general, it is common for you to notice a change in bowel movements or increased gas with the introduction of new foods so continue to monitor symptoms.
When should a child be tested for celiac disease?
Celiac disease may reveal itself shortly after a baby has his or her first bowl of wheat-containing infant cereal, but in some cases, symptoms are so minor that the condition can be overlooked for years and a diagnosis may not be made until adolescence or even adulthood. In children with normal risk of developing celiac disease (approximately 1%), screening should only occur if a child develops symptoms. For those at high risk, including those with a family history of celiac disease, children with Down, Turner and Williams syndrome or children with type I diabetes, should be regularly screened beginning at 2-3 years of life or earlier if symptoms develop.
Deepest thanks to Dr. Anthony Porto, MD for sharing his expertise on this topic. Anthony is an Associate Professor of Pediatrics and Associate Chief of Pediatric Gastroenterology at Yale University. He is the medical director of the Yale Pediatric Celiac Program. He sees patients in Greenwich, Norwalk, and New Haven, CT. He has won numerous awards including the Norman J. Siegel Award at Yale University in 2015 for leadership and providing outstanding clinical care as well as Physician of the Year during his time at Morgan Stanley Children’s Hospital. He has been named Castle Connolly Top Doctors since 2012.
Anthony is interested in nutrition, especially in the care of children with difficulty gaining weight, feeding issues, and celiac disease. He is the co-author of the Pediatrician's Guide to Feeding Babies and Toddlers (affiliate link) and contributes articles to numerous national medical societies, on-line health blogs and news outlets.
(He graduated from Columbia University with a Bachelor of Arts in Neuroscience and Behavior and attended medical school at Tufts University School of Medicine where he also received his master of public health. He completed his pediatric residency at the Children’s Hospital at Montefiore Medical Center and his pediatric gastroenterology fellowship at the Morgan Stanley Children’s Hospital of New York at Columbia University. For more guidance on infant and child health, follow Dr. Porto on Instagram.
