What’s so important – and stressful – about family dinner?

A recent study about the stress of getting family meals on the table has been getting lots of attention from both the media and moms. A Slate piece, “Let’s Stop Idealizing the Home-Cooked Family Dinner,” posted Wednesday, has already garnered 3.5K comments on the article itself and more than 26K Facebook shares. This has obviously struck a nerve. While feeding a family is a big and often stressful job, some perspective about why we do it and what matters most about family meals might be helpful to families feeling the mealtime crunch.

The study itself, titled “The Joy of Cooking?”, was published in Contexts, a publication of the American Sociological Association geared to be accessible to the general public. The paper itself is a really interesting read and freely available online.

Researchers in the sociology and anthropology departments at North Carolina State University conducted the study. This was a qualitative study, which means that the data came in the form of stories, generated from interviews with real people. From the paper:

“Over the past year and a half, our research team conducted in-depth interviews with 150 black, white, and Latina mothers from all walks of life. We also spent over 250 hours conducting ethnographic observations with 12 working-class and poor families. We observed them in their homes as they prepared and ate meals, and tagged along on trips to the grocery store and to their children’s check-ups. Sitting around the kitchen table and getting a feel for these women’s lives, we came to appreciate the complexities involved in feeding a family.”

These kinds of methods are common in sociology and anthropology research, and they allow researchers to understand the many complex variables that contribute to how people feel and why they feel that way. However, we have to be careful about interpreting these studies beyond the individual stories that they provide. For example, this study wasn’t a random sample of moms, and it can’t give us quantitative information like the percentage of moms who find cooking to be an unbearable chore versus rewarding or enjoyable. It doesn’t allow us to look at correlations between family income and nights of home-cooked meals per week, for example.

Here’s what it can tell us: Among the moms interviewed for the study, a common theme was that getting a home-cooked family meal on the table was stressful. The authors discuss the dichotomy of foodie standards for homegrown, home-cooked, preferably organic, meals, prepared with love and joy, and the realities faced by many families today. The moms interviewed in the study talked about how with both parents working long, irregular hours, there is simply no time to cook, much less sit down at the table at the same time. Others talked about the trade-offs between spending time cooking or spending time with their kids at the end of the day. Many noted that it was hard to please everyone with one meal, so they ended up sticking to tried-and-true, if boring, recipes rather than experimenting with new foods and flavors.

Family meals don't have to look like this. Credit: National Cancer Institute, Public Domain.

Family meals don’t have to look like this. Credit: National Cancer Institute, Public Domain.

Interestingly – though not surprising to me – poor moms in this study actually routinely cooked at home, because they recognized that it was the most cost-effective way to feed their families. That didn’t mean that cooking was joyful, but it was a necessary part of raising a family on a tight budget, even with barriers like not having reliable transportation, access to good food stores, or well-equipped kitchens.

 However, middle class moms cited financial barriers, too:

“To our surprise, many of the middle-class mothers we met also told us that money was a barrier to preparing healthy meals. Even though they often had household incomes of more than $100,000 a year, their membership in the middle-class was costly. While they did not experience food shortages, they were forced to make tradeoffs in order to save money—like buying less healthy processed food, or fewer organic items than they would like.”

Let’s face it: planning and preparing meals is hard work. It takes time, money, and effort, and doing it in the presence of children can make it more difficult. It may or may not be enjoyable, but it is definitely work and should be recognized as such. The Pinterest boards, food blogs, and gorgeous food magazines can be helpful inspiration, but they can also set us up for unreasonable expectations for family meals.

There is good evidence that family meals are important to kids. Eating regular meals as a family supports greater fruit and vegetable intake and displaces soda and fried foods. Not surprisingly, this results in better nutrition, and these same patterns can last at least into young adulthood. Research also shows that adolescents who eat family meals are protected from disordered eating, overweight, and substance abuse. There’s always debate about whether these association are because of the meal itself or the conditions that make family meals feasible, but there is evidence that family meals provide benefits to kids independent of other factors.

