Coeliac Disease & Kids: The guide to help parents manage their child's gluten-free diet
Written By Kate Annat, APD
What is Coeliac Disease in children?
Coeliac disease in a child happens when their immune system reacts to gluten, the protein in wheat, barley and rye. It causes trouble in the small intestine and can lead to stomach issues, tiredness and stunted growth. The solution? A gluten-free diet for life. This may feel overwhelming initially, but with some adjustments to the diet, your child can lead a healthy and happy life. Regular check-ins with your doctor will be necessary to ensure you have them on the right path. And I’m always here to help you through this journey.
What are the common signs and symptoms my child has Coeliac Disease?
Children with Coeliac Disease may exhibit a variety of symptoms, and the severity and combination of symptoms can vary from kid to kid. There are some common signs to look out for including:
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Digestive issues such as chronic diarrhoea, constipation, bloating, and abdominal pain,
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Poor growth or a noticeable slowing down of rate of growth,
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A general feeling of fatigue,
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Regular episodes of irritability and changes in behaviour,
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Unexplained weight loss
What is the process for diagnosing a child with Coeliac Disease?
Step 1: Initial consultation with your child’s Paediatrician
The Paediatrician will review the child's medical history, discuss symptoms and perform a physical examination.
Step 2: Refer your child to a Gastroenterologist
The Gastroenterologist will also review your child’s medical history, discuss symptoms and perform a physical examination, but as an expert in Coeliac Disease and other gut disorders, this consultation will be more specialised.
Step 3: Run blood tests
If the Gastroenterologist suspects Coeliac Disease, typically a series of blood tests will be performed to check for antibodies commonly associated with this condition. One such test is the tissue transglutaminase IgA (tTg-IgA) test, an enzyme that lives in the intestine. Commonly this test is run twice, for a more accurate reading.
Step 4: Biopsy to confirm diagnosis
The Gastroenterologist might recommend performing a biopsy examination to determine conclusively if your child has Coeliac Disease. A biopsy, whilst seeming dramatic, allows for direct examination of the small intestine tissue, to check for any damage or inflammation of this area. Blood tests alone are indicative only, but a biopsy is necessary for a definitive diagnosis and to assess the extent of intestinal damage.
What happens next after the diagnosis of Coeliac Disease?
Now it’s time to start working on the solutions.
As a Paediatric Dietitian, I'll work closely with you and the medical team to review the child's current diet and provide guidance on a gluten-free diet. Sometimes, a gluten challenge, involving the reintroduction of gluten for a period, may be recommended to determine the severity of the condition. Don’t worry, I have expertise in guiding parents the whole way, from the initial diagnosis of Coeliac, to developing a feeding plan and then on-going support to get your child thriving and back on track with normal growth and development.
What are the long term effects my child with Coeliac Disease may experience if they continue to eat gluten?
For a child with Coeliac Disease, eating gluten can be detrimental to their health and development in many ways. Some of these include:
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Intestinal damage: Continuous exposure to gluten can cause persistent inflammation and damage to the lining of the small intestine, leading to poor absorption of crucial nutrients like vitamins and minerals, necessary for overall well-being.
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Nutritional deficiencies: The compromised intestine may struggle to assimilate essential elements like vitamins and minerals, leading to deficiencies that impact growth and development.
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Delayed growth and puberty: Untreated coeliac disease in children can lead to delayed growth and delayed onset of puberty due to nutritional deficiencies and the impact on hormonal balance.
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Poor bone health: Long-term exposure to gluten can contribute to reduced bone density, increasing the risk of fractures and osteoporosis in the future.
The good news is, kids with Coeliac Disease can avoid these problems by sticking to a gluten-free diet. Thankfully today, there are many GF options children enjoy eating without feeling like they are missing out.
What are gluten-free foods that I can feed my child?
It's important to strictly adhere to a gluten-free diet, as even small amounts of gluten can trigger symptoms. But don't worry as there are many foods kids like that are gluten-free and safe to eat. If a product is processed in any way, always check the label to learn if it is gluten-free or not. Below I will show you what to look out for when reading labels. My list of gluten-free foods include:
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Fruits and Vegetables: Fresh fruits and vegetables are naturally gluten-free. Be cautious with pre-packaged or processed options, as they may have added ingredients that contain gluten.
