What To Do About Babies and Peanuts: New Study Finds Early Exposure Can Prevent Allergy

You’ve probably already seen headlines about a study showing that feeding children small amounts of peanut products in the first 5 years of life can prevent the development of peanut allergy. The study was conducted in the U.K., led by Gideon Lack of King’s College London, and was published this week in the New England Journal of Medicine (free full text available here).1

Why is this study important?

Photo by Sanja Gjenero

Photo by Sanja Gjenero

Food allergies are on the rise in Western countries, and peanut allergy is one of the scariest. In the U.S., more than 2% of children and their families are now living with a peanut allergy, representing a 5-fold increase in prevalence since 1997.2,3 And this allergy isn’t just an inconvenience; it’s now the biggest cause of anaphylaxis and death related to food allergy in the U.S.4 This is a huge concern to parents wondering when and how to introduce peanuts to their kids, but the advice on this matter has been really confusing over the last 15 years.

In 2000, the AAP recommended delaying the introduction of peanut and other commonly allergenic foods (i.e., wheat, eggs, fish, cow’s milk) until at least the first birthday and until age 3 for kids thought to be high-risk for allergy.5 While this advice may have seemed reasonable, it was never based on good evidence – just a best guess based on knowledge at the time.

Meanwhile, the incidence of food allergies continued to climb, and epidemiological evidence emerged that avoiding allergens might backfire. In 2008, the AAP issued new guidelines stating that there was no evidence that delaying introduction of solid foods, including common allergens, beyond 4 to 6 months of age would protect children from developing allergies.6 This document was intentionally vague, because at the time, there weren’t any studies to give more specific guidance on when to introduce what, in what amounts, etc. And this flip-flop in advice, which was also mirrored in many other countries, has left a lot of parents confused.

Gideon Lack and colleagues published a study in 2008 that found that the incidence of peanut allergy among Jewish children in the U.K. was 10-fold higher compared with those growing up in Israel.7 Comparing the mean age of introduction of peanut protein between the two countries, they found that babies in Israel were commonly introduced to peanut in their first year, while babies in the U.K. were not. This led them to their hypothesis that early exposure to peanut might help prevent the development of peanut allergy, and that’s what the current study tested.

How was this study conducted?

The researchers recruited babies between the ages of 4 and 11 months that were high risk for developing peanut allergy because they had severe eczema, egg allergy, or both. Before entering the study, the babies were tested using a skin-prick test to see if they were already sensitive to peanut. If so, they were excluded from the study. Those who showed no sensitivity (530 babies) or only mild sensitivity (98 babies) were included in the study and randomized to two groups. In the “avoidance” group, parents were instructed not to feed their children peanut at all. In the “consumption” group, parents were asked to give their children 6 grams of peanut protein per week, spread across at least 3 meals. Both treatments were continued through age 5, when all of the children were tested for peanut allergy.

bambaWhat does 6 grams of peanut protein look like? It’s the amount in about 25 peanuts, or 3-4 tablespoons of peanut butter. In this study, parents in the consumption group were encouraged to feed a snack called Bamba, made of puffed corn and flavored with peanut butter. (Think Cheetos but with peanut butter instead of neon cheese powder.) Bamba was chosen because it was reported to be one of the main peanut sources for Israeli babies in the previously mentioned study. Kids who weren’t into Bamba were given smooth peanut butter instead.

What were the results of the study?

The study found a striking reduction in peanut allergy in the kids that ate peanut during the first 5 years of life. Among the kids without peanut sensitivity at the start of the study, 13.7% of those that avoided peanut had peanut allergy, whereas just 1.9% of those who had consumed peanut were allergic by age 5. That’s an 86% reduction in peanut allergy, and yes, that’s a HUGE result.

