Celiac Disease Handbook for School
What is celiac disease?
- Celiac disease is an autoimmune disease that affects the small intestine. The small intestine digests and absorbs nutrients.
- Eating products with gliadin causes damage to the lining of the small intestine and can affect digestion and absorption.
- A child with celiac disease cannot properly digest a part of gluten called gliadin.
- Gliadin is found in wheat, rye and barley.
- Celiac disease requires life-long treatment.
- Other family members may also have celiac disease.
What are the symptoms of celiac disease?
Toddlers:
- Poor growth or weight gain
- Diarrhea; sometimes constipation
- Poor appetite
- Vomiting
- Irritability
- “Pot belly”
- Bone mineral loss (osteopenia, osteoporosis, multiple fractures)
- Small itchy blisters on elbows, knees, and feet (Dermatitis Herpetiformis)
Children and adolescents:
- Weight loss
- Abdominal pain or cramping, and bloating
- Diarrhea
- Constipation
- Gas
- Bone mineral loss (osteopenia, osteoporosis, multiple fractures)
- Small itchy blisters on elbows, knees, and feet (Dermatitis Herpetiformis)
How is the disease treated?
The Gluten Free Diet (GFD) is currently the only treatment for celiac disease.
- Elimination of gluten from the diet improves symptoms and allows healing of the small intestine and immune system.
- Treatment of celiac disease is life-long avoidance of gluten.
- This diet involves eliminating wheat, rye and barley.
What happens if a child with celiac disease accidentally digests gluten?
The reaction may vary between individuals. Reactions that occur following gluten ingestion include:
- Stomach cramping
- Diarrhea
- Irritability
- Vomiting
- Headaches
Some children may have no visible reaction to gluten ingestion.
What to do if gluten is accidentally ingested:
Please notify the parent(s) or guardian as soon as possible and allow the student to use the bathroom as needed. This is medically necessary.
How do you know if a food contains gluten?
Label reading is key! Below are general guidelines to avoid cross contamination. Attached is a chart providing you with general guidelines for ingredients that are allowed and those to avoid.
Avoid cross contamination
- Encourage the child with celiac disease to wash his hands prior to eating.
- Thoroughly disinfect the child’s eating surface and chair prior to meals to aid in the elimination of gluten particles.
- Ensure that there is adequate workspace between the child with celiac disease and those without to avoid cross-contamination.
- Use fresh serving utensils and fresh gloves to serve gluten free food items. Never serve a person with celiac disease with the same unwashed utensil that foods containing gluten may have come in contact with.
- Children require supervision to ensure that they do not share utensils, drink out of each other’s cups, touch each other’s napkins, exchange lunches, etc.
- Paints, play-dough, stamps, and envelopes may contain gluten.
- Use gluten free paints and play-dough if possible and include other children at the same table as the celiac child.
- Disinfect tables and wash hands after art projects and eating.
- Designate separate containers for gluten free butter, peanut butter, jelly, cream cheese, frosting, etc. It is best to purchase condiments that come in a squeeze bottle.
- Use separate cutting boards, toasters, pots pans and utensils for gluten free prep work and cooking.
Additional sources of information about celiac disease:
- Celiac Center Website address: www.chop.edu/celiac
- Email address: Children’s Hospital of Philadelphia – Celiac Center – celiaccenter@chop.edu
The gluten-free diet
These are general guidelines for the gluten-free diet. Please remember that ingredients can change at any time. Carefully read ingredient lists and periodically contact manufacturers to ensure safety. Avoid products without labels unless ingredients are confirmed with the manufacturer.
| Allowed | Questionable | Avoid | |
| Grains | Breads/bread products containing: amaranth, arrowroot, buckwheat, corn bran, corn flour, cornmeal, cornstarch, flax, legume flours (bean, garbanzo or chickpea, garfava, lentil, pea), mesquite flour, millet, MontinaTM flour (Indian rice grass), nut flours (almond, chestnut, hazelnut), potato flour, potato starch, quinoa, rice bran, rice flours (white/brown/sweet), sago, sorghum flour, soy flour, sweet potato flour, tapioca, teff | Buckwheat flour (pure buckwheat flour is gluten-free; however, it may also contain wheat flour) | Bread/bread products containing wheat, wheat starch, wheat germ, wheat bran, rye, triticale, barley, oats, oat bran, oat flour, oatmeal, graham flour, gluten flour, durum flour, atta, bulgur, farina, wheat based semolina, spelt, kamut, einkorn, emmer, farro, imported foods labeled “gluten-free” which may contain any of the above ingredients |
| Hot Cereals: puffed amaranth, puffed buckwheat, cornmeal, cream of buckwheat, cream of rice, hominy grits, millet, rice flakes, quinoa flakes, soy flakes, soy grits Cold Cereals: Puffed (amaranth, buckwheat, corn, millet, rice), rice crisps or corn flakes, rice flakes, soy cereals | Rice cereals (some may contain barley malt extract or barley malt flavoring) Corn cereals (some may contain barley malt extract, barley malt flavoring, or oat syrup) | Cereals made from wheat, rye, triticale, barley and/or oats; cereals with added malt extract/malt flavoring | |
| Pasta: macaroni, spaghetti, and noodles made from beans, corn, lentil, pea, potato, quinoa, rice, soy and wild rice | Buckwheat pasta | Pastas made from wheat, wheat starch and other ingredients not allowed | |