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Meat and Poultry: Fresh, unprocessed meat and poultry are gluten-free. However, some processed meats, such as sausages, may contain gluten as a filler or binder, so it's essential to check labels.
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Fish and Seafood: Fresh fish and seafood are generally gluten-free. However, be cautious with processed or breaded seafood, like fish fingers, as it may contain gluten. Find a gluten-free alternative, or make your own gluten-free coating.
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Dairy Products: Most dairy products are gluten-free, including milk, cheese, and yogurt. However, flavoured dairy products may contain gluten, so check labels carefully.
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Eggs: Eggs in their natural form are gluten-free.
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Grains and Flours: While wheat, barley, and rye contain gluten, there are many gluten-free alternatives, such as rice, corn, quinoa, millet and buckwheat. Check below for an extensive list of gluten-free flours and those to avoid.
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Gluten-Free Pasta and Bread: Many gluten-free pasta and bread options are available, typically made from rice, corn or other gluten-free flours.
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Nuts and Seeds: Nuts and seeds are naturally gluten-free. However, cross-contamination can occur during processing, so choose products labeled as gluten-free.
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Legumes: Beans, lentils and peas are gluten-free but check for cross-contamination.
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Snacks and Treats: Many gluten-free snacks and treats are available, including gluten-free crackers, chips and cookies. Look for those labelled as certified gluten-free products.
This covers many of the flours and grains available in Australia but it is by no means an exhaustive list. If you find a flour not on this list, check the product label to determine if it's a safe, gluten-free product or not.
How to read a label to check if it's gluten-free
Some products make it easy by clearly stating it as ‘gluten-free'. However, it's always a good idea to read the label to be sure. In Australia, manufacturers must follow labelling regulations to provide consumers with important information about the product. To understand if a product is gluten-free or not, the sections to check are:
Ingredients statement:
If an ingredient comes from wheat, rye, barley, or oats, it will be clearly stated in bold in the ingredient list. If these grains are not mentioned, it means none of the ingredients are derived from gluten-containing grains.
Contains statement:
The ‘Contains’ statement lists specific allergen foods in a product. The food code requires gluten and wheat be listed as separate ingredients.
Exceptions to the rules:
Sometimes a product will list that it contains wheat, barley or rye, however the product states it is gluten free. This is because after food processing the total content of gluten in the product is less than 20ppm and is therefore deemed GF. Examples include:
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Wheat derived glucose, Caramel colour (150), Dextrose (wheat), Fructose (wheat), Maltose (wheat), Sorbitol (wheat), Maltitol 965, Gluconodelta-lactone 575, Glutamate based flavours 620-625
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Food additives sourced from wheat or barley are safe to eat unless listed after the number eg 234 (Barley) and 1400 - 1450 (Wheat)
Precautionary Allergen Labelling statement:
These are voluntary statements and can be written as such:
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‘May be present: Gluten’,
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‘May contain: Wheat’,
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‘Manufactured on the same line as gluten containing products’
For safety, it’s best to avoid foods with gluten or wheat listed in this statement but it’s an individuals choice.
I created a one pager on reading labels to help you understand the labelling rules and what to look out for when selecting safe foods for your child with Coeliac Disease Please download and use it as a reference guide for next time you're shopping.
Check products online before shopping to create your gluten-free food shopping list
If you shop at Woolworths or Coles, I highly advise you check their websites beforehand. They both make it easy to filter products by allergen. Here's how to filter the products that are gluten-free on their websites.
Click to go to the Woolworths homepage
Step 1: Type in your product category (eg cereal, snacks) in the search bar at the top.
Step 2: Scroll down to the section with oval buttons spread across the screen from left to right. Click on the 'Allergens' button to expand the list. Now check the box for 'Gluten Free'. Scroll a bit further down this list and click on the green button, 'See results'. Now you have a list of safe, gluten-free foods for your child to eat.
You can also add in multiple filters to make the selection more specific. For example, if you are looking for kids lunchbox gluten-free products. Follow this:
In the top search bar, type in 'kids'. Now click on the 'Categories' button and check 'Lunchbox'. Look to the right and click on the 'Allergens' button. In the dropdown list, check 'Gluten Free'. You now have a list of ideas for the lunchbox.