Among the kids that had a mild reaction to the baseline skin prick test, peanut allergy was more common, but again, the prevalence was reduced by peanut consumption early in life (10.6% in the consumption group vs. 35.3% in the avoidance group). Thus, the researchers concluded that exposing kids to small amounts of peanut protein early in life could both prevent peanut allergy and even treat those already mildly sensitized. Remember that all of the kids in this study were already high-risk for developing peanut allergy due to having eczema and/or an egg allergy. Normally, about 15-20% of this group would end up with a peanut allergy

We don’t yet know what will happen beyond 5 years of age, but the researchers are conducting a follow-up study in which the same children have been asked to completely avoid peanut for a year to see if this impacts their development of peanut allergy.

What does this mean for parents feeding children?

We should always be cautious about changing practices based on the results of just one study. However, this is is a really strong study showing dramatic results. Although we’ve known for a while that avoiding peanuts early in life doesn’t help, this is the first study to test peanut exposure in high-risk kids, and it showed that this can actually prevent allergy. I think it is a game changer.

Still, there is a lot we don’t know. We don’t know if there is an optimal window for introducing peanut or how much is really needed, and we don’t know if early peanut exposure could help infants that have already developed a real peanut allergy. We need more studies to help clarify these questions, but at least we’re asking the right questions now.

In a Scientific American interview (well worth reading in its entirety), the lead researcher for this study, Gideon Lack, gave his advice to parents wondering what to do about peanuts (Note that in the U.K., the term “weaning” means the introduction of solid foods, not stopping breast or bottle-feeding.):

“Among low-risk kids that account for 80 to 90 percent of population—those that don’t have eczema in the first six months to year of life and don’t have any evidence of food allergies—I would recommend that these children eat peanut protein or peanut in various forms, depending on the culture. Low-risk children should start eating peanut butter as soon as weaning is established. You don’t want peanuts to be the first food because if the kid is gagging or choking, it could represent allergic manifestation but it may also just indicate the child hasn’t developed the coordination to eat solid foods.

Higher-risk kids, those with any manifestation of eczema or food allergy, should see an appropriate health care provider, which could be an allergist or a pediatrician, and have skin prick testing done for peanut as soon as these high-risk symptoms develop. If the child tests negative, the child should be encouraged to eat peanut at home. If the skin test is a small positive, like it was for some of the kids in our study, then the children should have their first exposure or consumption of peanut under medical supervision; and if they tolerate it they should be encouraged to continue to have peanut regularly in their diet for at least the first three years of life. Based on the evidence we have, one could arguably say the first five years of life.”

I think this advice makes good sense. If you’re worried that your baby might be high-risk for peanut allergy, definitely talk to your child’s pediatrician to make a personalized plan for introduction. Keep in mind that you should always pay close attention whenever your baby tries a new food for the first time so that you can be alert to a reaction. Also take care to ensure you’re introducing peanut in a form that your child can handle, like smooth peanut butter or peanut sauces, avoiding whole peanuts until you’re confident that your child can chew them without choking. (Anyone want to place bets on how long it will be until we see a Bamba-like product marketed towards babies and young kids in the U.S.? I’m not aware of one currently.)

The big question in my mind is whether or not this same strategy of early exposure will apply to other common allergens. We already have some evidence for this. For example, one study found that children first exposed to wheat between 4 and 6 months (vs. after 6 months) had a 4-fold decreased risk of wheat allergy.8 Another found that children who first had cooked egg at 4 to 6 months had the lowest incidence of egg allergy, whereas those starting egg at 10-12 months had a 6-fold increased risk.9 Interestingly, this protective effect only worked with cooked egg (boiled, scrambled, fried, or poached), not with egg in baked goods. (Maybe baking denatures the egg protein more?) However, these were observational studies – not randomized – and confounding factors could have influenced allergy risk and early feeding practices. We need more randomized studies like the current peanut one to know if the early exposure strategy will work for other allergens and to figure out optimal timing and amounts of exposure.

The peanut study adds to a growing body of evidence that there may be a kind of sweet spot for introducing food proteins, including those that can trigger allergy – not too early and not too late. Studies show that introducing foods before 4 months can increase the risk of allergy, but waiting too long might also be problematic. Introducing babies to these foods at the right time seems to give their developing immune systems a chance to learn to tolerate the protein rather than attacking it.

