Should I Give My Baby Grains?

Hi, I’m Cinthia Scott, The Baby Dietitian.

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Should I Give My Baby Grains?

Have you ever been told that introducing grains to your child should be avoided because babies can’t digest them? Or that the introduction of grains can contribute to food allergies or gut issues? I am here to debunk these myths and provide the evidence behind the introduction of grains. You might be surprised to hear that there are actually beneficial impacts of early introduction of grains. As with all foods, the best strategy is to introduce your child to many different varieties of foods to provide a balanced diet to ensure nutritional needs are met, grains included! 

Common misconception: “They don’t have enough amylase to digest grains!”

Let’s unpack this one, but bear with me because it may be a little “science-y.” 

There are six different digestive enzymes used in different percentages in the body to break down starches. (1) 

  1. Salivary a-amylase

Salivary a-amylase is found in the mouth and is the first enzyme that starts breaking down starch as soon as we place the food in our mouth. Due to the very acidic nature of an infant’s stomach, salivary a-amylase can survive those acidic conditions and continues to help digest starches in the stomach. At 3 months of age, salivary a-amylase has reached adult levels in an infant. (1)  

Breast milk contains a-amylase which further helps break down starch in the stomach (DOI: 10.1002/star.201700012). Breast milk a-amylase is not destroyed in the stomach as the pH is raised sharply after a meal of human milk and remains between 5.2 and 6.4 for as long as 120 minutes after the meal [69]. It is conceivable that milk a-amylase is an important enzyme for starch digestion in infants.

Blood amylase levels are stable immediately after birth. When feeding infants with starches (e.g., rice, corn, and potato starch), blood amylase activity decreases, and blood glucose concentration increases. This finding supports the view that there are no adverse effects in feeding young children starches.

Disclaimer: This digestive enzyme reaching adult levels at 3 months does not mean we need to introduce solids at that point. We adhere to all top health organizations on the need to wait until around 6 months of age, with all signs of readiness before the introduction of solids. 

  1. Pancreatic amylase

One of the most important enzymes for starch digestion in adults is pancreatic amylase. As we begin to introduce grains at six months of age, our body naturally begins to produce more pancreatic amylase which helps digest starch in the stomach. Pancreatic amylase is used for 30% of the amylase activity in the human body. (1) 

The activity of pancreatic a-amylase at birth is about 3% of that of adult levels, begins to increase at 7–8 months, and doesn’t reach adult levels until the age of 5-8 years old, but that is okay – thanks to all the other digestive enzymes we do have in adult levels at this age to help break down the grains. 

We also know that as soon as grains begin to be introduced, the human body naturally starts to produce more pancreatic amylase in response to this. (2) This is the same thing that happens as babies consume more protein, their body provides more enzymes to digest.

To note again, pancreatic amylase is only used for 30% of amylase activity in the human body. There are six different digestive enzymes required to break down starch molecules and they all work together in various %’s. 

Bonus, human milk contains a-amylase which further helps break down the starch in the small intestine, which can help compensate for the lower levels of pancreatic amylase in young children. (3) 

  1. The 4 other digestive enzymes

The four other digestive enzymes that the body needs to break down starch (α-glucosidases, including Maltase-glucoamylase and sucrase-isomaltase) reach adult levels during gestation or shortly after birth. Meaning yes, your baby can digest grains and other starchy foods like root vegetables, fruits, and legumes. (4) 

“Starch digestion is dependent on a combination of pancreatic and salivary amylase and the intestinal brush border enzymes glucoamylase and sucrase-isomaltase.” (5)

One of the primary enzymes used for starch digestion in infants is maltase-glucoamylase which is similar to adult levels in infants and is thought to be sufficient to deal with the starch content in diet at this stage of life. (6)

As you can see, it is true that starch digestion does not happen in the same way in adults as it does in infants, but it does happen!

“Have any studies been conducted to evaluate whether babies are experiencing malabsorption of starch?”

Yep, they are working on creating more research trials on this to determine the exact amount of starch a child can digest, with the digestive enzymes they do have at the age of introducing solids. 

Some thing that may surprise you is that in some of the studies that showed some malabsorption, the undigested carbohydrates are actually fermented in the intestine and produce a beneficial change in the gut microbiome that has been shown to have health benefits. 

“Current research suggests that infants may not absorb on average ∼20% of the starch they consume, a somewhat greater proportion than in adults” (6) 

Even in adults, we do not digest all the starch we consume, which is labeled as “resistant starches”. These resistant starches feed our gut bacteria to promote a healthy microbiome. The starches do not just sit there and “rot” as some people like to claim, but they move to the large intestine and “ferment.” Resistant starch introduction promotes gut microbiome changes that are beneficial for overall health. PMID: 38282825 

This is especially helpful for babies! The beneficial bacteria in the large intestine that it is feeding when it ferments increases the amounts of nutrients babies can absorb from the food they eat and is used as an additional source of energy when needed. 

