Child Care and Education : Managing Your Coeliac Child’s Dietary and Health Needs
(This is the fifth part of the series ‘Gluten Free Kids – A Practical Guide to Parenting a Coeliac Child’. To access the Introduction and subsequent ‘chapters’, please click on the drop down menu ‘Coeliac Parenting Guide’ on the menu bar).
In this section, I think about how to manage the Coeliac journey through school and childcare.
Depending on the age at which your child is diagnosed, at some stage, you will have to plan and work with child care and education professionals to raise awareness about health and dietary needs, how best to manage snacks and lunch and how to keep them safe in the general day to day interactions with other pupils and staff. The older your child is and the better they have learnt themselves how to manage being Coeliac, the safer they will be. From the moment Miss GF was diagnosed, she was constantly on the look out for potential dietary mistakes and would be more than vocal in correcting those making them.
If your child is already in child care or education at the point of diagnosis, you will inevitably be learning how to manage Coeliac Disease yourself whilst also teaching your child’s carers and teachers how to support keeping your child gluten-safe. Share new knowledge as you learn and remember you are all on a steep learning curve and an occasional mistake may be made, particularly in the early days. Whilst it is important to keep a clear watching brief to make sure carers stick to the rules of gluten-freedom, excessive parental anxiety is not helpful and will ultimately have a negative emotional impact on your child, who is also learning to live with the new ‘normal’ of what they can and can’t eat.
When your child changes school or starts with a new child-care provider, it helps to plan well ahead and talk with carers before transition. As the parent of a Coeliac child, you will find you are responsible for educating teachers and carers about your child’s needs and how to meet them. Teach them well and you can relax in the knowledge that your child will be safer.
Child Minders, Preschool and Primary School
Whether or not you have to use alternative child care for reasons of working yourself, at some stage your child is likely to attend a preschool nursery or a childminder (whether for early education, day care or to support after-school and holiday care). Even if you choose to care for your child at home or with extended family until they go to school, there will come a time when you need to face the inevitable and put your child’s health needs in the hands of strangers as they progress into the education system.
It is essential that you work closely with anyone caring for your child, to ensure they have a good knowledge of the implications of ingesting gluten and that they understand what foods contain gluten, how to read food labels, how to avoid cross-contamination and how to keep safe during day to day activities. Most child-care staff are more than willing to work with and alongside you to make sure health needs are met, but will be helped by being given clear information (written if necessary) and instruction on what is okay and what to avoid. We copied and shared ingredients and do’s and don’ts lists with Miss GF’s carers.
Whilst you want to have assurance that staff will be competent and vigilant in overseeing physical health needs, it is also important that they recognise the emotional adjustments being made, as your child experiences the conflict of being ‘different’ and of not always being able to have what other children take for granted. Your child needs to be supported in their occasional frustrations as well as being encouraged and given the confidence to question food safety and to look after themselves. Although with Miss GF, our aim was always to help her to fit in and feel as normal as possible (constantly trying to stay one step ahead with providing information and gluten free alternatives to parallel what the other children were experiencing), we also used situations of potential food-conflict as opportunities to talk about Coeliac safety, ‘play down’ the element of difference and reassure her through each new challenge. Ultimately you want for your child to become confident and self-reliant in their Coeliac management and food choices. The earlier they learn and ‘own’ the importance of maintaining strict boundaries around gluten-freedom, the better their adjustment to their normality as they progress through adolescence and beyond.
Communication is key to good support, wherever it comes from. Knowing when the school are planning to hold celebrations involving food, have cookery sessions or hold continental breakfasts requires good liaison with teachers and carers and the more consistent you make your contact, the better. If you can’t always be the one to drop your child off at the nursery or primary class door, make good use of home-liaison communication books and be clear with staff that you and your child will be helped to be able to plan for foodie events with plenty of notice.
Specific things to consider in preschool and primary school care
– Does your child need a care plan? – This is not something that we ever needed to do with Miss GF as the school was willing to work closely with us to understand the parameters of Coeliac care and to ensure gluten-safety, but if you feel you are not understood or want extra reassurance, then it is reasonable to discuss having a more formalised plan with the school or nursery, which clearly outlines the what, why and how.
– School dinners vs Packed Lunches. – This may be a decision based not just on your child’s pickiness and school menu, but importantly on the willingness of the nursery/childminder/school/school kitchen to work with you to meet safe dietary provision, as well as the confidence you have in your child not getting sick. With Miss GF, I was a heel-digger. Her primary school was large and had a well-embedded school kitchen, cooking meals from scratch on site, with a nutritionally-sound menu (which to all intent and purpose was in line with the Jamie Oliver era). I wanted Miss GF to be able to sit and eat her lunch with her friends and that meant school dinners were to be fought over as a ‘right’, if necessary.