But let’s also consider how “family meal” is defined in the research. For example, in this paper, kids were asked, “On how many of the past 7 days was at least one of your parents in the room with you while you ate your evening meal?” There is nothing in that definition about meals made from scratch with all-organic ingredients. There isn’t anything in there about using real plates and forks or even the nutritional quality of the meal. All of those things might be desirable and might add more pleasure to a meal, but the most important thing about family meals is time spent together. If everything else is causing stress, then remember that as the first priority for family meals.

However, we do want to serve nutritious meals to our kids and support them in growing good eating habits, so let’s think about nutrition for a minute. Putting together a balanced meal means including all or most of the food groups. By offering this variety of foods, at least for most meals, you pretty much ensure that meals will be nutritionally adequate without having to fret much about individual nutrients. Your balanced meals may be elaborate and impressive, but they don’t need to be. Protein can be a scoop of peanut butter served next to apples, chickpeas from a can, or 3-minute scrambled eggs. The grain can be whole-wheat sandwich bread with butter. Vegetables can be the frozen variety, prepared in a minute in the microwave, then seasoned with a little butter and salt. (From a nutrition standpoint, these options are just as good as fresh. Also, conventionally grown produce is just as nutritious as organic.) These meals may not meet the standards of Martha Stewart or Michael Pollan, but they can still be nutritionally balanced, and their easy preparation may allow dinner to be more relaxing.

I enjoy cooking – to a certain extent – and I have the privilege of usually having the time and money to prepare the kinds of foods that I want for my family. Still, from my own qualitative research in the laboratory of my kitchen, I’ve observed a few things. First, there is zero correlation between the effort that went into the preparing the food and the quality of the interactions between children and parents at the table. Second, there is a high correlation between the complexity of the meal I’ve prepared and my stress level by the time I sit down at the table. For me, both of these observations are unique to cooking with and for young kids, and I expect they’ll get better as kids get older and can help in the kitchen and better appreciate good meals. In the meantime, though, I try to keep meal preparation simple and focus on enjoying food together.

Are family meals important in your house? Are they a source of stress? How do you pull them off?

 

P.S. – I’m sorry for my long and unintended absence from the blog. I’ve received several expert peer reviews on my book manuscript and have been working on finishing up edits – the book will soon be officially IN PRESS! We’ve also been doing summer things like swim lessons, camping, and refinishing the deck. The leaves are starting to turn, the fall college term is about to start, and we’ll be back in more regular routines in life and on the blog soon. Hope you all have had a great summer!

Caffeine and Breastfeeding

If anyone needs a little caffeine, it’s a new mom. My labor with Cee took me through two mostly sleepless nights, and when she finally arrived, we took a little time to nurse and get to know one another, and then our whole little family took a long nap. When we woke up, the first thing I did was send my husband to get me a latte. The second thing I did was breastfeed my new baby again. That dose of caffeine felt like good therapy to me, but what about for Cee? Was it good for her?

caffeine structure

Source: Wikimedia Commons

A few weeks ago, I wrote about the safety of caffeine in pregnancy, and several readers wanted to know about the postnatal effects of caffeine – how mom’s caffeine intake might affect her breastfed baby. I promised to take a look at the literature and report back, and so here we are.

 

When you drink a cup of coffee, how much caffeine ends up in your breast milk?

Several studies have examined this question, and although they are small, they give us a general idea of the transfer of caffeine from mom’s blood to her milk. After a cup of coffee, caffeine is rapidly absorbed into mom’s blood and then passively diffuses across the epithelial layers of the mammary gland. Caffeine appears in milk within 15 minutes of consumption and peaks within an hour. The concentration of caffeine in breast milk ends up being about 80-90% of that in mom’s plasma. However, taking into account the amount of breast milk consumed and adjusting for body weight, studies have estimated that the infant receives no more than 10% of the maternal dose of caffeine, and likely much less (see here, here, and here).

Is this amount of caffeine safe for a baby?