“Transitioning to a more mature microbiota is suggested to have beneficial host effects such as increased vitamin biosynthesis and xenobiotic degradation, training and shaping of the immune system, and a growing ability to metabolize increasingly complex substances leading to the production of valuable fermentation products” (7) Epidemiological studies have consistently demonstrated a beneficial relationship between whole-grain intake and risk of cardiovascular disease, obesity, and diabetes in adults.

“If a baby can’t digest 100% of the starches, why should we even give them any?”

  • Early introduction of starch stimulates pancreatic a-amylase production
  • Early introduction of gluten-containing foods may reduce the risk of celiac disease. (8)
  • Early introduction of allergenic foods including wheat has been shown to potentially reduce the risk of food allergies. (9)
  • Grains can promote a healthy gut microbiome, which in return, reduces the risk of certain diseases. (10)
  • Grain-based cereals have long been used around the world as an easy first food source that can be fortified with essential nutrients for development (i.e. iron, zinc, b vitamins) during a rapid phase of growth. Fortified cereals are an effective strategy to prevent nutrient deficiencies and malnutrition. (11, 12, 13, 14)
  • Cereals are an excellent source of energy, and their soft texture and smooth, semi-solid consistency might aid in transitioning from exclusive milk feedings to foods with increasing texture. 

Introducing a wide variety of foods and textures during a period of adventurous eating helps establish a diverse palate and ensures nutritional needs are being met. Starches are not just found in grains but also in root vegetables, legumes, and certain fruits, which should not be limited in an infant’s diet due to their nutritional content and known health benefits. Restricting food groups can make it difficult to meet a baby’s high energy and nutrient needs.

Starches in Infant Formula

Did you know infant formula contains starches? They actually have between 9g-14g of carbohydrates per 100 calories! Lactose, maltose, sucrose, glucose, maltodextrin, glucose syrup, precooked starch, and gelatinized starch can all be used in infant formula. Even some modified starches, such as octenyl succinic acid (OSA) modified starch, are used in infant formula!

Another fun fact: Infants should be have at minimum, 40% of their total energy from carbohydrates (mainly in the form of lactose)! This percentage gradually increases to 55% by the time they reach 2 years old, hence why incorporating starches into baby’s diet is so important!

Summary:

With the current research we have available, it is clear that babies do have the digestive capacity to digest a significant proportion of the starches they consume. The undigested starch is used to promote beneficial gut microbiome changes that decrease the risk for chronic health conditions. 

We do not have any research that shows negative health impacts of including beneficial whole grains and starch-rich foods in an infant’s diet, and avoiding starch-containing foods could potentially increase the risk for food allergies or wheat intolerance. 

Overall, current research suggests that while infants have lower levels of pancreatic and salivary amylase compared to adults, they possess the capacity to digest starches from early infancy, with their digestive capabilities gradually improving as they grow older and transition to a more diverse diet. As the infant matures and transitions to a more diverse diet, their ability to digest starches increases. 

To say it one more time, no harmful effects of negative outcomes of starch consumption during complementary feeding have been reported. (15)

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Resources: 

