Families are presented with quite a few obstacles when a child suddenly requires a gluten free diet (GFD). The time surrounding the diagnosis of a celiac child is challenging and stressful. It can cause a lot of frustration for everyone involved, with a great deal of trial and error and parents often feeling confused.
Before the diagnosis these children often present with poor growth, developmental delay, irritability and gastrointestinal issues. Upon accurate diagnosis and treatment, children usually improve quickly. It is at this time when proper education regarding Celiac Disease becomes crucial for the future of the celiac child. Compliance with the GFD often falters as a result of the initial reprieve from symptoms, putting the child once again at risk for the complications of untreated celiac disease.
Recent studies indicate that the prevalence of CD in children worldwide could be as high as 1 in 80. Accordingly, the number of families dealing with the GFD is growing, since CD is ranked as the most common chronic disease among children. The reasons for the increase are not clear, but changes in how we feed infants and new recommendations for screening high-risk groups have surely had an impact. Some studies indicate that breastfeeding results in a later onset of CD. The reason may be the more gradual introduction of gluten. The onset of the disease seems to be merely postponed though, with no clear confirmation that it helps to avoid it altogether.
The most crucial issue is compliance with the GFD (Gluten Free Diet). Observance has been reported to be between 45% – 80%. However, even people who reported strict compliance had positive biopsies which points to a gross overestimation. Both the family and the child (if age appropriate) should be educated on the repercussions of untreated CD: osteopenia, osteoporosis, iron deficiency anemia, as well as several autoimmune diseases.
The key issue for a celiac child will be ensuring his or her optimal nutrition within the parameters of the GFD. Ideally, the majority of the nutrients should come from a sound diet. Replacing gluten-filled junk food with gluten-free junk food should never be the goal. The cornerstones of this diet should be healthy fats, vegetables, fruits, high quality proteins of animal origin and grains lacking gluten such as millet, rice, amaranth and quinoa. In order to bridge possible deficiencies, an appropriate GF multivitamin/mineral complex is recommended due to malabsorption issues. Nutrients of particular concern are calcium, iron, folate, thiamin and riboflavin.
The soundest long term strategy is empowering the GF child with age appropriate understanding and expanding on that knowledge as the child gets older. It is essential to the success of the GF lifestyle. Children should be encouraged to read labels and be involved in meal planning and cooking. Through this process a GF child can learn about making safe food choices and healthy eating. Equally important are frequent follow-ups by medical professionals. GF children should be encouraged to participate in educational activities and support groups that will not only ensure compliance but will also make the learning process enjoyable and fun.
Parents should plan meals ahead, especially when non GF kids are to partake of them as well. Children do not want to feel different from other children when it comes to food choices. To avoid uncomfortable situations for the GF kid, GF friendly recipes for spaghetti, macaroni and cheese, pizza, cookies, muffins and breads that look “normal” (now widely available) can be provided. Though these “look alike” foods should not constitute the backbone of a healthy GF diet, they clearly help to make the transition to a GF diet much less traumatic.
Finally, do communicate with family, friends, teachers, school administrators and day-care providers so they are aware of what your child cannot eat. Provide them with a printed “safe and unsafe” food list and always pack an ample amount of healthy GF snacks that they can safely give to your child when you are away.