Just because levels of caffeine in breast milk are low relative to what adults normally consume doesn’t mean that these amounts are necessarily safe to a baby. Another important factor is how efficiently a baby can metabolize caffeine, and it turns out that newborn caffeine metabolism is really slow. Whereas the half-life of caffeine in adults is around 2-6 hours, it is an average of 3-4 days in newborns and can be even slower in premature babies. In other words, a morning cup of coffee for mom will easily clear her blood by bedtime, but caffeine may linger in her breastfed newborn for much longer. Metabolism gradually ramps up as the baby matures and the necessary enzyme levels come on board, and most babies can metabolize caffeine at rates similar to adults by 5-6 months of age. Continue reading

Getting our 3-Year-Old Back to Good Sleep… In 9 (Not Easy) Steps

Yesterday, I wrote about how we found ourselves struggling with sleep with Cee. We knew it was time to make a change, and we knew this meant asking Cee to fall asleep on her own at night, without one of us sitting in her room with her. This was not exactly a new thing for her; until the last 6 months, she’d been falling asleep on her own since she was a baby. Still, given how things had gone lately, this was a big change for all of us.

I want to share how we approached this transition, but I don’t believe this is a magic formula by any means. I don’t think there are easy answers to parenting challenges like these, and what works well in one family might be a flop in another. I am proud of how we thought this through and put a plan into action, and it has seriously given our entire family (Cee included) more happiness around bedtime. Here’s what we did.

1. Husband and I did this together. All of this would have been much harder without his help. He is great at staying calm in stressful situations, which has a calming effect on Cee, and he is thoughtful and empathetic. We also recognize that our relationships with Cee are different. He’s the more fun parent; he’s more lenient with Cee in many ways but is also very good at setting rock solid boundaries when it is important. I’m still the parent that she turns to when she needs comfort. This often means a sweet hug or snuggle session, but it can also mean being on the receiving end of a bunch of messy emotions. Cee and I also tend to end up in power struggles more often, something I’m working on. Because of these differences, Husband was the parent who initially sat down to talk with Cee about bedtime changes. We also made sure he’d be around at bedtime for the first few days (he often works evenings and nights, so this isn’t always the case), so that we could take turns and he could take over if needed.

The importance of a strong parenting partnership has been shown in the research. A recent study from Doug Teti’s Penn State lab found that one of the greatest predictors of high maternal emotional availability at bedtime (discussed in my last post) was the quality of coparenting, even when dads weren’t directly involved with bedtime.

2. We told Cee about the change. We told Cee that it was time for her to start falling asleep on her own again and that we wouldn’t be sitting in her chair anymore. We didn’t dwell on trying to explain why, because we didn’t want her to feel like this change was a punishment for previous bedtime behavior. We didn’t emphasize that big girls go to sleep on their own, because that might have made her wonder if being a big girl was really such a great thing. We simply told her that she used to fall asleep on her own, and we were going to help her do that again.

3. We asked Cee to help us make a new plan for bedtime. “How do you think we can help you with bedtime now that we won’t be sitting in your chair?” Husband asked. Continue reading

How My 3-Year-Old’s Sleep Fell Apart

A couple of weeks ago, I wrote that after I finished my book, I needed a sort of parenting reset with Cee. One of the big areas that we needed to work on was sleep. Bedtime had become a battle, and it was taking Cee a long time to fall asleep. This was leaving us all frustrated at the end of the day, and Cee was waking up grumpy in the mornings. I didn’t have the energy and attention to work on it while I was trying to finish my book, although in hindsight I’m not sure why we waited this long. Over the last couple of weeks, we’ve made some big changes to get us back to happy bedtimes.

Let me back up and tell you how we got into trouble with sleep in the first place. Last August, we moved to a new house. By this time, Cee had been in a toddler bed for almost a year, but she had no problem staying in it at bedtime or through the night. We had a sweet bedtime routine that ended with kisses goodnight, turning off the light, and then good sleep for Cee. After we moved, Cee started talking about being afraid of things like the deer and turkeys that wandered through the yard of our new house. We talked about these fears, got her a night light, and spent a little more time with her before saying goodnight, singing a couple of rounds of Twinkle, Twinkle and rubbing her back for a few minutes. All of that was fine.