  1. Lin, A.H.-.-M. and Nichols, B.L. (2017), The digestion of complementary feeding starches in the young child. Starch – Stärke, 69: 1700012. https://doi.org/10.1002/star.201700012
  2. Zoppi G, Andreotti G, Pajno-Ferrara F, et al. Exocrine pancreas function in premature and full term neonates. Pediatr Res 1972; 6:880–886.
  3. Heitlinger LA, Lee PC, Dillon WP, Lebenthal E. Mammary amylase: a possible alternate pathway of carbohydrate digestion in infancy. Pediatr Res. 1983 Jan;17(1):15-8. doi: 10.1203/00006450-198301000-00003. PMID: 6188091.
  4. Lee PC, Werlin S, Trost B, Struve M. Glucoamylase activity in infants and children: normal values and relationship to symptoms and histological findings. J Pediatr Gastroenterol Nutr. 2004 Aug;39(2):161-5. doi: 10.1097/00005176-200408000-00007. PMID: 15269621.
  5. Rodríguez, M.D., León, A.E. & Bustos, M.C. Starch Digestion in Infants: An Update of Available In Vitro Methods—A Mini Review. Plant Foods Hum Nutr 77, 345–352 (2022). https://doi.org/10.1007/s11130-022-01001-1
  6. Stephen A, Alles M, de Graaf C, Fleith M, Hadjilucas E, Isaacs E, Maffeis C, Zeinstra G, Matthys C, Gil A. The role and requirements of digestible dietary carbohydrates in infants and toddlers. Eur J Clin Nutr. 2012 Jul;66(7):765-79. doi: 10.1038/ejcn.2012.27. Epub 2012 Apr 4. PMID: 22473042; PMCID: PMC3390559.
  7. Plaza-Diaz J, Bernal MJ, Schutte S, Chenoll E, Genovés S, Codoñer FM, Gil A, Sanchez-Siles LM. Effects of Whole-Grain and Sugar Content in Infant Cereals on Gut Microbiota at Weaning: A Randomized Trial. Nutrients. 2021 Apr 28;13(5):1496. doi: 10.3390/nu13051496. PMID: 33925049; PMCID: PMC8145071.
  8. Logan K, Perkin MR, Marrs T, Radulovic S, Craven J, Flohr C, Bahnson HT, Lack G. Early Gluten Introduction and Celiac Disease in the EAT Study: A Prespecified Analysis of the EAT Randomized Clinical Trial. JAMA Pediatr. 2020 Nov 1;174(11):1041-1047. doi: 10.1001/jamapediatrics.2020.2893. PMID: 32986087; PMCID: PMC7522778.
  9. Trogen B, Jacobs S, Nowak-Wegrzyn A. Early Introduction of Allergenic Foods and the Prevention of Food Allergy. Nutrients. 2022 Jun 21;14(13):2565. doi: 10.3390/nu14132565. PMID: 35807745; PMCID: PMC9268235.
  10. Chen Z, Liang N, Zhang H, Li H, Guo J, Zhang Y, Chen Y, Wang Y, Shi N. Resistant starch and the gut microbiome: Exploring beneficial interactions and dietary impacts. Food Chem X. 2024 Jan 3;21:101118. doi: 10.1016/j.fochx.2024.101118. PMID: 38282825; PMCID: PMC10819196.
  11. Nicklas TA, O’Neil CE, Fulgoni VL 3rd. Nutrient intake, introduction of baby cereals and other complementary foods in the diets of infants and toddlers from birth to 23 months of age. AIMS Public Health. 2020 Mar 4;7(1):123-147. doi: 10.3934/publichealth.2020012. PMID: 32258195; PMCID: PMC7109529.
  12. Ekoe T, Bianpambe OI, Nguefack F, Pondi DM, Kana-Sop MM, Hays NP, Medoua G, Koki PN. Efficacy of an iron-fortified infant cereal to reduce the risk of iron deficiency anemia in young children in East Cameroon. Food Sci Nutr. 2020 Jun 4;8(7):3566-3577. doi: 10.1002/fsn3.1639. PMID: 32724619; PMCID: PMC7382166.
  13. Klerks M, Bernal MJ, Roman S, Bodenstab S, Gil A, Sanchez-Siles LM. Infant Cereals: Current Status, Challenges, and Future Opportunities for Whole Grains. Nutrients. 2019 Feb 23;11(2):473. doi: 10.3390/nu11020473. PMID: 30813426; PMCID: PMC6412837.
  14. Plaza-Diaz J, Bernal MJ, Schutte S, Chenoll E, Genovés S, Codoñer FM, Gil A, Sanchez-Siles LM. Effects of Whole-Grain and Sugar Content in Infant Cereals on Gut Microbiota at Weaning: A Randomized Trial. Nutrients. 2021 Apr 28;13(5):1496. doi: 10.3390/nu13051496. PMID: 33925049; PMCID: PMC8145071.
  15. McKeen, S.; Young, W.; Mullaney, J.; Fraser, K.; McNabb, W.C.; Roy, N.C. Infant Complementary Feeding of Prebiotics for the Microbiome and Immunity. Nutrients 2019, 11, 364. https://doi.org/10.3390/nu11020364
  16. Gillard BK, Simbala JA, Goodglick L. Reference intervals for amylase isoenzymes in serum and plasma of infants and children. Clin Chem. 1983 Jun;29(6):1119-23. PMID: 6189641.
  17. Lindberg T, Skude G. Amylase in human milk. Pediatrics. 1982 Aug;70(2):235-8. PMID: 6179037.
  18. Morzel M, Palicki O, Chabanet C, Lucchi G, Ducoroy P, Chambon C, Nicklaus S. Saliva electrophoretic protein profiles in infants: changes with age and impact of teeth eruption and diet transition. Arch Oral Biol. 2011 Jul;56(7):634-42. doi: 10.1016/j.archoralbio.2010.12.015. Epub 2011 Mar 22. PMID: 21429473.
  19. Nichols, Buford∗; Klish, William J.†. Complementary Starch Feeding of the Young Child: Starch Digestion Consortium Workshop 18. Journal of Pediatric Gastroenterology and Nutrition 66():p S1-S3, June 2018. | DOI: 10.1097/MPG.0000000000001972

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Cinthia Scott is a Registered Dietitian (RD) and International Board Certified Lactation Consultant (IBCLC) with over 7 years experience in the field of dietetics. Cinthia focuses on ensuring optimal nutrition in the first 1000 days of life to ensure optimal growth and development as well as set the stage for long-term health. Cindy is an author, starting solids expert, and advocate for caregivers receiving evidence based education and support surrounding breastfeeding and starting solids. 

Cinthia is co-author of the 101beforeone Starting Solids Book, “101beforeone -baby-led feeding cookbook,” and is the founder and owner of The Baby Dietitian LLC which is her private practice built to provide virtual 1:1 services for caregivers surrounding infant nutrition, toddler nutrition, and breastfeeding support. Cinthia is also the creator of the Starting Solids 101 Program which provides caregivers 1:1 support from a Pediatric Dietitian on how to provide optimal nutrition from the start and create healthy eating habits that will last their whole lifetime. To work with Cinthia, you can access her services here. 

Cinthia provides tons of free information for parents on her social media accounts as well. 


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