The fact that meals were cooked with fresh ingredients on site was key to my willingness to push hard, as I knew there would be more flexibility to deviate ingredients if necessary to cater for Miss GF. Had they bought their catering in from outside, I may have thought differently as I would likely have had less freedom to negotiate and less control. I viewed myself as a bit of a crusader for other children with dietary needs too and I was right…. Once I stuck my head above the parapet, lots of other children came forward for their previously unattainable school dinners and the number of children with Coeliac (and other allergies and intolerances) became starkly obvious.
If you choose to go down the negotiation route, then make your intentions known to the school office/head teacher and ask for details of the key contact in the kitchen and also the contact for any linked catering supply company. Make direct contact with the school kitchen lead (usually the head cook) and any catering supplier as helpful and arrange to meet with them to discuss menu and options available. Working closely with kitchen staff and offering your support and knowledge is your key to success. By providing information on Coeliac Disease, on ingredients to avoid and by looking through recipes they use to consider what is naturally safe and what could be easily tweaked, you may be surprised at how much leeway there is. Stay positive and work alongside rather than against them.
I was really fortunate with having kitchen staff who gave me free rein on their larder to check labels (particularly relevant for ingredients like stock powder, custard, baked beans, chips, etc) and where there were problems, they agreed to change their brands to make them safe. A few months in and roast day was accompanied by gluten free gravy for all children and no risk of cross-contamination. A couple of years in and they were actually making gluten free cake and bread and using gluten free pasta for the children that needed it. I am proud of my achievements!
Where ingredients can’t be easily substituted, look to negotiate ways to alter the meal for your child that won’t add too much time or effort for the Cook… With Friday Fish and Chip Day, kitchen staff would use an un-battered piece of fish that they would oven bake separately in foil for Miss GF and then would be able to serve with uncontaminated chips (which were always cut in the kitchen from fresh potatoes). This was not considered a problem and on one menu round, even resulted in Miss GF being served parcel-wrapped salmon. We knew she was truly cared for and understood.
In advance of each menu change (most schools have a termly or seasonal menu that then rotates two to four weekly), request a copy of the menu and set up a further meeting with the school cook to discuss any tweaks and changes. Following each meeting, it is helpful to draft and copy a specific agreed menu which can then be stuck on the kitchen wall, outlining what your child can/can’t have – something like :
The written menu plan effectively ensures that all kitchen staff are able to be clear. With Miss GF, on the rare occasions when there was a need for deviation due to an ingredient/menu item not being available or possible, the Cook would call me direct (I gave her my mobile number) to let me know of any substitution. The system worked perfectly and I made absolutely sure to keep them on side, show regular gratitude and appreciation and at the end of each term, would send in a box of chocolates or treat to say ‘thank you’. It was more than worth it.
Although it would have been absolutely fine for Miss GF to have fruit/yoghurt/ice cream each day for dessert, you will see that there are a number of ‘home-provided’ puddings on the example menu, which were designed to ‘mirror’ what her friends would have been having from the main school menu, but in gluten free form. Although this was purely a matter of choice and involved me sending in a ‘pudding pack’ at the start of each week (cakes which would be batch-baked in advance and ready in portions in the freezer), it helped to avoid Miss GF feeling ‘different’.
– Snacks at the Childminder and at Nursery : Again, similar rules apply. Information, communication and negotiation are key to ensuring your child is safely and equally catered for. We had an arrangement where we would send a small (regularly topped up on request) supply of pitta bread/rolls etc in clearly labelled bags, stored in the child-minder’s freezer to be defrosted as and when needed. We also provided a similarly labelled and wrapped supply of ambient snacks such as crackers and cookies and Miss GF had small ‘baby-food’ sized airtight containers with her own labelled and un-contaminated butter/spreads, etc, a personally labelled Philadelphia Cheese or houmous tub and some individual jam/Nutella/marmalade portions (the type that you get at hotel breakfast buffets).
For any special events such as leaving parties or celebrations, the childminder would let me know in advance what was needed and when, so that I could provide comparable GF products.
It may be that your childminder/nursery is confident to source and supply gluten free alternatives themselves and that may work well for you and your child, but however you proceed, be sure that they understand the rules around cross-contamination and the need to avoid food-sharing. All your hard work can be easily undone by an inadvertent shared knife, spoon or plate.
– Play dough, salt dough, cereal ‘pits’ and pasta art (activities involving food and food products) This is an area which can be easily missed and be an unexpected source of gluten-contamination for your child, especially when they are too young to be fully aware of the dangers or lack the confidence to ask questions themselves.
The use of play dough, salt dough, pasta, cereal and even grains such as barley in nurseries, other child-care facilities and schools is amazingly common, whether in pursuit of creativity, art and for general play. All of these items potentially contain wheat flour and gluten, which has a high chance of being transferred to your child and ingested from hands being put into mouths or through oral exploration with younger children.
Be sure to clarify what materials are used in the setting (including at after school clubs) and discuss what alternatives could be supplemented instead (this may mean for all the children, particularly where items are freely available for play) and how best to ensure safe supervision.
Gluten free Playdough is now available commercially, through smaller companies like Tiny Land, or an alternative can be made at home.