Then Cee started getting out of her bed after we left her room for the night. She’d pad into the living room or my office to find me. I’d walk her back to bed and tuck her in again, but some nights this happened over and over. I would be shocked to see her in my office door at 9:00 or 9:30 PM, long after her 8:00 bedtime. She was also waking up during the night, coming into our room, and patting my shoulder until I woke up. I would walk her back to her room, often lying down next to her until she went back to sleep. Alternatively, I’d pull her into bed with me, but neither of us slept very well this way. All of this was adding up to fewer hours and less restful sleep for both of us.

When did the sweetness of a good nap become something to resist?

When did the sweetness of a good nap become something to resist?

Things seemed to get worse around the holidays. Cee was getting out of bed more and more after bedtime, and she was having a hard time separating when we tucked her back in. She started asking us to sit with her while she fell asleep, and this actually seemed like a reasonable solution. At least if we sat in her room we could make sure that she stayed in her bed, and maybe she would fall asleep easier and get more rest this way. I reminded myself that she was just 3, and if she was asking for more support in her transition to sleep, why shouldn’t we give that to her? (Never mind that she had been falling asleep on her own since she was a baby.)

There was something else going on at this time, too. I thought that maybe Cee’s struggles with sleep were because I wasn’t there enough for her in the day. I was going through a really tough period, approaching the 1-year anniversary of our first miscarriage and beginning some fertility testing. Continue reading

Caffeine Safety in Pregnancy

My first trimester of pregnancy coincided exactly with the last three months before my book deadline. I was lucky to have only mild nausea during this time, but I was really, really tired, especially in the afternoon. I tried hard to get enough sleep at night, but my body also seemed to want a 2-hour nap after lunch, when I just couldn’t stay awake, much less think and write. Pre-pregnancy, I responded to a post-lunch slump by pouring myself a cup of coffee or, even better, spending the afternoon at my favorite coffee shop, where a latte and the people around me helped keep me focused for a productive afternoon. A cup of herbal tea in the same atmosphere just made me want to curl up in one of the comfy chairs and take a nap, even as my caffeine-fueled coffee shop friends typed energetically around me.

But now I was pregnant, after 18 month of trying and several miscarriages, and I wanted to do all I could to minimize the risks of losing this pregnancy. In previous pregnancies I’d just given up most caffeine, and that wasn’t that hard to do. In this one, I was more afraid than ever of a miscarriage, but I also needed the caffeine boost more than ever to finish my book. I wanted to know what the research says about the safety of caffeine in pregnancy so that I could make an informed decision about whether to consume caffeine, and if so, how much.

Photo by Kevin Tuck

In her book, Expecting Better, Emily Oster includes an excellent discussion of caffeine in pregnancy. I consulted this for a quick answer to my question, and her analysis of the research on this topic helped me feel comfortable strategically drinking a little coffee in the afternoon. However, as much as I like and respect Oster’s book, I’ve also found that my approach to risk in pregnancy is a bit more conservative, and as soon as I had the chance, I wanted to look at the studies myself. Continue reading

Emerging: A Book, a Pregnancy, and Summertime

I’m back. In so many ways, I feel like I’m coming up for air after a long, long time.

I finished my book, or at least the first draft. I submitted it to the publisher a few weeks ago, and it’s now at the mercy of peer-reviewers. Like any big project, this is a huge weight off of my shoulders. It has commanded so much of my attention and energy over the last 18 months that I feel an almost unsettling freedom in each block of free time that comes my way. Where do I put my energy next? Between traveling, a much-reduced childcare schedule, and a sick Cee, I haven’t had much free time. However, since finishing my book, I’ve suddenly noticed cobwebs in the corners of our house, that our living room was still full of toddler toys that Cee never plays with, and that she had commandeered the lower shelf of the pantry for now-forgotten objects like band-aids, old catalogs, puzzle pieces, bottle caps, and pieces of gravel from the driveway. For a couple of days, all I wanted to do was clean and organize.