As parents, it can be frustrating to see the “official” advice on introducing allergens flip-flop so dramatically in just 15 years. I’m sure there are parents out there who diligently followed the AAP’s advice from 2000, avoiding giving their children peanut, maybe even avoiding it themselves during pregnancy and breastfeeding, whose kids ended up with peanut allergies. Now we know how wrong that advice was, and that’s just maddening. But this is an area where the science has rapidly advanced in the last couple of decades, and the AAP and other health organizations have just been giving the best advice they can based on what we know. Finally, I think we are headed towards true evidence-based recommendations in this area. As a parent who will be introducing peanut to my baby in a few months, I think that’s something to celebrate.

What advice were you given about introducing peanuts to your baby? Will this study change the way you do it with a new baby?

References:

  1. Du Toit, G. et al. Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy. N. Engl. J. Med. 0, null (2015).
  2. Sicherer, S. H., Muñoz-Furlong, A., Godbold, J. H. & Sampson, H. A. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J. Allergy Clin. Immunol. 125, 1322–1326 (2010).
  3. Bunyavanich, S. et al. Peanut allergy prevalence among school-age children in a US cohort not selected for any disease. J. Allergy Clin. Immunol. 134, 753–755 (2014).
  4. Sampson, H. A. Peanut Allergy. N. Engl. J. Med. 346, 1294–1299 (2002).
  5. Nutrition, C. on. Hypoallergenic Infant Formulas. Pediatrics 106, 346–349 (2000).
  6. Greer, F. R., Sicherer, S. H. & Burks, A. W. Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas. Pediatrics 121, 183–191 (2008).
  7. Du Toit, G. et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J. Allergy Clin. Immunol. 122, 984–991 (2008).
  8. Poole, J. A. et al. Timing of Initial Exposure to Cereal Grains and the Risk of Wheat Allergy. Pediatrics 117, 2175–2182 (2006).
  9. Koplin, J. J. et al. Can early introduction of egg prevent egg allergy in infants? A population-based study. J. Allergy Clin. Immunol. 126, 807–813 (2010).

International Travel with Kids: 10 Lessons Learned

By Sarah Ruttan

In yesterday’s post, I talked about the highs and lows of traveling abroad with young kids. While we’re not planning any international trips in the near future, we definitely learned some important lessons on this trip that we’ll take into account when planning future travel. Some of this advice relates to any type of travel with children, but there are special considerations when traveling out of the country.

1. Travel light. We didn’t bring a stroller, opting instead for our trusty Ergo. I almost felt naked getting onto the plane, yet also slightly liberated. The cobble stone streets of colonial Peru wouldn’t have made a stroller any fun, anyway. Depending on your destination, mode of travel, and itinerary, you may be able to leave car seats behind, or rent them for any car rides you’ll take. We planned our trip so that we were primarily traveling by plane or boat and made do without car seats for the short taxi ride from the airport. (Once there, we also found that most taxis didn’t have seat belts or clips, so we wouldn’t have been able to use car seats had we brought them.) We strategically packed a few clothing items that both kids were about to outgrow so that we could leave the clothes and have room for a few souvenirs on the return trip. [This paragraph was edited after posting to emphasize that the car seat decision is really dependent on where you’re traveling and how you plan your trip. It isn’t one to be taken lightly, and Sarah and her husband carefully considered their options before deciding not to bring them. ~Alice]

A word about diapers: We only had one child in diapers and brought just enough with us to last until we knew would be in a city where we could buy more (4 days worth). Diapers are bulky to pack and widely available in most cities, so only bring what you absolutely need.

Photo by Sarah Ruttan.

Photo by Sarah Ruttan.

