Making Accommodations for Children with Celiac Disease

            More school food service directors/managers are making dietary accommodations for children who have been diagnosed with celiac disease.  Since this diagnosis is increasing, it is helpful for you to have a basic understanding of this illness so you and your staff can provide appropriate meals for children in your school.

Celiac disease (CD) is an under-diagnosed genetic disorder that affects one out of 133 Americans. Only three percent of these cases have been diagnosed leaving 2.1 million Americans unidentified. This large number is the reason for a campaign to increase awareness of CD and provide supportive information for those living with it.

            The basis of the disease is the inability to digest gluten. Gluten is a protein commonly found in wheat, rye, barley and oats, among other foods. A typical person consumes 10-40 grams of gluten per day. However, only 0.1 gram is necessary to cause damage to a celiac. Gluten contains a particular sequence of amino acids, which when consumed by a person with celiac disease, sets off a response that causes damage to the small intestine. This damage then prevents the small intestine from absorbing essential nutrients into the body.

            Individuals with celiac disease differ from one another in the symptoms they incur. Some patients may have “latent” or no symptoms, while others could have extreme reactions. Regardless, in most instances, people who suffer from celiac disease are malnourished as a result of the small intestine’s inability to absorb nutrients from consumed foods. Other indicators of the disease include vomiting, gas, diarrhea, weight loss and abdominal pains. Delayed growth and puberty, along with skin rashes, infertility and osteoporosis are a few of the more severe symptoms associated with CD. A proper diagnosis is vital as untreated cases of the disease can potentially lead to cancer.

            It is recommended that patients who suffer from celiac disease engage in a life-long elimination of gluten products. This not only includes the digestion of these foods, but also preventative measures in food storage and preparation to ensure that no cross-contamination with gluten items has taken place. It is important to note that even after following a strict diet, some food sensitivities, such as lactose intolerance, may continue.

            School food authorities (SFAs) are required by law to provide substitutions to the school meals for children with celiac disease if their needs are supported by a statement signed by a licensed physician.

            SFAs should work closely with the child’s physician to clearly understand the foods that must be omitted from the child’s diet and the choices of foods and quantities to be substituted. Under no circumstances are school food service staff to revise or change a diet prescription or medical order.

            The physician’s order may require certain products to be purchased for the child. Schools may not charge children with disabilities, or with certified special dietary needs who require food substitutions or modifications, more than they charge other children for program meals or snacks. In other words, free children cannot incur any charges for their meals and full-priced children cannot be charged extra for the special foods the school has to purchase.

            Gluten can be found in a number of our favorite foods such as pasta, bread and cookies. However, it can also be hidden in a variety of processed foods. Therefore, reading labels may not always be the most sufficient way to remain healthy and symptom-free.

Examples of grains to avoid include gliadin (found in gluten of wheat), kamut (also found in wheat) and possibly edible and food starch, flour and grits, depending on content and cross-contamination. Some forbidden foods to a gluten-free diet are ice cream, salad dressings, frozen french fries, rice mixes and processed cheeses. On the other hand, items such as chestnuts, chickpeas, herbs, corn, masa flour, castor oil and flaked rice are just a few of the “safe” foods that are available on the market.

For more information about celiac disease visit www.celiac.nih.gov and www.csaceliacs.org. Gluten-free foods and products can be found at http://www.glutenfree.com/online-store.htm and http://www.celiac.com/catalog/index.php. If you have questions regarding your responsibilities for a child with celiac disease, contact Paula Tyner-Doyle at (518) 432-5066 or by email at PTYNERDO@MAIL.NYSED.GOV.