Coeliac disease affects about one in a thousand people and is frequently diagnosed in childhood. It is a serious condition which involves special catering considerations. Luckily there are many gluten-free, coeliac-friendly foods available.
What is coeliac disease?
Coeliac disease involves a complete intolerance to the protein gluten, found in certain grains. It means that the child must avoid all sources of gluten. Gluten damages the wall of the small intestine, and so nutrients then cannot be absorbed properly, resulting in malnutrition.
Symptoms range from mild to severe. They include digestive upsets, mouth ulcers, tiredness, breathlessness, anaemia, diarrhoea and weight loss.
Coeliac disease is diagnosed via blood tests and confirmed by a tissue biopsy from the small intestine.
In children, coeliac disease leads to 'failure to thrive', where the child does not grow sufficiently in height or weight. If a child drops through two centiles on their growth chart over a six-month period and has accompanying cramps and possibly loose bowel movements, then coeliac disease should be considered a possibility. It is usually a lifetime condition.
There is also a disease called tropical sprue which comes from a bacterial parasite infection picked up in hot countries, resulting in coeliac-like symptoms, but this can be treated with antibiotics.
Coeliac disease is not the same as a food allergy (which results in hives, swelling or breathing difficulties) or a more generalised 'intolerance' to wheat or other grains (which can be unpleasant and involve various symptoms from bloating to headaches, but is rarely a serious threat to health).
What to avoid
Wheat contains gluten, while rye, barley and oats contain very similar proteins. Some coeliacs can tolerate oats, though a nursery must be very certain of this before giving a child oats - the child's gastroenterologist will give guidance. Because these grains, and wheat in particular, are so common in staple and processed foods, avoiding them involves careful attention. Tiny amounts of gluten can set off a full reaction in a highly sensitive child.
Major sources of gluten are bread, breakfast cereals and muesli, pasta, pastry, biscuits, cakes, pies and puddings - in fact, any food made with the flour of these grains.
Manufactured and processed foods commonly include flour or starch. These are used as thickeners, binders and fillers in all sorts of processed foods. Look out for the words 'flour' or 'starch' on labels, although if these are not included it is not a guarantee that the food is gluten-free.
Less obvious sources of gluten include bulgar (wheat), couscous (usually wheat unless it specifies otherwise), spelt, sprouted wheat and tricale.
It is very easy to trip up. For instance, an innocuous-looking chocolate could contain small amounts of gluten. All sorts of foods can contain gluten, especially those with sauces or 'composite' ingredients where full labelling is not required. Cross-contamination also can happen during food manufacturing or storage.
Catering for coeliacs
Many foods are naturally gluten-free - meat, fish, eggs, cheese, milk, vegetables, fruit, nuts and seeds. The easiest way to plan meals is to offer a plain piece of fish or meat without sauce (unless you are certain it has been only thickened with potato starch or cornflour), a non-gluten carbohydrate source such as potatoes, rice, or special gluten-free bread or pasta, and vegetables. A gluten-free yoghurt or piece of fruit would be a suitable dessert.
Many dishes can easily be made with other grains - for example, polenta cake or millet porridge. Grains which do not contain gluten are corn (popcorn, polenta, cereals like cornflakes, corn starch, corn breach, polenta cake, tacos, nachos - but check that these don't include gluten-grains), rice, quinoa, millet (porridge, muesli), buckwheat (not wheat despite the name, used in pancakes and pasta) and kasha (toasted buckwheat).
Other starchy foods which are all gluten-free include potato, sweet potato (yam), chestnut flour, sago, tapioca, gram (chickpea flour) and lentil flour.
There is a vast range of labelled gluten-free packaged foods available from supermarkets, health food shops and large chemists. While these tend to be more expensive, a diagnosed coeliac can get some of these on prescription from the doctor. Gluten-free products include breads (usually made with rice flour and not hugely palatable), corn cakes (much better), mueslis, cereals, biscuits (which can be good but sugary), and pastas (made from various grains, they may have a different texture and cook slightly differently but work well). NW This article has been sponsored by the Organix Children's food Advisory Service, where Suzannah Olivier is the consultant nutritionist
Resources
* Coeliac support www.coeliac.co.uk,helpline: 0870 444 8804
* Glutano foods www.glutenfree-foods.co.uk,tel: 020 8953 444
* Children's Food Advisory Service pack for nurseries www.childrensfood.org
* Organic Baby and Toddler Cookbook by Lizzie Vann of Organix. Visit their website www.babyorganix.co.uk.Organix provide the only fully gluten-free range for babies up to eight months and many products for older children, such as the Goodies Snack Bag range, are also gluten-free.
* Suzannah Olivier is the author of several books including What Should I Feed My Baby? and Healthy Food for Happy Kids ( see www.HealthyFood4HappyKids.com)