2. Think about time zones. Sometimes you can’t choose where you travel, but when you do have a choice, consider how many time zones you want to cross with young kids. Jet lag can be brutal for adults, and it’s worse with toddlers who often take several (painful) days to adjust. We didn’t choose Peru because of time zones, but it was definitely a nice perk to only contend with a one-hour adjustment. We’ll likely save crossing the Atlantic or Pacific until our kids are a bit older and able to entertain themselves once we’re home and I want to sleep!

3. Choose an itinerary that will work for your kids at whatever stage they’re in. Continue reading

Stamps in their passport: The highs and lows of travel with children

I’m really excited to welcome my friend Sarah Ruttan as a guest blogger this week. Sarah and I had our first babies 5 weeks apart when we both lived in Tucson, AZ, and we developed a tight bond as we shared the early months of motherhood. Sarah is also an experienced traveler – with and without kids – so I was thrilled that she offered to write about some of her experiences with international travel with young children on Science of Mom. Today, she reflects on why she and her husband choose to travel with their kids and how it has pushed her to the edge of her parenting comfort zone – and maybe beyond. Tomorrow, she shares her best tips for pulling off an international trip with kids. Enjoy, and please feel free to share your own experiences in the comments!

Stamps in their passport: The highs and lows of travel with children

By Sarah Ruttan

Our family recently returned from a trip to Peru. It was our first travel adventure outside of the U.S. with both our son (almost 4) and daughter (16 months). My husband was headed to Peru for a training program and we decided to try making the journey together. Before you congratulate me on successfully traveling to another continent with two kids in tow, I have a confession to make: I’m REALLY tired. And the trip – while a good experience – was only sort-of-fun, in the way that many experiences with young kids end up being: great highs, followed by meltdown lows.

I’m a slow learner when it comes to this parenting thing. I should have recognized that hauling two kids to Peru was going to be a lot of work and that we would arrive back home exhausted, barely able to process the experience, wondering if it was worth it. Yet, I needed to do it to know what my limits are when traveling with kids, to know how much is too much and what the right balance of adventure is for us at this point in our lives.

IMG_6719

The author entertains her 16-month-old daughter on a 1.5 hour boat ride on the Amazon River in Peru.

Let’s be honest – there was an element of “We just want to prove that we can still do this” in our trip planning. Of all the things we missed most about life pre-kids, it was travel, and in particular, international travel. My husband and I have traveled to more than 30 countries. Some of those trips were taken as a couple in our pre-kid days, others on our own before meeting each other. I have fond memories of both my solo trips and our later trips together – carrying a backpack and exploring new cities, seeing foreign landscapes from the window of a train or bus, and clumsily navigating menus in languages we didn’t speak. These journeys expanded my view of the world and my place in it. We talked on those trips about what kind of travel we wanted to do when (if) we had kids. Continue reading

Parenting in the Present Moment: A Review and Giveaway

First, a baby update: no baby yet! I’m past 38 weeks now and definitely getting excited for baby’s arrival. I still feel like I have a lot of things on my to-do list that I’d ideally like to get done before I go into labor, but I’ve also entered a stage of acceptance that, ready or not, when the baby arrives, we’ll carry on with life even if the fridge isn’t fully stocked and the floors haven’t been mopped. However, one thing on my to-do list is this post, because I wanted to share with you a new parenting book that came at just the right time for me, and I think you’ll find it particularly helpful in the midst of the holiday craziness.

The book is Parenting in the Present Moment: How to Stay Focused on What Really Matters by Dr. Carla Naumburg, published in October by Parallax Press. I received a free review copy of the book, but as always, I only review books that I love and can whole-heartedly recommend (more on my review policy here). I have loved this book so much that I’ve already purchased several more copies to pass on to friends.

The last month or so has been really busy with copy-editing my own book and finishing up the college teaching term. A 3-week-long cold hit my late pregnancy body like a freight train in the middle of that, and I felt like I was barely getting to the most urgent tasks each day while my to-do list piled up around me. But every night, I would read a few pages of Parenting in the Present Moment before crashing into sleep, and I would feel like I could accept how that day had gone and reset my intention for parenting and for caring for myself for the next day.