Another weight has lifted, too. I’m pregnant! Finally. It turned out that it took me longer to make a baby than to make a book. I’m now 15 weeks pregnant, and everything looks healthy so far. This experience – of trying to conceive, infertility, and pregnancy loss – has been more difficult than I imagined. When I tackled writing the book, I knew that the final product would be a result of how much time, effort, thought, and desire I put into it. Not so with getting and staying pregnant. This has been a lesson in relinquishing control and in patience. Having made it through the anxious first trimester, I’m now trying to adjust my attitude from one of bracing myself for something to go wrong to enjoying the pregnancy and letting myself think ahead to a new baby in December.

And now, it really feels like summer. I’m not teaching at all this summer, the first term I’ve had off in nearly two years. We’ve cut Cee’s childcare schedule way back to just a few mornings per week – just enough to give me a little time to write and edit the book as needed. We’re taking a few trips, catching up on appointments for our whole family, and sharing good meals made from our CSA produce. Best of all, we’re spending time together.

Cee and I especially need this. Over the last few months, my husband and I were doing a lot of baton parenting – both of us working long hours and then taking turns with Cee so that the three of us were rarely all together. I was starting to feel like my limited time with Cee was spent in too many battles and limit-setting and not enough connection and cooperation. Over the past couple of weeks, I’ve been thinking about and putting into action a sort of parenting reset – trying to think clearly for the first time in a while at what is working and what isn’t and being intentional about how to change it. Happily, I already feel like we’re back in a better place, and I’m looking forward to lots of time with her this summer.

I’m also setting my intention to getting back to regular blogging this summer. I plan to post at least once per week, maybe a bit more. I’ll be blogging about pregnancy, miscarriage, infertility, babies (of course!), and some of my current parenting journey. I have a long list of topics accumulated over the last year or so, but I’m always open to new questions; if you have topic ideas, send them my way!

I’m really looking forward to blogging and engaging with you all again. Thanks for all of your kind notes over the last few months and for bearing with me. It’s good to be back!

Hopeful for the New Year

I, for one, am not sad to see 2013 go. It’s been a rough year for me. I haven’t been blogging about it – haven’t been blogging about much of anything, actually – and I think it is time for an update.IMG_5374 2013 started with a miscarriage in progress, finally ending with a D&C on January 4. I grieved that lost pregnancy openly on this blog. It was therapeutic for me to blog about it and to feel support from women who had had similar experiences, or at least had empathy for the magnitude of love and hope that comes with a pregnancy. I started to feel better. I was confident that I would be pregnant again soon, and that was the obvious way to fill the gaping hole in my heart.

In the spring, I watched seedlings poke through wet dirt. Our neighborhood burst with color and new life, and I felt hopeful. But as the days grew longer and hotter, I felt sadder and sadder.  I still wasn’t pregnant. My previous due date came and went, now just another day, but such a heavy one for me. Cee and I sorted through newborn clothes in our hot attic, not for a new baby for our family, but to lend to a friend. Cee asked to keep a few onesies for her baby doll. I showed her how to fasten the snaps and then sent her downstairs so I could cry.

In August, I had another miscarriage, this time very early. Then, another one in October, early again (and thankfully spontaneous) but far enough out that I let myself think ahead to another summer due date. That one really crushed me. I know miscarriage is common, and it’s easy to chalk the first up to bad luck. But by the third time around, I had really lost faith in my body. It has failed, repeatedly, to do one of the things I feel it was always meant to do. I’ve always wanted children, and the family that I have, for which I am exceedingly grateful every day, doesn’t feel complete. There’s still a gaping hole here, and it’s only gotten bigger.

Meanwhile, Cee turned three in November. I know my sadness has affected her, and it’s affected my parenting, because my emotional reserve is just plain depleted. I am working hard at being enough for her and at assuring her that she is enough for me. (And she is. She really is. I’ve come to terms with that, most days anyway.) Continue reading

Amylase in Infancy: Can Babies Digest Starch?

