Should You Introduce Gluten To Kids Early? A Pediatric RD Answers
Gluten has become a hot topic in recent years. Chances are you know someone with celiac disease, a gluten sensitivity, or another reason to remove gluten from their diet. So it's no wonder many parents struggle with whether or not they should keep gluten off their child's plate.
What if I were to tell you that gluten, a protein found in wheat, rye, barley, and triticale, may actually be beneficial as an effective prevention strategy for celiac disease? You may reconsider removing it from your child's diet after all.
What the research says.
Here is a staggering fact: One in 100 children and over 3 million Americans suffer from celiac disease, an autoimmune condition in which ingesting gluten damages the lining of the small intestine. Because I am a nutritionist, and veteran celiac myself, the recent results from a randomized clinical study out of the U.K. could prove to be exciting and promising for celiac families.
The Enquiring About Tolerance (EAT) Study, published in JAMA Pediatrics, examined whether the early introduction of gluten1 beginning at 4 months, over a three-year period, would reduce the prevalence of celiac disease by age 3.
The participants included 1,000 breastfed children, who were randomly divided into two groups:
- Four-month-olds consumed high doses of wheat.
- Low doses of wheat were introduced at 6 months.
The study suggested there was, in fact, reduced celiac prevalence in the children who were given high doses of wheat beginning at 4 months. This is the first study indicating these findings. Larger randomized trials may be necessary for further confirmation before putting early introduction into everyday practice.
Should I really be introducing my child to allergens?
Current guidance from the American Academy of Pediatrics recommends starting solid foods at around 6 months of age. But when it comes to introducing allergens, it presents new questions for parents: When to start, which allergen should you introduce first, how should you introduce each allergen?
While celiac disease is not a food allergy, the EAT Study results may prove to have a similarly beneficial impact in the prevention of celiac disease as the groundbreaking LEAP study had for the prevention in peanut allergies2.
So what should you know about introducing gluten early?
- Never introduce any solids prior to 4 months, including gluten-containing solids.
- Always wait two to three days between the introduction of allergens to ensure there are no delayed reactions to a potential food. If there is an allergic reaction, offering allergens with a time delay will help identify the cause more easily.
- If you have a family history of celiac disease, be sure to consult with your pediatrician before any gluten introductions.
What to consider if your child is diagnosed with celiac:
Some nutrients may need more love.
Because of the damage to the small intestine lining, proper nutrient absorption from food can be an issue. Therefore, many children early in their celiac diagnosis often have a number of nutrient deficiencies including iron, calcium, folate, vitamin B12, and zinc. Being aware of these deficiencies is important, as they can lead to delayed growth, development, and other health concerns.
Here are some quick, easy ways to boost those vitamins and minerals in your child's diet:
- Iron: meat, poultry, beans, spinach, and quinoa
- Calcium: cheese, yogurt, beans, lentils, rhubarb, and almonds
- Folate: leafy greens, broccoli, chickpeas, avocado, and lentils
- Vitamin B12: meat, eggs, tuna, salmon, and soft cheeses
- Zinc: meat, tofu, oatmeal, seafood, nuts, and seeds
Look out for these gluten-free diet pitfalls.
Eating gluten-free can certainly be healthy when the bulk of your meals come from whole, naturally gluten-free foods such as fruits, veggies, meat, poultry, nuts, seeds, and dairy. However, there are some typical misconceptions to consider when transitioning your child to a gluten-free diet.
While there is always a place for "fun" foods, such as cookies and chips, remember that just because a product is labeled gluten-free, that doesn't necessarily mean it's nutritious.
Because gluten is responsible for the elasticity and spongy texture in most baked goods, extra fat and sugar are often added to mimic the texture of gluten-containing goods. These additions mean they're more heavily processed and less nutrient-dense.
Many gluten-free products are also not fortified in specific micronutrients compared to some of their gluten-containing counterparts, so they may be lower in iron, folic acid, and other B vitamins.
Until the research dictates more concrete guidelines, early introduction of gluten is absolutely a personal preference. It's a choice you should discuss with your pediatrician to determine what works best for you and your family.
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Erica Fand, M.S., R.D, is a registered dietitian and founder of Jeweled Nutrition. She uses her decade of personal experience with celiac disease coupled with her masters education from Columbia University and clinical training from NewYork-Presbyterian Hospital, to help busy, overwhelmed parents navigate their children’s nutrition concerns. Her passion is to make nutrition easy, fun, and accessible so that families can live an effortlessly healthy life.