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Children and Celiac Disease: Going Back to School
Going back to school is usually full of excitement and anticipation. For parents of children with celiac disease, it can also be a time of anxiety.
Keeping children gluten-free in the school cafeteria and at school parties, classmates’ birthday parties, and after-school activities can be a trying task for parents. Health care providers—doctors, nurses, dietitians—can support parents in their efforts to keep their children safe when they eat at school and other places away from home.
“How you intervene really depends on the age of the child,” said Steven Schwarz, M.D., chairman of the department of pediatrics and chief of pediatric gastroenterology at University Hospital of Brooklyn-SUNY Downstate Medical Center. “When they’re younger, they’re really not aware of being different. It’s in the 2nd, 3rd, and 4th grades that you have to be very careful with kids. They want to be like their friends—they don’t want to be different.”
To avoid being ostracized, Schwarz advises against “broadcasting to the school that you have a child with celiac disease.” However, parents should meet with the school principal, nurse, and dietitian to ensure they are aware of the special needs of students on a gluten-free diet. Public schools must make reasonable accommodations for children on a gluten-free diet under the Americans with Disabilities Act, according to Pam Cureton, a dietitian with the Center for Celiac Disease Research at Massachusetts General Hospital and the University of Maryland celiac clinic.
Dietitians can help parents prepare for a meeting with the school dietitian, provide them with gluten-free alternatives to popular kids’ foods, and offer lunch menu suggestions.
“Diagnosing the disease is only the beginning,” said Cureton. “Health professionals must provide the education and support families need to stick with a gluten-free diet for a lifetime.”
Health care providers can play an important role supporting parents in their school interactions, according to Schwarz. They could
- Offer reassurance. Remind parents that children who inadvertently ingest a small amount of gluten—unless they are acutely sensitive—will not experience significant clinical symptoms.
- Intervene on the family’s behalf. Call and speak with the school principal or write a letter to the school explaining the child’s diagnosis and special dietary needs.
- Suggest alternatives. Offer parents suggestions for nutritious gluten-free foods they could substitute in their children’s diets and where they could find these products. Provide them with a list of dietitians and information about insurance coverage for nutrition counseling.
- Recommend sources of support. Direct parents to celiac disease support groups in the community or suggest they start one. Share a list of voluntary organizations parents could contact for information about local support groups and about celiac disease in general.
- Provide information. Give parents information to help them communicate more effectively with school staff. The Celiac Support Association’s website has information for “Getting Along at School” that includes sample letters parents can share with principals, school nurses, and cafeteria staff explaining what celiac disease is and how they can keep children with the disease safe at school.
Health care providers also should encourage families to schedule follow-up visits to ensure their children are sticking to their diets, controlling symptoms, growing, and staying healthy.
“Children of all ages should learn about their disease and diet along with their families and caregivers,” said Cureton. “With a health care provider’s guidance and support, parents and their children can work together to find ways to adhere to a gluten-free diet during the busy school year.”
For More Information
The following resources offer information about students and celiac disease:
“Getting Along at School,” Celiac Support Association
Understanding Your Student, Gluten Intolerance Group
“Bright Ideas for Gluten-Free School Lunches,” National Foundation for Celiac Awareness
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Page last updated September 24, 2014