First of all, I absolutely love the cover of this book. It speaks perfectly to the content of the book and one of the greatest challenges of parenting: maintaining balance even while your agile offspring challenge it. As a side note, something similar seems to happen to me almost daily: I squat down to pick something up, in a graceful way that only a 38-week-pregnant woman can manage, and my daughter comes up behind me to give me a surprise “hug,” which sends me teetering off balance.

Parenting-In-Present-Moment-Cover-Small

Just seeing that photo makes me smile and feel motherhood has always been this way, regardless of the species, and I’m doing okay.

This book is about parenting with mindfulness. What is mindfulness? Naumburg explains, “Mindfulness is about making a choice, over and over again, to pay attention to whatever is happening in the present moment without judging it or wishing it was different.” Really paying attention to what is happening with our kids and in our own minds can help us come back to the present moment and respond intentionally and effectively, with kindness and compassion for our children and ourselves. Continue reading

New Research on Gluten Introduction to Infants and Risk of Celiac Disease

If you’re worried about your child’s risk of celiac disease and wondering when to introduce gluten-containing foods, then you’ll want to know about two new studies published in the New England Journal of Medicine this week.

Gluten is delicious to most of us, but it can be devastating to those with celiac disease. Photo by Adrian van Leen

Gluten is delicious to most of us, but it can be devastating to those with celiac disease. Photo by Adrian van Leen

Celiac disease is an immune response to gluten, a protein found in wheat, barley, and rye. It causes inflammation and damage to the small intestine, and while it can be successfully managed with a gluten-free diet, it is a lifelong disease. (Celiac disease is distinct from non-celiac gluten sensitivity, which is a murky and controversial condition that may not be related to gluten at all.)

I reviewed the research on early infant feeding and risk of celiac disease on my blog about a year ago (Breastfeeding, Gluten Introduction, and Risk of Celiac Disease). I have since received lots of comments and messages from parents concerned about this, so I wanted to be sure to write about these important new studies.

These latest studies dramatically advance our understanding of this topic because they are randomized controlled trials. Both started with a group of babies already identified as being high-risk for celiac disease, randomly assigned them to different time of introduction of gluten, and then tracked their development of the disease. Previous studies were all observational, thus only able to identify associations between variables, and were limited by confounding factors and other sources of bias.

The first study was led by researchers in the Netherlands but included children born in 7 European countries and in Israel. 944 babies were identified as being high-risk for celiac based on a genetic predisposition (HLA genotype) and having a first-degree relative (parent or sibling) with celiac. The babies were randomized to two groups, and one group was given a small amount (100 mg) of gluten starting at 4 months of age, while the control group was given a placebo and instructed not to introduce gluten until 6 months, at which point parents in both groups were advised to gradually introduce gluten-containing foods. The incidence of celiac disease was tracked through 3 years of age, with all suspected cases confirmed with an intestinal biopsy. Overall, about 5% of the study participants developed celiac disease by age 3, and it made no difference whether gluten was introduced at 4 or 6 months. It also made no difference whether the babies were breastfed (exclusively or not) or currently breastfed at the time of gluten introduction.

The second study was conducted in Italy and had a similar design but instead compared gluten introduction at 6 vs. 12 months. Continue reading

Zero to Five: A Book Review and Giveaway

I received a review copy of a really cool book over the summer: Zero to Five: 70 Essential Parenting Tips Based on Science (and What I’ve Learned So Far) by Tracy Cutchlow. I loved the book and wanted to review it on my blog, and the publisher offered to give away 5 copies to Science of Mom readers! (If you’re curious about my policy on reviews and giveaways, check my About Me page.)

Author Tracy Cuthlow with her daughter, Geneva.

Author Tracy Cuthlow with her daughter, Geneva.

