Coeliac disease is a life-long condition, caused by intolerance to 'gluten'
- a protein that occurs naturally in food staples such as wheat, rye, barley and oats. Four-year old Carly was diagnosed as having coeliac when she was 14 months, having been taken to her GP repeatedly with vomiting, diarrhoea and lethargy. She was small for her age and 'failing to thrive'. Her stomach was distended and sensitive to the touch, and she had up to 15 nappy changes a day when her symptoms were at their worst.
Eventually it was suspected that Carly had coeliac. She had a blood test to detect antibodies to gluten and a faeces sample was sent for analysis of the fat content. Following positive results for both of these, Carly was referred to her local hospital for a jejunal biopsy under a light sedation.
Children and adults with coeliac are unable to absorb sufficient nutrients to maintain good health because the 'finger-like' protractions (villi) on their intestines are flattened by the condition. This severely reduces the available surface area for absorption.
Carly's biopsy confirmed that she had flattened villi.She was immediately placed on a gluten-free diet under the supervision of a community dietician. Within two months she had begun to gain weight, her diarrhoea had reduced and she was a far happier and more energetic toddler.
How common is it?
The exact numbers of the population who have coeliac is uncertain. In the past it was mostly thought to develop in early childhood, coming to light when the infant was first introduced to foods containing gluten, and it is now recommended that gluten should not be introduced below seven months of age - or below a year in families where coeliac is already present. However, there has been a significant increase in the number of adults diagnosed with the condition later in life.
Carly displayed typical symptoms of the condition, but many sufferers vary in how their body reacts, and their symptoms can sometimes mirror other health problems, making diagnosis difficult.
What to eat?
Attending to the dietary needs of children with coeliac requires care, as finding alternative carbohydrate foods may at first be difficult, and maintaining a nutritional balance is not always easy. Many everyday foods contain gluten, or are produced in factories where gluten-containing flour is used in the food process.
Carly's parents gradually found alternatives to their normal supermarket product choices, many of which are suitable for the whole family. Gluten-free bread, flour and pasta are available on prescription, but can be bought in health food shops and many supermarkets in an emergency. They are expensive. However, no child likes to be different, and a slight change to everyone's diet is a small price for Carly's family to pay if it enables her to eat the same meals as they do.
Cookery activities also play an important role in nursery life. No-one should allow a child to join in the cooking while telling them they cannot eat the end product! At Carly's nursery, the staff have found that making slight changes to cookery ingredients does not usually detract from the end result. They have asked Carly's parents for advice on suitable products, and they have been happy to contribute gluten-free flour and pasta.
The possibility of very young children putting playdough into their mouths also needs to be considered. On rare occasions when a child has severe gluten intolerance they will be unable to even handle playdough containing gluten. When Carly was younger and first attended nursery, the staff successfully made playdough with gluten-free flour.
* More information on gluten intolerance can be obtained from the Coeliac UK website at www.coeliac.co.uk.
Sandy Green is an early years consultant and trainer, and has coeliac herself
Wait for it
* No changes should be made to the diet of any child suspected of having coeliac without a confirmed diagnosis from a GP, gastroenterologist or paediatrician, and usually the advice and guidance of a dietician.
Alternative baking
* There are many alternatives to 'normal' and 'prescribed' flours that can be used, including rice flour, cornflour, buckwheat and chickpea flour (often called gram flour). Between them these will produce good cakes, biscuits and pancakes, although bread and pastry is less successful for the novice gluten-free baker!
