Treating Celiac Disease in Children

The most common gluten-containing foods are those made with wheat flour. This includes bread (both white and wheat), pasta, cereal, cake, and pizza dough. Gluten is also often found in sauces, gravies, salad dressings, condiments, and most packaged foods. Learn to read food labels to look for gluten in everything your child eats. An expert in food and nutrition (dietitian) can help you start learning about foods with gluten. In general, your child can't eat foods made with:

• Wheat

• Rye

• Barley

• Spelt

• Kamut

• Bulgur

• Malt

• Semolina

• Oats. Oats are often fine. But some oats are contaminated with wheat. Talk with your provider or dietitian about safe brands.

There are plenty of foods that are naturally gluten-free. You can also find gluten-free breads, pastas, and other products normally made with wheat flour. Safe foods and ingredients include:

• Fruits and vegetables

• Fresh meats, such as beef, poultry, lamb, and pork

• Seafood

• Many dairy products

• Corn

• Rice

• Potatoes

• Beans

• Tofu

• Amaranth

• Buckwheat

• Millet

• Quinoa

Giving your child a gluten-free diet can take some time and planning. Your child’s food can’t come into contact with gluten. So all of your child’s meals will have to be made with separate utensils. This includes knives, cutting boards, toasters, and storage containers. It also means being extra careful at restaurants, parties, and anywhere you aren’t preparing your child’s food yourself. Gluten can also be found in a variety of nonfood products. Accidental ingestion can happen with products such as toothpaste, mouthwash, shampoo, lotion, makeup, glue, and soap. Some medicines also contain gluten, so ask your child’s healthcare provider what medicines your child should not take. One way to help prevent accidental exposure is for the whole family to go gluten-free. This can save you time and energy, and reduce your child’s risk of exposure to gluten. 

Getting used to your child’s gluten-free lifestyle can be a strain on the whole family. Your child may be upset about feeling different from friends or siblings. School events, parties, and holidays are times when your child might worry about not getting favorite foods. And your child’s siblings may resent strict controls over food in the house. If you face problems like these, a celiac disease support group can help (see box below). Support groups offer tips on making your child’s gluten-free lifestyle easier on the whole family. You may also wish to have all family members tested for celiac disease.

You can’t watch over your child 24 hours a day. Even if you are very careful, slip-ups can happen. But your child can learn how to avoid gluten when away from home. Here are some ways that you can help:

• Make sure your child knows that eating even a small amount of gluten can hurt the lining of the intestines. This can cause symptoms to return.

• Explain that your child will need to learn how to say “no” to foods with gluten.

• Provide safe foods for your child to bring to parties and school events. This can help keep your child from feeling left out.

• Don’t worry if slip-ups sometimes happen—kids will be kids! Your child will learn through practice.

Your child should be seen by their healthcare provider at least once a year for a celiac checkup. A simple blood test can show if your child’s celiac disease is under control. The blood test will check for antibodies. These are proteins made by your child’s immune system in response to the presence of gluten. If antibody levels are high, continued exposure to gluten may be the cause. This test is not helpful if the antibodies are not elevated before you start treatment. In this case, the healthcare provider can discuss with you how to find the source of gluten and get rid of it.

For more information about managing your child’s celiac disease, see:

• Celiac Disease Foundation at www.celiac.org

• National Institute of Diabetes and Digestive and Kidney Diseases at www.digestive.niddk.nih.gov

• Academy of Nutrition and Dietetics at www.eatright.org

• North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) at www.naspghan.org