Want to avoid celiac? Don’t delay wheat past six months

The Pediatric Insider

© 2013 Roy Benaroch, MD

Current recommendations suggest the introduction of complementary, solid foods between 4-6 months of life. Starting foods like grains, legumes, and probably eggs and cow’s milk later than six months seems to lead to an increased risk of food allergy.

And maybe other adverse reactions, too. Celiac disease isn’t an allergy—it’s an autoimmune disorder triggered in susceptible people by exposure to gluten, a protein found naturally in wheat, barley, and rye. It affects probably 1 in 100 people, and those people should not ever eat foods containing gluten. Norwegian researchers just published a study looking at when babies started eating wheat—and found that introduction earlier than 4 months, or later than  6 months, led to the highest later rates of celiac disease.

It’s a pretty nifty study, too. They followed a cohort of 107,000 babies, tracking their feeding habits and later diagnoses of celiac disease. The effect size wasn’t huge, but after controlling for other factors like mom’s celiac status, the risk of celiac for babies who first ate wheat after six months was increased by about 25%.

A surprising, second finding: babies nursed for longer than 12 months also seemed to have a modestly increased risk of celiac disease.

So: again, forget about all of that delayed solids business, once thought to help prevent allergy. Between 4-6 months of life, start adding solids to Junior’s diet—and it doesn’t just have to be traditional “baby food.” Anything puree-able is good. Little jars are fine for convenience, but the best way to get a good mix of food is to mash up whatever you’re eating.

Yum!

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6 Comments on “Want to avoid celiac? Don’t delay wheat past six months”

  1. Ceridwen Says:

    What do you think about the AAP advice that exclusive breastfeeding should continue until 6 months then? And about the “food before 1 is just for fun” thing I see repeated all over the internet.

    I would also be curious to know your take on the whole “introduce one food at a time with several days between new foods” business. We completely threw that piece of advice out the window from day 1, introducing our daughter to both oatmeal and bananas on the same day at 4 1/2 months. My logic was that 1) we would spend years introducing foods if we actually tried to stick to this and 2) allergies don’t always show up the first time a food is eaten, so waiting between them didn’t even simplify the process of finding a problem food very much. I have yet to find an evidence base for the recommendation and also worried that it would make us likely to find false associations that would lead to us unnecessarily restricting her diet. As it was we ended up spending a week thinking she had an issue with bananas that turned out to just be irritation from the mesh feeder they were in.

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  2. Dr. Roy Says:

    Ceridwen, the AAP hasn’t been consistent about their message regarding the exact timing of the introduction of complementary foods. Their 2008 statement on food and allergy referred to a window of 4-6 months; however, their 2012 statement on breast feeding explicitly called for nothing but breast until 6 months.

    The AAP’s policy on iron deficiency calls for iron supplementation for breast fed babies starting at 4 months, and continuing until iron-rich complementary foods (like fortified cereals) are introduced. I don’t think that’s widely followed by those who recommend exclusive breast until six months.

    I know of no data parsing the duration of breastfeeding finely enough in the developed world to say that 4 or 5 or 6 months is best. There is data to say that earlier than 4 months or later than six months may be less beneficial than starting complementary foods in the 4-6 months window, so that’s what I recommend.

    “Food before 1 is just for fun” doesn’t make medical sense. Clearly babies exclusively breast fed for that length would have great risk for iron deficiency (including permanent neurocognitive impairment) and vitamin D deficiency. Besides, you’d miss an important developmental time for learning how to eat (instead of drink).

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  3. Alexis Says:

    What sort of symptoms would parents who have reason to believe their child is at high risk for ciliac be looking for after a trial of wheat? Is it the typical food allergy stuff (rash, etc.) or is there something unique to an autoimmune disorder that would cue them in?

    Thanks!

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  4. Dr. Roy Says:

    Alexis, the typical symptoms of celiac are subtle and develop over time– they typically wouldn’t be noticed until well after repeated wheat exposure. Unlike allergies, the autoimmune reaction is not fast.

    Children with celiac can present with GI problems (diarrhea, pain, bloating, or constipation), or symptoms outside of the GI tract (unexplained vitamin D deficiency, anemia, elevated liver enzyme tests, ataxia, a very itchy and intractable rash, and other things). The symptoms can be very varied. But unlike allergies, these symptoms are not usually quickly reproducible upon wheat consumption.

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  5. Rachel Says:

    I kind of figured this out on my own when my kids were babies. Our doctors and the moms I knew seemed slightly hysterical when it came to introducing a baby to food. My doctor recommended not introducing peanuts until age 3, introducing a single food at a time and then waiting for days for a reaction before introducing another one. They even gave out a complicated chart detailing when each type of food could be introduced – rice cereal at six months, wheat at 8 months, eggs at one year.

    It also was trendy among many of the moms I knew to withhold solid food until well past six months, In fact, this seemed to be one of the signals of being a “good mom”. I know lots of moms who were proud to have withheld any solid food until after 8 months and only then introduced tiny amounts mixed in with breast milk.

    Basically, the community seemed to be treating babies as if they were delicate, alien creatures who might keel over if fed cheese prior to a year old. I pondered this idea for a while and decided that everyone had gone a little batty and just fed my babies food – pureed food at first and then whatever we were eating. I think lots of moms and even my nurse practitioner thought I was being irresponsible to feed my five month old rice cereal and baby food.

    It’s kind of nice to hear that maybe I wasn’t the crazy one after all.

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  6. Scott Says:

    I have found that most of the AAP exclusive breastfeeding until 6 months arguments stem from misinterpreting studies showing that moms who introduce solids before 6 months are more likely to introduce formula. That group of docs has some causation/correlation issues.

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