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

What’s Your Feeding Style? (Fearless Feeding Review and Giveaway)

Do you have a feeding philosophy? What’s your feeding style?

These are not the most common topics in parenting discussions. We’re often too busy talking breast and bottle, baby led weaning or purees, organic or conventional, and how to get our kids to eat more vegetables. But the question of feeding style, I believe, matters more to children than any of these oft-discussed topics.

I am really pleased to have a new book on my shelf that covers the HOW and WHY of feeding children just as well as it covers WHAT to feed: Fearless Feeding: How to Raise Healthy Eaters from High Chair to High School, by Jill Castle and Maryann Jacobsen. Both authors are registered dieticians, mothers, and bloggers. They take a long-term view on feeding – that we shouldn’t just be concerned with what our kids are eating today, but also about teaching kids to eat well for a lifetime.

9781118308592_Castle.inddFeeding style is one of the first topics in Fearless Feeding, so if you’re not sure how to describe your own feeding style, here’s your chance to give it some thought. Castle and Jacobsen discuss 4 feeding styles, analogous to parenting styles that may be familiar to you: Continue reading

Potty Training: 7 Lessons Learned

Cee has been wearing undies for six months, and I think I’ve drafted a potty post for each of those months. Each time, before I had a chance to edit and publish it, something would change, and the post would seem irrelevant. Potty training is truly one of the hardest things I’ve done as a parent, but not in any of the ways that I expected. I thought I’d finally share some of the lessons I’ve learned so far. In other words, this post is mainly about my missteps and mistakes.

I write this knowing that your process, and the challenges that you face along the way, might be very different. Every kid is different, as is every parent. Like any two-year-old, Cee really wants to do things herself, but she is also a really sensitive kid. And as she’s been learning to use the potty, I’ve been learning more and more about her and how she ticks.

1. Begin when your child is ready.

Okay, I actually think that we got this part right. Cee started showing some interest in using the potty around 18 months. When she started daycare last fall, she jumped into the potty rotation with the bigger kids. By January, she was coming home at lunchtime in the same diaper (dry!) as when I dropped her off in the morning. And in February, after admiring her friends’ underwear, Cee told me that she wanted some too.

Cee was around 27 months when we made the switch to undies. Some would say that’s late, and some would say that’s early. I don’t think there’s a magic age, but I can’t imagine starting this process if Cee wasn’t interested in it. It’s been challenging enough as it is.

Of course, I did dig into the scientific literature to see if I could find some guidance on optimal timing and “methods.” But I think this is an area where the science is just not that helpful. Melinda Wenner Moyer recently wrote a review of scientific support for different methods of potty training at Slate, and she concluded that there’s decent support for parent-led and child-led and quick and gradual methods. This is true, but I also think that the potty training research is limited by the bias of the authors. Potty training is a culturally diverse practice, and a study conducted in a given place at a given time is always going to be framed by the norms of that place and time. Lacking good science, and considering that Cee is not interested in doing things just because I want her to, I waited until it was her bright idea to try going diaper-free. I began with the simple strategy of following her lead, praising her successes, and responding to accidents in a neutral way. Easy, right?

2. Ultimatums don’t work.

Here’s where I made my first mistake. Continue reading

Preparing Your Child for a Big Move (Book Giveaway!)

So, we’re moving this summer. At least, we think we are. The deal isn’t done yet, and we’re not even sure of our exact closing date, which is maddening. But probably, by the end of the summer, our little family will move to our first-ever, very-own home, just about a mile away from our current rental.

Talking about a move with Cee has been interesting. She’s been coming to look at houses with us from the beginning, starting in February. We struggled to explain to her why we were spending so much time dragging her through empty houses. We talked about moving to a new house, and she just looked confused. “Why, Mama?” Why, indeed, would we want to leave the only home she likely remembers? (We moved from Arizona to Oregon when she was 7 months.) What could be better than this house, the place of warm memories and celebrated milestones?

Cee thrives on the familiar. Even though we’ll still be living in the same neighborhood and not much else about her life will change, I know this move will be stressful for her. Heck, moving is stressful for everyone. So what can we do to ease the transition? I’ve had this question at the back of my head all summer.

I received the following guest post a couple of weeks back from the folks at Twigtale, a small parent-owned company that makes custom photo books to help kids with transitions. The Twigtale books are really cool, and I encourage you to check them out. Putting together a custom photo book for a big event is the kind of thing I might intend to do for Cee but never get around to, but Twigtale makes it easy with with a template and text written by child development experts. (Cee loves looking at our photo albums, but you know how long those take to put together. I’m still working on our 2012 family photo book!) So, I’m posting this article for those of you who, like us, might be approaching a move and as a sort of shout-out to Twigtale. They’ve also kindly offered to give away any custom photo book (about moving or any other topic they cover) to one Science of Mom reader. See the end of the post for more details!

