Care and mobility considerations
Children with coeliac disease can remain completely well on a gluten free diet. Parents will need to provide this for their children on a daily basis until the child can manage their own dietary intake. The consequences of eating gluten are not life threatening in children with coeliac disease; however the consequences of continuing to eat gluten even if it does not cause symptoms are significant. They include an increased risk of other autoimmune diseases (diabetes, thyroid disease), osteoporosis, and very rarely, development of small bowel lymphoma. There is no treatment to reduce symptoms having eaten a foodstuff containing gluten.
Care needs
Children diagnosed with coeliac disease will require more care and attention to their diet than an unaffected child. This is because they are unable to eat a common component of the diet, namely gluten. Parents will need to provide completely gluten free meals for their children and will need to ensure that their food does not become contaminated with gluten during food preparation or storage. For example gluten free bread should not be toasted in a toaster used for normal bread; similarly separate butter should be used so that butter does not act as a transfer medium for gluten containing crumbs to the gluten free bread. Children will eat a diet of naturally gluten free foods and some gluten free substitutes for wheat based products.
Children are not at risk from gluten in the environment or from touching or using wheat based products providing that they do not put them in their mouths or eat them.
Typical food preparation practice
Typically, parents of children with coeliac disease will be very knowledgeable about their condition and foods that may contain gluten.
In order to avoid feeding their child gluten, families will often prepare most meals from scratch at home. This is the only way to ensure meals are not contaminated. Pre-prepared meals and sauces for home use or in catering often contain many different ingredients and unless clearly stated on the box there is always the possibility of contamination. A suitable item might list ‘gluten free’ or ‘suitable for a gluten free diet’ on the label. The Coeliac Society provides updated lists of safe foods including gluten free substitutes, recipes and tips for managing the diet. This type of information makes managing a gluten free diet much easier than it otherwise would be.
A common problem when eating out is contamination of cooking oil for example fish and chip shops may fry chips separately having previously used the oil to fry battered fish. So, although the chips should be safe, they are contaminated with gluten from wheat flour batter. Similarly, other bought products may be unexpectedly contaminated e.g. gluten free chick pea flour may be contaminated with wheat gluten during the milling process at the mill by wheat flour in the machinery or in the air. Very small amounts of contamination may make a food unsuitable. For example, the international standard for gluten free food which means that a food can be labelled gluten free is that the food contains less then 20 parts per million of gluten. Such food is safe for anyone with coeliac disease. ‘Very low gluten’ foods can be labelled as such if they contain less than 100 parts per million of gluten – this may be too much for some people with coeliac disease. Parents will provide supervision to prevent their child from eating gluten and provide gluten free food until they can do this for themselves.