Being able to search not only is convenient, but it's also a great way to see all the options you have available and makes the gluten-free diet not seem so restrictive.
And a third way, is to start with 'gluten free' in the top search bar. Now apply filters to the search through the 'Categories' button. The two most relevant categories for children are 'Lunchbox' and 'Baby' (further down the list).
For Coles, it's similar. Here are the steps.
Click to go to the Coles homepage.
Step 1: Type in your product category (eg cereal, snacks) in the search bar at the top.
Step 2: In the Filter by section, look to the right for Allergens. Click and a side box will pop up. Check the Gluten Free box and now you have the filtered product list.
Can my child with Coeliac Disease eat oats?
Oats are naturally gluten-free. However, there are 2 problems with oats:
1. The protein in oats is very similar to gluten. A small percentage of children with Coeliac Disease will also react to oats.
2. Oats are often cross-contaminated with gluten. This means they are processed on machinery where gluten containing products are also process, such as wheat.
How can I determine if my child will react to oats?
You will work with your Paediatric Gastroenterologist to determine their tolerance to oats. Start your child on a gluten-free diet and exclude oats. After some time of being on the diet, your Paediatric Gastroenterologist will conduct a blood test to check your child's TTG IgA levels. If they have normalised, this is a good sign they are responding well to the gluten-free diet. Now your Gastroenterologist will guide you on when to reintroduce oats. You will need to make sure the oats are 'pure' oats, those guaranteed to be free of any cross-contamination. If your child has no symptoms and their blood tests remain negative, you know they can tolerate oats. I can help you manage your child's gluten-free diet once the negative blood test results have be obtained.
What do I need to know about cross-contamination?
Cross-contamination is important because even tiny amounts of gluten can trigger adverse reactions in children with Coeliac Disease. This can happen when things like kitchen tools, cooking surfaces or shared ingredients are used for both gluten-containing and gluten-free foods. With the proper precautions in place it is preventable. Educating the whole family is also important, to make sure everyone is aware of how to prevent cross-contamination.
Here are my tips for what to do at home.
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Use separate cutting boards, knives and cooking utensils for gluten-free foods (to make this clear to everyone, label the items as gluten-free only items)
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Use separate appliances like blenders, mixers and food processors to eliminate any gluten residue
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Clean and sanitise surfaces used for gluten-free food preparation thoroughly
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Have a gluten-free only toaster
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Use fresh water in the pot for gluten-free pasta and either clean the colander thoroughly or have a separate colander for straining the gluten-free pasta
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Wash your hands thoroughly after handling gluten containing foods
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Clean pots and pans with soap and water
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Using a dishwasher will remove gluten
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Have separate jars of butter, jam, vegemite etc to prevent gluten-containing crumbs from contaminating them
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Store gluten-free items separately from gluten-containing products in the pantry and refrigerator and label them clearly as such
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If possible, create a dedicated gluten-free space in the kitchen for storing and preparing gluten-free foods
Here are my tips for what to do at school, not only to prevent cross-contamination but also to inform the school of your child's diagnosis of Coeliac Disease.
1. Clearly explain your child's diagnosis of Coeliac Disease and the necessity of a strict gluten-free diet
2. Educate the child's main teacher on the importance of preventing cross-contamination
3. Ensure that the teacher is aware of the signs and symptoms of accidental gluten exposure, such as stomach pain, fatigue, or headaches, so they can respond appropriately
4. Request advance notice about any special events, class trips or classroom celebrations involving food
5. Provide a list of safe snacks and treats that your child can enjoy and also give the teacher a stash of gluten-free snacks that can be kept in the classroom for unexpected situations
6. Provide a list of foods and ingredients that contain gluten
7. Encourage open communication between you and the teacher
My tips on what to do when eating out.
