Introducing gluten in baby’s diet

Mariah Kay Jackson
I have celiac disease and I am pregnant. When is the best time to expose my baby to gluten? How much gluten should they eat?

Answer


First-degree relatives (parents, children, siblings) of those with celiac disease (CeD) do have an increased likelihood of also having CeD (1,2). Therefore, it is recommended your baby be tested for CeD by age 3, regardless of the presence of symptoms, as there is a strong hereditary link (3). Children and other high-risk individuals should be tested at regular intervals (every 3-5 years) as CeD can develop at any stage in life. Awareness of signs/symptoms of CeD in young children is important, such as following growth, gastrointestinal symptom changes, timing of puberty, and behavioral changes. Talk with your pediatrician about testing sooner than age 3 if you notice any symptoms or delayed growth. See the Raising Our Celiac Kids (ROCK) website for more information on caring for children with CeD.

There is limited research on the timing and amount of gluten exposure in children at risk of developing CeD. While recent observational research may trend toward suggesting a reduction of gluten-containing foods in early life for at-risk populations, no definitive conclusion can be made on the risks or benefits of gluten introduction The Massachusetts General Hospital Center for Celiac Research and Treatment states gluten can be introduced when your baby starts solid foods (3), however no guidelines on optimal amounts of gluten to be introduced at weaning have been established (9). Current ongoing research studies are examining the many factors at play, in addition to gluten, that may contribute to the development of CeD, including the role of the gut microbiome and total diet quality- so stay tuned! However, there is abundant evidence on the importance for all children to eat a diet rich in whole grains, fruits, vegetables, and legumes, regardless of the risk of developing CeD.

The bottom line: Talk with your pediatrician about routine testing for celiac disease and introduction of gluten. If children follow a gluten-free diet, take care to provide a diet rich in whole grains, fiber, fruits, and vegetables (5).

Resources

ROCK Website (raisingourceliackids.org)

What is the best way to ensure that my child is getting all the nutrients they need?

References

  1. Singh P, Arora S, Lal S, Strand TA, Makharia GK. Risk of Celiac Disease in the First- and Second-Degree Relatives of Patients With Celiac Disease: A Systematic Review and Meta-Analysis. Am J Gastroenterol. 2015;110(11):1539-1548. doi:10.1038/ajg.2015.296
  2. Meijer CR, Auricchio R, Putter H, Castillejo G, Crespo P, Gyimesi J, Hartman C, Kolacek S, Koletzko S, Korponay-Szabo I, Ojinaga EM. Prediction models for celiac disease development in children from high-risk families: data from the Preventcd cohort. Gastroenterology. 2022 Aug 1;163(2):426-36.
  3. Mass General for Children: Center for Celiac Research and Treatment. Tips to Introduce Gluten to your Baby. Published 2021. https://www.massgeneral.org/children/celiac-disease/tips-to-introduce-gluten-to-your-baby
  4. Olshan KL, Leonard MM. Nutrition and risk of celiac disease - you are what you (wh)eat. Am J Clin Nutr. 2023;118(6):1071-1072. doi:10.1016/j.ajcnut.2023.09.011
  5. Leonard MM, Fasano A. Gluten and Celiac Disease Risk: Is It Just a Matter of Quantity?. JAMA. 2019;322(6):510-511. doi:10.1001/jama.2019.9678
  6. Hård Af Segerstad EM, Mramba LK, Liu X, et al. Associations of dietary patterns between age 9 and 24 months with risk of celiac disease autoimmunity and celiac disease among children at increased risk. Am J Clin Nutr. 2023;118(6):1099-1105. doi:10.1016/j.ajcnut.2023.08.009
  7. Auricchio R., Calabrese I., Galatola M., Cielo D., Carbone F., Mancuso M., et al. Gluten consumption and inflammation affect the development of celiac disease in at-risk children. Rep. 2022;12(1):5396. doi: 10.1038/s41598-022-09232-
  8. Crespo-Escobar P, Mearin ML, Hervás D, et al. The role of gluten consumption at an early age in celiac disease development: a further analysis of the prospective PreventCD cohort study. Am J Clin Nutr. 2017;105(4):890-896. doi:10.3945/ajcn.116.144352
  9. Szajewska H, Shamir R, Mearin L, et al. Gluten Introduction and the Risk of Coeliac Disease: A Position Paper by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2016;62(3):507-513. doi:10.1097/MPG.0000000000001105

Published June 7, 2024

Note: This information is provided by NCA and Mariah Jackson, PhD, RDN, LMNT. This information is meant for educational purposes only and is not intended to substitute for personalized medical advice or replace any medical advice provided directly to you by your health care provider. No liability is assumed by the NCA or Mariah Jackson, PhD, RDN, LMNT by providing this information.

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