Coeliac disease affects one in 300 of the UK population, yet the first time that many childcare professionals hear of the condition is when a coeliac child is placed in their care. Even then they can be unaware of the severity of the condition, and uncertain about how to care for the coeliac child.
Coeliac disease is caused by an inability to digest gluten, a protein found in cereal grains such as wheat, oats, barley and rye. It is a permanent, auto-immune condition that lasts for life and, if incorrectly handled, can cause serious health problems including bowel cancer, bone disease and infertility.
A person can be diagnosed at any age but, in many cases, the condition is discovered within the first five years of life. Once a child is suspected of having the condition, a small intestinal biopsy and a trial on a gluten-free diet can confirm the diagnosis.
Symptoms vary, but the ones most commonly found in children are:
* a failure to thrive
* small stature
* abdominal distension (with or without pain)
* frequent diarrhoea
* irritability, and
* vomiting.
There is no form of medication for the disorder, but once diagnosed, a child is able to live a normal, healthy life on the condition that they adhere to a strict diet.
Case study
Jenny is a bright, sunny member of a school nursery class. She was diagnosed as a coeliac at two years and ten months of age, and is now well established on her diet and in excellent health.
The school provides gluten-free lunches for Jenny and she has a good understanding of her condition. Her fellow pupils and all members of staff are supportive and encouraging about 'Jenny's special food'.
During one break period, the playground assistant saw Jenny's friend take a handful of crisps from her own bag and place them into Jenny's packet. The assistant quickly removed the bag from Jenny, explaining that her friend's crisps might make her unwell, and replaced it with a bag from a special supply of 'safe' goodies that Jenny's parents had provided.
Later, at story time, the teacher praised the children for their kindness in sharing, but gently reminded them that some types of crisps might make Jenny ill. She also explained the situation to Jenny's mother at home time and asked her to remind Jenny about the danger of sharing food.
After this incident, staff were also asked to be extra vigilant during break-time supervision.
Settling in
So how should early years settings prepare for the admission of a coeliac child? An ideal first step is to organise a meeting with the parents, child and all staff members (including catering staff). Parents can provide literature, information and advice about their child's needs, while the setting can reassure the family that the child's condition will be taken seriously.
Settings will need to decide whether they are equipped to provide gluten-free meals and snacks, or whether these must be brought from home.
Obviously, it is beneficial to the child if the setting can cater for them, as this helps them to feel settled and prevents them from feeling different to the other children.
However, providing meals for a coeliac diet is a serious undertaking and must be properly organised. A gluten-free diet involves more than just omitting bread, cakes, pastry and biscuits. The products that a coeliac is or isn't allowed can be very specific. For example, one brand of ready salted crisps may be allowed while another is not. In fact, a coeliac child can eat a full-size or a snack-size Mars bar but not the fun-sized variety, which uses wheat in the production.
Another major area of concern when preparing gluten-free meals is the problem of cross-contamination. Staff must use a separate area, utensils and apron. It is futile to make a gluten-free sandwich on a breadboard that has just been used for normal bread. Likewise, if your setting provides toast for breakfast, it would need to use a separate toaster for making gluten-free toast. And, of course, it is essential for staff to wash their hands and clean their nails thoroughly between preparing foods containing gluten and those that do not.
The coeliac Society provides invaluable advice on all aspects of a gluten-free diet, including a list of do's and don'ts, and a copy of The Gluten-Free Food and Drink Directory, which lists all foods, broken down into items and brands that are free of gluten. A monthly amendment list is also provided, as manufacturing techniques and recipes change constantly.
In attendance
Once the child starts attending the setting, staff must maintain a high level of awareness about the condition.
A coeliac child, once firmly established on the diet, is not ill and will not want to be treated differently from their peers. It is important to meet the child's emotional and physical needs, by promoting their diet in a positive light, and encouraging understanding and acceptance by the other children and staff members.
One way to do this is to use the terms 'coeliac condition' or just 'coeliac', as 'coeliac disease' wrongly creates the impression that the condition is infectious, which could be used by older children as a taunt.
With a little extra planning and vigilance, practitioners can incorporate all activities easily into a child's gluten-free regime. For example, packed lunches for school trips can be sent from home and goodies for parties can either all be gluten-free or each child can bring a pre-prepared party plate.
One area that causes particular concern for staff is the children's cookery sessions. These needn't be a problem as most stores now stock gluten-free ingredients, and libraries have many gluten-free cookbooks.
It is preferable if all of the children use gluten-free ingredients. If this isn't practical, the coeliac child can use separate ingredients and utensils. However, extreme care is needed to avoid cross-contamination and there is a risk the child may feel excluded from their friends.
Further information
* The Coeliac Society, PO Box 220, High Wycombe, Bucks, HP11 2HY, tel: 01494 437278, e-mail: foodlist@ coeliac.co.uk
GLUTEN-FREE RECIPES
The following gluten-free recipes are easy to follow and favourites with young children: Ham and cheese butterflies Ingredients *2 slices of ham per child *1 large tub of Philadelphia cheese spread *1 lettuce *1 cherry tomato per child *grated carrot To make
* Using a blunt knife, spread the cheese on to the slices of ham and roll tightly into a tube.
* Leave one tube per child intact and slice the other tube into sections.
* Place the uncut tubes in the centre of a plate, one for each child.
* Add the lettuce for the butterfly wings, a cherry tomato for the head and grated carrot for the antennae.
* Decorate the edge of the plate with the chopped up tubes.
* These are ideal for incorporating into nursery activities or including in picnics.
Chunky chocolate chip cookies Ingredients
*75g soft margarine *50g caster sugar *50g light brown sugar *1 egg, beaten *few drops of vanilla essence *pinch of salt *150g rice flour *1tsp gluten-free baking powder *100g gluten-free milk chocolate chips To make
* Pre-heat the oven to 190C/ 375F/Gas mark 5.
* Lightly grease two baking sheets.
* Put the margarine and sugars in a bowl and blend until fluffy.
* Beat in the egg and vanilla essence.
* Fold in rice flour, baking powder, salt and then the chocolate chips.
* Place spoonfuls on the baking sheets, leaving spaces in between.
* Cook for 10 to 15 minutes until lightly browned.
* Leave to cool before transferring to a wire rack.
* The cookies can be stored in an airtight container for up to one week.
They can also be frozen.
GOOD PRACTICE: TOP TEN TIPS
1 Store all gluten-free cooking utensils separately.
2 Mark gluten-free utensils and ingredient bags with a waterproof marker.
3 Keep The Gluten-Free Food and Drink Directory and amendment lists in a known area that is easily accessible to staff.
4 Ensure that students and helpers are aware of the needs of a Coeliac child, and understand their own role in creating a gluten-free environment.
5 Plan ahead. When organising parties or trips, make helpers and guests aware why a child may have a gluten-free diet.
6 Supervise all play dough activities carefully - play dough is made from wheat flour and is not gluten-free.
7 Ask parents of a coeliac child to provide a supply of 'safe' treats for 'emergencies', such as when another child brings in sweets to share.
8 Ensure all medicines provided by the setting are gluten-free - some medicines can contain gluten.
9 Wash your hands and nails thoroughly before handling gluten-free products, to avoid any cross-contamination.
10 Use the words 'condition' or 'coeliac' instead of 'disease' as this may have negative implications.
