Introducing Gluten to Infants: Current Guidelines
We recommend breastfeeding be encouraged and gluten be introduced into the diet in small amounts when solids are being introduced.
Updated: November 7, 2020. Copyright CCA Professional Advisory Council, its authors and the CCA. No reprints without the written permission of the CCA. Email: firstname.lastname@example.org for more info.
A recent research article published in JAMA Pediatrics1 provides more information about the timing of introduction to gluten in babies first foods and the risk of developing celiac disease.
This study wanted to know if the risk of allergy to six common food allergens (peanut, sesame, egg, cow’s milk, fish and wheat) could be reduced for babies by earlier introduction than the standard timing of six months of age. The study was also able to look at the number of children who developed celiac disease, depending on whether they were in the early introduction or standard introduction groups. Over 1000 babies were included and assigned by chance to the early introduction group at 4 months or to the standard group at 6 months. All the babies were breast fed for the first six months. After the study finished, it was determined that the early introduction group actually ate more gluten per week than the standard group up until 9 months of age. At 3 years of age there were no children diagnosed with celiac disease in early introduction group, while there were 7 in the standard group.
This very interesting study suggests that early introduction of gluten at 4 months of age may result in a decreased risk of developing celiac disease. However, this study was not perfectly designed to answer the question about risk of celiac disease because it was more interested in all six foods and allergy. It is not known if the introduction of all these foods early together influenced the findings in unexpected ways. Also, as we will discuss, there are better designed studies to address this issue for babies at a high genetic risk of celiac disease. Altogether, the number of celiac disease cases diagnosed was very low (only 7) and the follow up time was quite short, so we don’t know if we followed the children for longer, whether similar numbers of celiac disease cases would be diagnosed in both groups. Also, the study does not tell us the amount of gluten babies need to be introduced to with their first foods in order to prevent an increased risk of celiac disease. This is simply not known even from other studies.
A number of other studies have attempted to address the issue of timing of introduction of first foods and risk for celiac disease. These studies all differ according to the age at which gluten was introduced, the amount of gluten given and the length of follow-up2• Some of the most compelling studies only included babies at genetic risk or with a family history of celiac disease3-5 and, like the study we discussed above1, used a group randomization approach3’4. Altogether, the results of these studies demonstrate that early introduction of gluten at 4-6 months does not increase the risk of celiac disease later in life, appears to be safe and may well actually decrease the risk of developing celiac disease.
It is encouraging to see another prospective study on the effect of introduction on the development of celiac disease. Further studies are still needed to determine the optimal time to introduce gluten as well as the optimal amount of gluten to introduce to minimize the risk of developing celiac disease. For now, we continue to recommend that breastfeeding be encouraged and gluten be introduced into the diet in small amounts when solids are being introduced.