Zero to Five is a book of parenting advice starting with pregnancy and going up through age 5. Author Tracy Cutchlow is a former journalist at the Seattle Times and edited John Medina’s books Brain Rules and Brain Rules for Baby. Then she had a daughter, now 2, and was inspired to create a book that would bring together relevant, evidence-based parenting advice into an enjoyable and accessible format. I’d say she succeeded.

Each of the 70 parenting tips are explained in 2-4 page spreads summarizing the research in the area and accompanied by gorgeous candid photographs of children and parents. The tips are practical, and they’re explained simply, but they’re rooted in science.

ZTF-guard-babys-sleep

The book is divided into 9 topics headings, listed below with examples of some of my favorite tips in parentheses:

  • Prepare (Bolster your friendships; Expect conflict as a couple)
  • Love (Create a feeling of safety; Comfort newborn with the familiar)
  • Talk (Talk to your baby a ton; Read together; Teach sign language)
  • Sleep, eat, and potty (Guard your sleep; Guard baby’s sleep, too; Let baby decide how much to eat)
  • Play (Let baby touch that; Save the box; Make music with baby)
  • Connect (Choose empathy first; Allow mistakes, discomfort, boredom)
  • Discipline (Be firm but warm; Label intense emotions; Teach instead of punish)
  • Move (Rock, jiggle, and swing; Keep moving)
  • Slow down (Be still; Don’t bother to compare)

Some of these tips are obvious, like talking to your baby. But they’re also really important, and that’s one of the things I love about this book. 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

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

Traveling with Kids: It Isn’t All Bad (plus 7 tips to keep it that way)

I apologize for my long absence from the blog. It’s been a busy couple of months. We finally bought a house, and with the help of many friends, got moved to our new home. Then the projects began – and continue. Summer school term wrapped up, and I’m prepping for fall term to begin in a couple of weeks. My book is coming along slowly what with all of the above. The blog has been completely neglected.

But I need to get back here. It’s like running and yoga for me; once I get out of the habit of lacing up my shoes or rolling out my mat or actually hitting “publish” on a blog post, these things I love seem to get a bit harder to do. So today,  I thought I’d share my latest installment of Things I’ve Learned About Traveling with Children. (Follow the links to previous installments on traveling with babies and toddlers).

Last week, Cee and I traveled together to Kentucky, where I grew up. It was a last-minute trip, tickets booked just days before our flight. Husband was working and couldn’t leave on such short notice. The reason for our trip was bittersweet. A dear friend died unexpectedly, and we went to mourn her loss and celebrate her life. Despite the sadness, it was a special trip with Cee. It was her first visit to Kentucky, so she met (and vice versa) lots of old friends, many of whom now have kids of their own. (I no longer have immediate family in Kentucky, so we don’t visit there often.) Together, we explored the little house where I grew up, touched the grave of my father, and splashed in the creek where I spent the summers. My mom and my brother also came, so it was full reunion of family and friends.apple tree kids

Something else made this trip special: Cee was an absolute joy as a travel companion. Until this trip, travel always felt like a scary limbo – so long as we were in airports or on planes, until we had a bed and a home base, I carried the knowledge that everything might fall apart at any moment. There could be a poop explosion on the plane or projectile vomit upon landing. My bare boobs might fly out of my shirt as my nursing baby squirmed, the two of us wedged in the middle seat between two strange men.There could be two hours of inconsolable crying on a fully booked red eye from Oregon to New York. I say this because all of these things have happened over the last few years of traveling with Cee. We’re experienced travelers, we know the tricks, and we roll with the punches when things get messy. And they usually do, so I don’t much look forward to traveling.

But now… Cee is potty trained, so no poop explosions (although she did wear a pull-up while we were flying, just in case). She can now tell me when she feels nauseous, so we had plenty of time to get out the little complimentary motion sickness bag. And she’s weaned, so no need to lift my shirt. She sleeps when she’s tired, avoiding that dangerous over-tired state. sleepy headCee is two, but when people ask how old she is, I now feel the need to add that she’ll be three in November. Especially after this trip, she doesn’t feel like a toddler anymore. Continue reading