– Cookery Clubs and Lessons and Shared Food Preparation : Nurseries and primary schools in particular, often promote cultural festivals through food or have shared cooking in classes to promote healthy eating or other skills learning. At Miss GF’s school, they offered everything from pancake and pizza-making in class, to making an ancient middle-aged Jumble recipe and sharing a French breakfast.
Let your child’s teachers know that gluten-avoidance is required even when the curriculum involves food and ask that you are given ample notice of food-based events. It is really important that your child does not get left out either from an educational or social standpoint, so try and go the extra mile to provide alternative ingredients, recipes or substitutes where necessary. Request that your child uses a separate ‘cooking table’ for any food preparation, to reduce the risk of cross-contamination from flour, etc. and where baking is required, ask that their creation is kept separate by foil or space in the oven.
– Day Trips and Residentials : Whether as part of the school/pre-school curriculum or because your child belongs to a club, they are unlikely to go through their school years without joining a day or residential trip. Packed lunches that you supply for day trips are relatively straight forward, although if your child is young, it will be important to remind staff to supervise closely and employ a food ‘no-sharing’ policy.
For residential trips, you are likely to need greater reassurance. At the time of the trip booking being discussed with parents, consult with staff who will be attending the trip and ask them what experience that have previously had of the residential venue. It is likely that they have been there before or would have undertaken a risk assessment visit, so they should have considered the dietary needs of their children already.
It is also worth looking up the venue on the internet and making direct contact with the manager, to discuss in advance how they manage dietary and health conditions and what food will be on offer for your child. It is highly likely that they will have managed similar issues before and direct discussion is usually enough to reassure. Either way, it is worth having a later telephone call just before your child’s attendance on the trip, with both school/club staff and residential venue to confirm arrangements.
Class Birthdays : Most pre-school and school settings are keen to celebrate children’s birthdays and this often includes children bringing in a tin of cakes or sweets to share with their class-mates. Often this happens at the end of the school day and is always a matter of great excitement for the children in receipt of the treats. Of course you want your child to be part of the excitement and celebration, but you have little control over what will be shared, when and whether it will present a risk.
Make sure you work out a strategy with your child’s current teacher/carer as early as you can. It also helps if you have carefully explained the plan for managing such events (and importantly why) to your child in language they can understand. With Miss GF, the teacher had a small tin of gluten free sweets that she kept separately and would offer it in place of whatever the birthday-child had brought in, so that she was still able to enjoy the event. It’s amazing how quick other children catch on though, and within weeks, some parents were kind enough to send in something especially for her.
Christmas and Leaving Parties : These celebrations often centre around food and games, with participating children bringing in food to share (often on a list-ticked basis of what is needed) and games being rewarded with sweets and treats. This is one situation where I would absolutely recommend sending in a ‘party-pack’ for your child… There is simply too much risk from the crumbs, spillages and gluten-contaminated fingers and in amongst all the excited chaos, it is nye on impossible for staff and helpers to keep track. Make sure that you have labelled the pack with your child’s name and explicit instructions that it is not to be shared with the other party food and why this is the case.
So that your child feels as much like his/her friends as possible, it helps if their pack contains the sort of ‘party food’ that other children will be eating (sandwiches, crisps, cocktail sausages, colourful biscuits, etc) and if possible, either make or ‘pimp up’ a couple of fairy cakes with pretty icing and sprinkles to rival those they will see on the party table.
It is also important for supervising staff to be aware of the ‘no gluten’ requirement for party ‘prizes’ and to talk to your child as well, to make sure they are aware of the arrangements and are able to discuss any worries (either practical or emotional) in advance, for reassurance. If possible or appropriate, you might also offer to be one of the parent-helpers. It can be fun as well as helpful to see how your child gets on.
– Helping Your Child Gain Awareness and Confidence : Your young child is ripe for learning and is willing (for the most part) to listen to advice and ‘rules’ around their diet and health (when they hit adolescence, this willingness may lessen and the belief that ‘they know best’ may cloud their cooperation and their judgement). Use every opportunity to teach them and to help build confidence and independence around managing their Coeliac needs.
Although you will be the key negotiator with carers and school, take them along to meetings and discussions with you and offer them (as they get older) the opportunity to lead the conversation. Encourage them to ask questions about what they are being fed, to be observant about how food has been prepared and served and to challenge when they are not sure it is safe.
Help them to feel competent in explaining their condition. You could even consider with your child’s teachers whether it might be helpful to have a class lesson on allergies and intolerances and to involve other children in the class in talking about their needs as well, what this means for them and why there need to be clear rules on food-sharing. Children make amazing educators for their peers… Miss GF (as part of a home-work activity) made a colourful leaflet explaining Coeliac Disease to her friends, but you may equally encourage your child to use events like Coeliac Awareness Week to promote knowledge of the condition in school.
However your child develops, remember they are Coeliac for life. This is their normal. Support them unconditionally and they will become strong and safe.
Gluten Free Alchemist © 2013-18 unless otherwise indicated