Moving Guide – Preparing Your Child for a Big Move

By Allison LaTona, MFT

Summer is here, and with the warm weather and sunshine comes a lot of change for families.  The structure of the year gives way to more down time and loose fun.

Kids may be anticipating a new school year, with new teachers and classrooms, or perhaps starting school for the very first time.  Some parents decide to work on potty learning in the summer, as they can take advantage of the warmth outside providing more “naked time” for their children to better listen to their bodies.  And perhaps most stressful of all, you may be moving this summer.

So the burning question is, how to best prepare your young children for the move? Continue reading

My Favorite Parenting Strategy

A few weeks ago, I blogged about Cee’s long, drawn-out process of getting ready in the morning. She was maddeningly slow at changing from pajamas to her clothes for the day, but she also insisted on doing it herself. If I tried to help, the pace of progress slowed even more. If I tried to take over, it became a physical battle, and I was sure that wasn’t worth it. I tried a few strategies to keep our mornings moving, and readers offered more great ideas in comments on my post.

One of my more brilliant ideas, I thought, was a hand-drawn morning schedule for Cee. I drew a step-by-step diagram of what she needed to do each morning – get dressed, go potty, brush teeth – and then I showed that we could have a few minutes to read a book or play together before leaving the house, assuming she could move through her schedule at a reasonable pace. We drew out the schedule and discussed it the night before, and she was really into it. She showed it to Daddy and carried it around for her bedtime routine, then carefully placed it by her bed before she went to sleep. In the morning, she was excited to follow the schedule and get to book time, and she did it! I thought it was quite a success story. But, by the next morning, Cee was bored with the schedule idea. In fact, I’m pretty sure she saw right through it as one more pressure tactic from me. Cee doesn’t respond well to pressure, thinly disguised or not.

So. I settled on my favorite parenting strategy: patience. Honestly, I can’t think of a more important asset to the parent of a toddler.

I did a lot of little things to ease our morning crunch. I got as much ready the night before as I could; I went to bed and got up earlier to get some work done before Cee woke; and I asked Husband to take over on mornings when he could squeeze it in his schedule, just to ease my nerves. And then, I tried to summon more patience and relax. I trusted that this was a phase that wouldn’t last forever.

dressed and ready

Dressed and ready to go

I’m happy to report that I was right. For the last few mornings, I have woken to the sound of little feet running down the hall. Cee has been waking early, dressing herself, and then coming to wake me up with bed head and a big smile. That whole dressing fiasco? It’s gone. She’s getting dressed on her own, while I’m still snoozing.

Why the change? It isn’t anything I did. Me telling her that she needed to get dressed faster had zero impact, I can assure you. It’s more likely that it prolonged the process. Maybe she’s discovered that it’s more pleasant to get dressed without me breathing down her neck. Maybe she herself got bored with the snail-paced process and figured she’d rather get on with more interesting things in her day. But whatever it is, she is very proud of herself, and I am too. We’re both relishing her autonomy.

But now Cee has moved on to other time-consuming projects. Lately, she’s been wanting to buckle her own car seat. She can do this, but it takes long minutes of sitting in the car waiting for her. Sometimes we’re in a hurry, and I tell her that I have to do it this time, and sometimes that causes a meltdown. But if I can, I try to find my patience and let her do it herself. Just like the dressing process, the learning part takes time – much longer than if I did it myself. But I trust that at some point she’ll get really good at buckling her own seatbelt (always followed by my check). And then she’ll feel proud and independent, and ultimately that means that she does more things for herself. So again, patience.

Patience tells a toddler: You don’t have to be more than you are right now. And when I choose the patience strategy, I’m telling myself the same thing: You don’t have to fix this. You don’t have to have an answer. Staying calm is enough.

It’s tempting to try to fix the little challenges of every stage, but so much of childhood we really can’t control. We can try to prevent meltdowns with attention to sleep, food, daily rhythms, and choices, but when it comes right down to it, the meltdowns are bound to happen at some point. We can do everything right (whatever that means) in the transition from diapers to undies, but we’re probably still going to have some accidents and setbacks along the way.  We can cosleep or sleep train or something in between, and we’re still going to have days when we’re dead tired. So much of parenting is riding out the stages, focusing on the parts of each that we love and then coping with the tough parts as best we can. And then waiting, with patience, trusting that we’ll come out the other side with our kids, who will be moving on to new challenges before we know it.

What are your kids working on that is requiring your patience? And maybe more importantly, where do you find more patience when you’re running low?