When should my baby eat wheat?

Introducing wheat at four months of age and not delaying this until after six months of age, is currently thought to decrease the chances of developing an allergy to wheat.

Wheat allergy and Coeliac Disease are the two main medical conditions related to wheat in childhood. Children with wheat allergy need only avoid wheat, while those with coeliac disease need to avoid gluten. Gluten is found in wheat, rye, triticale, spelt, barley and controversially oats.

Can I prevent my child from developing these diseases?

The answer right now is NO, but there is research looking into factors that might decrease the chances. In both groups breast feeding is encouraged, and food introduction should not begin before the child is four months old.

Wheat allergy

Parents are now encouraged to add small amounts of foods to the babies’ diet that contain the known food allergens. Wheat is now suggested from four months.

Unlike a typical wheat allergy which starts as a baby and is mostly outgrown by primary school, coeliac disease can be diagnosed at any age.

Coeliac Disease

Science does not have as clear a picture on what to advise for coeliac disease, because five, ten or more years after the child left the research study, they could still develop coeliac disease. Suggesting diet changes made as a baby might not really matter in the longer term.

When the European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines to introduce gluten to babies was developed in 2016, it was thought that the specific genetics of the child was the strongest determinant of whether the child developed coeliac disease or not. That may still be the case. Here are current early diet suggestions, but they are not official recommendations, as we don’t know how many from these studies below, will go on to develop coeliac disease later in life.

A recent 2020 study suggests that from the age of four months, at least two wheat breakfast biscuits should be consumed in a week. The group who did this had less coeliac disease three years later than those who delayed gluten introduction until after six months.

A 2019 study concluded that more coeliac disease developed in children eating the greatest quantities of gluten between 1-2 years of age. The research suggests that at most, 2-3 slices of wheat bread equivalent food choices should be eaten a day, between the age of one and two years. Use gluten free grain food choices to fill out the grain food for the rest of the day.

It’s important to understand that your baby or child may still develop either condition. If you feel your baby is reacting to wheat or gluten foods, then stop those foods and investigate this with your doctor.

REFERENCES

1. https://www.allergy.org.au/patients/allergy-prevention
2. JA et al. Timing of Initial Exposure to Cereal Grains and the Risk of Wheat Allergy. Pediatrics  2006, 117 (6) 2175-2182; DOI: https://doi.org/10.1542/peds.2005-1803.
3. Szajewska H et al. Gluten Introduction and the risk of coeliac disease: A position paper by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. JPGN, Vol 62(3);2016:507-513
4. Lionetti E et al. Introduction of Gluten, HLA Status, and the Risk of Celiac Disease in Children. Italian Society of Pediatric Gastroenterology, Hepatology, and Nutrition. Working Group on Weaning and CD Risk. New England J Med, 2014, Oct;1295-1303.
5. Logan K. Early Gluten Introduction and Celiac Disease in the EAT Study. A Prespecified Analysis of the EAT Randomized Clinical Trial. JAMA Pediatr. doi:10.1001/jamapediatrics.2020.2893. Published online September 28, 2020.
6. Mårild K et al. Gluten Intake and Risk of Celiac Disease: Long-Term Follow-up of an At-Risk Birth Cohort. Am J Gastroenterol, 2019;00:1–8.

About the author

Dr. Kim Faulkner-Hogg: BSc, Grad Dip Nutr & Diet, Adv APD, AN, PhD Kim is an Advanced Accredited Practising Dietitian with more than 20 years experience with coeliac disease and food intolerances. Kim has completed her PhD in Coeliac disease and the gluten free diet and was a consultant dietitian to Coeliac NSW/Australia for a number of years. She has a Private Practice in Malabar, Sydney and she lectures to dietitians, other health professionals, the food industry and the public on these topics.