1. Opt for restaurants with a good reputation for accommodating dietary restrictions, offering gluten-free options and understand the importance of correct food preparation to prevent cross-contamination
2. Call the restaurant before going, to ask what gluten-free options are available and how they prepare foods to ensure cross-contamination doesn't occur
3. Download the app, FIND ME GLUTEN FREE which gives a list of gluten-free restaurants filtered to specifics e.g. location or meal
4. Clearly communicate your dietary restrictions to the server and emphasise the importance of avoiding cross-contamination
5. Avoid foods fried in the same oils as batter which contains wheat
6. Be aware of potential hidden sources of gluten in sauces and marinades and ask the server for clarification of the ingredients
7. Select cuisines which are more likely to have a larger list of gluten-free foods like Indian, Thai, Mexican and Vietnamese
What are some helpful resources for children on a gluten-free diet?
These are my go-to websites and apps I tell parents to download and refer to regularly. They are a wealth of information and are kept updated on a regular basis:
Coeliac Australia helps with shopping. Details over 800 ingredients & 300 additives. Good for recipe ideas too.
Find Me Gluten Free helps with eating out. Lists gluten free restaurants filtered to specifics e.g. location or meal
FoodSwitch helps with shopping. Use the GlutenSwitch filter & scan barcodes to find gluten free choices. Available as an app on Apple and Google Play.
How can a certified Paediatric Dietitian help?
Once Coeliac Disease has been diagnosed, I will work with you and your child to manage the nutritional treatment plan. I’ve worked with many patients and families through the process and bring all this experience to your situation. Following the initial consultation, I will be supporting your child through their individualised nutrition plan. Please feel free to ask any questions or raise concerns you encounter. I am there for you and your child.
Working with me is easy. Just follow these 3 steps and we’ll get you and your child on the road to peace, health and happiness.
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Book an appointment: in-person or online video call
I’ll meet with you and your child via telehealth or face to face. We’ll discuss your child’s full history from birth until today and answer all your questions.
Get a customised nutrition plan
You’ll receive a nutrition plan that meets your child’s specific needs.
See your child thrive and their confidence grow
As your child’s digestion improves happiness will return to your mealtimes.
FAQs: About Coeliac Disease & the Gluten-Free Diet for Children
Here are some of the common questions I've been asked by parents and carers regarding their child with Coeliac Disease and how to thrive on a gluten-free diet.
How long will my child have to stay on a gluten-free diet?
Your child will need to be on a gluten-free diet for life. Luckily there are many very delicious and nutritious gluten-free foods so they don't have to feel like they are missing out or under nourished.
How strict do I need to be?
The smallest amount of gluten, even from cross-contamination may damage the small intestine, even if there are no noticeable symptoms.
Is wheat free the same as gluten-free?
No, many foods labelled as wheat-free will contain other gluten-containing grains such as rye or barley. Check the 'Contains' statement in the ingredient panel and it will tell you whether it is wheat-free and gluten-free.
Do I always have to make a 'special' dish for my child with Coeliac Disease?
No, there are so many gluten-free recipes the whole family will like that you can make the same meal for everyone. And there are many substitute ingredients for popular family recipes like using cornflour instead of plain flour in soups, stews and gravy. Remember to check all ingredients are gluten-free, especially the smaller items like stock cubes.
What should I do about my child going to birthday parties and other events not organised by me?
Of course children want to feel included and going to a friend's birthday party is a part of growing up. The advice I give my parents and carers is to call the family organising the party and explain your child is on a gluten-free diet. It's realistic to assume that the cake will not be gluten-free, so in this case, you might want to provide a gluten-free item, such as a cupcake or an ice-cream, for your child to be given and join in the celebration.
Is play dough made from plain flour a problem for a gluten-free child?
Gluten cannot be absorbed through the skin so playing with play dough made with a gluten containing flour like wheat is only a problem if they eat it! However, make sure the child washes their hands thoroughly after playing with playing dough as they are likely to eat with their fingers and this could cause a gluten reaction.
And if you think your child may try and eat the play dough, especially little ones, here's a gluten-free play dough recipe that's just as good as the regular one!
Ingredients:
230g (8oz) rice flour
230g (8oz) corn flour
230g (8oz) salt
4 teaspoons cream of tartar
2 tablespoons vegetable oil
2 cups water
Colouring
Instructions:
1. Place all ingredients in a saucepan.
2. Cook over a low heat for 5 minutes, stirring continuously. The mixture will start to thicken.
3. Add in the food colouring drop by drop, until you are happy with the brightness of the colour.
4. Keep in an airtight container. It will keep for several months.
5. Have fun!
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