Several readers have emailed me to ask about babies’ ability to digest starch. Here’s one:

“I have noticed you recommending cereals for babies several times.  I am sure that you are aware that many people look at feeding a baby grains before the age of one or even two as if you have offered your child strychnine. One of the reasons cited is that they supposedly do not have amylase to digest grains before that time. I have often wondered what exactly is happening to the cereal if it is not being digested, but the only statement I could find is something about it “rotting” in the gut.

I would love to get information from a scientific point of view on this topic.  Everything I have been able to find thus far has been very biased towards one point of view or another. Either “cereal is the perfect first food. Easy to digest and enriched with iron” from the infant cereal companies or “Cereal is junk.  No infant should ever eat grains. It is not natural or traditional and they can’t digest it” from online parenting sites.

I need a little clarity and common sense.”

~Hope

I love the skepticism in Hope’s email, and I can also empathize with her frustration about how difficult it is to find good information about a seemingly simple question: Can babies digest starch? If you search for the answer to this question online, you will run into dire warnings of the dangers of giving starch to babies. But these sites might set off your woo detector – as they should. So, after receiving multiple emails about this question as well as seeing it mentioned in discussions on the Science of Mom Facebook page, I figured it was time to put some evidence-based information about babies and starch digestion on the Internet.

Researching this question has given me an excuse to read some classic nutrition physiology papers harkening back to the 1960’s and 1970’s, and it’s brought back memories of years in the lab, exploring nutrient digestion and metabolism. And starch digestion in infancy, it turns out, is a really neat story.

Let’s start with some basics about carbohydrate digestion.

What is starch? How is it digested?

Starch is a type of complex carbohydrate. Made from lots of glucose molecules bonded together in long, branching chains, it is a plant’s way of storing glucose – product of photosynthesis and source of energy – in a stable form. We find starch in grains, root vegetables, winter squashes, beans, and some fruits, like bananas. Starch is an important storage depot for the plant, and it also makes for tasty staple foods for cultures around the world.

One little section of starch, containing 3 glucose molecules. Wikimedia Commons, public domain.

A chain of 3 glucose molecules, like a tiny section of starch.

Glucose is the major fuel for the cells of the body. When we eat starch, we have to break the bonds in those chains of glucose molecules, liberating them to be absorbed from the small intestine into our blood. Starch digestion begins in the mouth, where salivary amylase starts chopping up those large glucose chains. When this partially digested starch gets to the small intestine, amylase made and secreted by the pancreas jumps in to do more bond-breaking and is responsible for most of starch digestion in adults. A suite of enzymes produced by the cells lining the small intestine, including sucrase, isomaltase, maltase, and glucoamylase, work on the remaining short chains, finishing up the job and making glucose available for absorption.

Starch Digestion in Infants

Infants go through some incredible nutritional transitions in the first months of life. Prior to birth, their growth and development is fueled almost entirely by glucose from mom, absorbed across the placenta. After birth, they have to abruptly transition to an exclusive milk diet, which is high in fat and lactose, still a relatively simple sugar. As they start solid foods, babies have to adapt to a much more complex and varied diet. Around the world, starch is a major source of energy in the diets of children and adults alike. But when infants are first introduced to starchy foods – often in the form of cereals and porridges – starch is a novel nutrient to their digestive tract. They need to turn it into glucose, but are they equipped to do this? Continue reading

Two Mom-Driven Media Ventures You Should Follow (and Support!)

I want to take a minute to highlight a couple of newish media ventures that I think readers of this blog would love. Funnily enough, both are a little old-fashioned. One is a literary magazine, printed on real, honest-to-god, paper. It arrives in my mailbox, and I know I need to clear my evening – put away my laptop and phone and snuggle into my bed a few hours before I actually intend to go to sleep. And the other is a podcast. Maybe that doesn’t count as old-fashioned, but as I listen, this form brings all the warmth and comfort of a radio show that makes me want to slow down, close my eyes, and just listen.

Both of these projects are doing something special and filling our need for real parenting voices amidst the chatter from popular websites and advice-filled magazines.  After every installment, they leave me wanting more.

longest shortest time headerThe Longest Shortest Time is a podcast and accompanying blog created by Hillary Frank. Hillary is a writer and a professional radio producer, and her experience shows in the podcast. I love good radio, and this is good radio. I just discovered the Longest Shortest Time last summer, at the recommendation of a friend. I was immediately hooked, and I plowed through the 20 existing episodes, recorded over the last three years, while I packed up our house in preparation for our move.