| Miscellaneous: corn tacos, corn tortillas | Rice crackers, some rice cakes and popped corn cakes (multigrain products may contain barley and/or oats; some contain soy sauce, which may be made from wheat) | Wheat flour tacos, wheat tortillas | |
| Meats and meat alternatives | Fresh meat, fish, and poultry | Deli/processed meats: luncheon meat, ham, bacon, hot dogs, dried meat (ex. beef jerky), meat and sandwich spreads, meat loaf, frozen meat patties, sausage, pate, imitation meat or fish, meat product extenders (may contain wheat fillers/wheat starch) | Hydrolyzed or textured vegetable protein (HVP or TVP)* Hydrolyzed plant protein (HPP)* Fish canned in vegetable broth containing HVP/TVP/HPP* Turkey basted or injected with HVP/TVP/HPP* Frozen chicken containing chicken broth (made with ingredients not allowed) |
| Eggs | Egg substitutes, dried eggs | ||
| Lentils, chickpeas (garbanzo beans), peas, beans, nuts, seeds tofu | Baked beans, dry roasted nuts | ||
| Milk products | Milk (fresh/dry/evaporated/condensed); cream, most ice cream, buttermilk, plain yogurt, cheese, cream cheese, processed cheese, processed cheese foods, cottage cheese | Milk drinks (may contain wheat starch or barley malt) Flavored yogurt (may be thickened with a gluten source) Frozen yogurt (may contain granola or cookie crumbs) Sour cream (some low-fat/nonfat may contain modified food starch) Cheese sauces/spreads (may be thickened/stabilized/flavored with wheat | Malted milk, ice cream made with ingredients not allowed |
| Fruits and vegetables | Fresh/frozen/canned fruits and juices Fresh/frozen/canned vegetables and juices | Fruit pie fillings or fruits/vegetables with sauce (may be thickened with flour) Dried fruit (may be dusted with wheat flour) French-fried potatoes (those cooked in restaurants may contain wheat) | Scalloped potatoes (containing wheat flour) Batter-dipped vegetables |
| Soups | Homemade broth, gluten-free bouillon cubes; cream soups and stocks made from allowed ingredients | Canned soups, dried soup mixes, soup bases, bouillon cubes (may contain: barley, wheat flour/starch or HVP/TVP/HPP* from wheat) | Soups made with ingredients not allowed; bouillon/bouillon cubes containing HVP/TVP/HPP* made from wheat |
| Fats | Butter, margarine, lard, vegetable oil, cream, shortening, homemade salad dressing made with allowed ingredients | Salad dressings, some mayonnaise (seasonings may contain wheat flour/wheat starch) | Packaged suet |
| Desserts | Ice cream, sherbet, whipped toppings, egg custards, fruit ice, gelatin desserts, cakes, cookies, pastries made with allowed ingredients; cornstarch, tapioca and rice puddings; junket; Gluten-free ice cream cones, wafers, waffles | Milk puddings/custard powders/pudding mixes/cake icings/cake frostings (may contain wheat starch) | Ice cream, cakes, cookies, muffins, pies, pastries, ice cream cones, wafers and waffles made with ingredients not allowed |
| Beverages | Tea, instant/ground coffee (regular or decaffeinated); cocoa, soft drinks, cider, distilled alcoholic beverages such as rum, gin, whiskey, vodka, wines and pure liqueurs; some soy, rice and nut beverages | Some instant teas, flavored and herbal teas, flavored coffee/coffee substitutes, fruit-flavored drinks, chocolate drinks/mixes (may contain grain additives) Some rice/soy and nut beverages may contain barley, barley malt extract, or oats | Beer, ale and lager; cereal and malted beverages; some, rice or nut beverages made with barley or oats |
| Sweeteners Sweets, candy | Honey, jam, jelly, marmalade, corn syrup, maple syrup, molasses, sugar (brown & white), confectioner’s sugar | Spreads, candies, chocolate bars, chewing gum, marshmallows, lemon curd (may contain flour) Smarties® (Canadian product-contains wheat flour) | Licorice and other candies made with ingredients not allowed |
| Snack Foods | Plain popcorn, some potato and tortilla chips, nuts and soy nuts | Dry roasted nuts, flavored potato chips, tortilla/corn chips and soy nuts (flavoring/seasoning may contain wheat flour/starch or hydrolyzed wheat protein) | Pizza (unless made with allowed ingredients) |
| Condiments | Plain pickles, relish, olives, ketchup, mustard, tomato paste, pure herbs and spices, pure black pepper, vinegars (apple/cider, distilled white, grape or wine, spirit), gluten-free soy sauce | Seasoning mixes (may contain wheat flour, wheat starch or hydrolyzed wheat protein) Worcestershire sauce (may contain malt vinegar) | Soy sauce made from wheat; mustard pickles (made from wheat flour); malt vinegar; bouillon/bouillon cubes containing HVP/TVP/HPP* made from wheat |
| Other | Sauces and gravies made with allowed ingredients; pure cocoa, pure baking chocolate; carob chips and powder, chocolate chips; monosodium glutamate (MSG), cream of tartar, yeast, brewer’s yeast, aspartame, coconut, vanilla, gluten-free communion wafers | Baking powder (may contain starch from wheat source) | Sauces and gravies made from ingredients not allowed; HVP/TVP/HPP*; communion wafers |
*HVP/TVP/HPP must be avoided if the plant source is not identified or if the source is from wheat protein
Table adapted and revised October 2000 by S. Case, M. Malloy and M. Zarakadas from celiac disease Needs a Diet for Life Handbook, Canadian Celiac Association. Further revisions made by S. Case for Gluten-Free Diet: A Comprehensive Resource Guide, May 2001, April 2002, July 2003, May 2004, January 2005, March 2006 and September 2008.