The Longest Shortest Time is about stories. But stories are different when they’re told from one friend to another, or one mother to another, empathetic mother. That’s something that Hillary recognized. She says:

“Something I did know from having been a radio producer for about 15 years, is – if you have a microphone, and you stick a microphone in someone’s face, they will tell you just about anything, and it’s not awkward. I just started sitting down with moms and calling moms, and dads too, to hear their stories of struggles in early parenthood.”

These are some incredible stories. The most memorable is Hillary’s conversation with her friend Kelly McEvers, an NPR war correspondent, about what it was like to combine early motherhood with her very dangerous line of work. That’s a perspective that I’d never heard before. I am nothing like a war correspondent, in my personality or work, and my experience with motherhood is nothing like Kelly’s. But still, I felt a certain amount of kinship with Kelly when she said this:

LST kelly quote

Continue reading

Breastfeeding, Gluten Introduction, and Risk of Celiac Disease

A study published yesterday in the journal Pediatrics suggests that later introduction of gluten and breastfeeding beyond 12 months both increase the risk of a child developing celiac disease. These new findings add to the already muddy waters of our current understanding of the role of infant feeding in celiac disease.

Photo by Shree Krishna Dhital, via Wikimedia Commons

Celiac disease is an immune response to gluten, a protein found in wheat, barley, and rye. Celiac is characterized by inflammation and damage to the small intestine, leading to symptoms such as diarrhea and digestive pain. In the U.S., celiac disease is present in about 1 in 141 people, although many of these cases go undiagnosed. Infants that develop celiac disease often have poor growth or weight loss, because intestinal damage compromises nutrient absorption. They also may have chronic diarrhea and a swollen, painful belly.

Celiac can usually be treated with a gluten-free diet, but there isn’t a cure for the disease. Multiple genetic markers have been identified for celiac disease, but many genetically susceptible individuals tolerate gluten and never develop symptoms, leading to speculation about other risk factors, including early childhood nutrition.

This latest study was a large, prospective survey of infant feeding practices and development of celiac disease in Norwegian children. Parents were asked when they first introduced gluten and how long they breastfed their babies. Children that developed celiac disease were tracked through Norway’s national medical system. The study included 324 children with diagnosed celiac disease and 81,843 without celiac. The researchers then looked for patterns in the data that might help to explain why some children developed celiac disease and others did not.

There were two major findings to emerge from this study:

  1. Children that had not yet tried gluten by 6 months of age were more likely to develop celiac disease.
  2. Breastfeeding at the time of introduction to gluten did NOT appear to be protective. In fact, breastfeeding for longer than 12 months was associated with an increased risk, although it was borderline significant (P=0.046).

Both of these findings are contradictory to current infant feeding advice in the U.S. The AAP’s Section on Breastfeeding recommends exclusive breastfeeding for about 6 months before introducing solid foods, followed by “continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.” The same AAP policy goes on to say, “There is a reduction of 52% in the risk of developing celiac disease in infants who were breastfed at the time of gluten exposure.” But this Norwegian study effectively found that following the current advice of the AAP seems to increase a baby’s risk of celiac, not decrease it.

Obviously, we need more information here. And as usual, one study isn’t enough to give us the full picture of what we know and don’t know about this topic.

To understand the evolving hypotheses around celiac disease and infant feeding, we need to go back to Sweden in the mid-1980’s, when the rates of celiac disease in young kids suddenly quadrupled from an incidence of 1 in 1000 births to 4 in 1000 births over just a few years. It was an epidemic, and it appeared to be isolated to Sweden; neighboring countries weren’t affected. What’s more, celiac was showing up in really young kids. The median age of diagnosis during the epidemic was just about a year old. In 1995, celiac disease in Sweden plummeted back to pre-epidemic levels, and the median age of diagnosis increased to 4 years of age. Continue reading