Serving delicious and nutritious foods to support the growth and development of young children is an important role in the childcare centre. When a child has been diagnosed with a condition such as celiac disease, special care and consideration on how food is prepared and served is essential to ensuring a child's safety and well-being. Learning more about celiac disease and the strict gluten-free diet to adjust preparation and cooking practices is an important step to creating a safe eating environment.
What is celiac disease
Celiac disease is a lifelong autoimmune condition treated with a strict gluten-free diet. In people with celiac disease, any contact with gluten triggers a reaction from the body's immune system. This immune response to gluten results in damage to the lining of the small intestine, causing gastrointestinal symptoms, such as abdominal pain or the need for frequent bathroom breaks, and extra-intestinal symptoms, such as fatigue. This damage makes it harder for the body to absorb nutrients, such as vitamins and minerals, that are vital for health and functioning.
What is gluten and the gluten-free diet?
Gluten is the most common name of a family of proteins in grains that cause intestinal damage in people with celiac disease. Gluten is found in all forms of:
- wheat
- barley
- rye
- related grains such as triticale (a mix of wheat and rye)
A strict gluten-free diet, with no trace amounts of gluten, is the only treatment for celiac disease. While some sources of gluten are obvious to us, such as wheat-based breads, pastas and baked goods, others can be hidden in things like soups, ice creams or personal care items, such as hand creams. Some craft supplies, such as playdough or wheat-based paper mâché, also contain gluten. Carefully read labels to determine what foods and products are gluten-free.
It is also important to avoid gluten cross-contact. Cros-contact occurs when gluten is transferred from one food or object to another food or object, making it unsafe for people with celiac disease. Within the childcare centre, gluten cross-contact can happen through shared desk surfaces or the use of gluten-containing art supplies. Hand washing and cleaning surfaces with soap and water are both ways to prevent gluten cross-contact at your childcare centre. Hand sanitizers WILL NOT remove gluten.
For more information and resources about celiac disease and the gluten-free diet, it is highly recommended that you watch Module 2: The Gluten-Free Diet and consult supporting resources such as The gluten-free diet, Tips to maintain the gluten-free diet and Gluten-free diet: Grain products to allow, question and exclude.
How to create a safe food environment for children with celiac disease
Developing a gluten-free menu and avoiding gluten-cross contact when preparing food takes work and attention to detail. Clear communication and collaboration between a child's parents/caregivers and childcare staff who may serve food is key to ensuring a safe food environment and eating experience for children with celiac disease.
Here are some considerations for serving food to a child with celiac disease.
Involve the child's parents/caregivers
Meet with the child's parents/caregivers to discuss celiac disease and the strict gluten-free diet. Create a plan on how to meet the dietary needs of the child with celiac disease.
- You may want to ask the parents/caregivers:
- what gluten-free meals and snacks their child prefers to eat
- what gluten-free products they use at home.
- if they are currently eating gluten-free oats at home. *Depending on the timing of the child's diagnosis, their health-care provider may have asked them to avoid gluten-free oats until their next follow-up appointment.
- If parents/caregivers have chosen to prepare and bring gluten-free meals and snacks for their child, make sure their foods are clearly labelled and stored safely away from gluten-containing foods and ingredients, such as wheat flour.
- Provide the child's parents/caregiver with the weekly or monthly gluten-free menu to review in advance.
- Inform parents/caregivers if meals and snacks are made at another facility so that they can review the safety of these items.
- Notify the child's parents/caregivers if there is an incident of gluten exposure.
Create menus that incorporate naturally gluten-free ingredients
- Avoid foods that contain gluten, including wheat, barley, rye or related grains such as triticale. To better understand what foods are allowed (safe), to be questioned and are not allowed (not safe), see the Gluten-free diet PDF.
- Create menus that use naturally gluten-free whole foods and ingredients, such as vegetables and fruit, eggs, most dairy products, plain poultry and meats, and legumes.
- Choose gluten-free whole grains such as amaranth, brown or wild rice, buckwheat, millet and quinoa to serve at the childcare centre.
Choose supplies with clear food labels
- Avoid buying foods that have no nutrition or allergy information on the label.
- Avoid buying food from bulk bins. Products in bulk bins can become contaminated with gluten when scoops are used in more than one bin.
- Keep all labels provided by your food supplier. Sometimes labels are on the larger box that packaged the food item. Review the label each time you receive a shipment for changes to ingredients. Keep the label stored in a safe place, such as a binder, in case a child at the centre has a reaction.
Separate gluten-free foods and gluten-containing foods
- Store gluten-free foods separately from gluten-containing foods. You may want to have a designated cupboard for gluten-free foods and ingredients to prevent gluten cross-contact.
- Store gluten-free foods above gluten-containing foods at all times. It is important to avoid storing gluten-free foods under gluten-containing foods to prevent gluten cross contact from falling ingredients.
Prevent gluten cross-contact when preparing and serving food
- Clean all pots, pans, utensils and countertops with soap between uses.
- Use separate kitchen utensils or equipment that are difficult to clean for gluten-free foods, such as toasters, wooden cutting boards, wooden spoons and colanders/sieves.
- Wash counters carefully before preparing a gluten-free meal and have a designated area in your centre's kitchen to prepare gluten-free meals and snacks.
- Do not use the same gluten-containing pasta water to prepare gluten-free pasta or to boil or steam vegetables. This will lead to gluten cross-contact and make gluten-free foods unsafe to eat.
- Use tinfoil when cooking gluten-free foods on a barbecue, grill or in a toaster oven to prevent gluten cross-contact. NOTE: Heat does not "burn off" gluten.
- Avoid using a convection oven or air fryers unless foods are well covered. Convection ovens and air fryers work by using a fan to blow air throughout the oven or fryer. This poses a risk of gluten cross-contact as particles from gluten-containing food can come in contact with gluten-free foods if left uncovered.
- Avoid baking gluten-free foods at the same time you are baking gluten-containing foods. Gluten-containing flour is a high-risk ingredient as it can easily disperse in the air and come in contact with other foods and surfaces.
- Use condiments and spreads from a squeeze bottle or have separate condiments and spreads to be used with gluten-free foods (for example, butter or margarine, nut, seed or soy butters, jams, ketchup, etc.).
- Prepare gluten-free meals and snacks first, and store them in the fridge, securely sealed, until it is time to eat.
- If the childcare centre serves meals and snacks in a family style, serve the child with celiac disease their gluten-free food before serving other children to prevent gluten cross-contact and mixing of utensils.
Involve other childcare staff members
- Create a system with other childcare staff members that helps identify gluten-free meals and snacks. For example, use different-colour plates or cups for gluten-free and gluten-containing items.
- Train other childcare staffs or chefs/cooks on how to safely prepare gluten-free meals and snacks.
- Provide clear oral and written instructions to other childcare staff or chefs/cooks about how to safely prepare gluten-free meals and snacks if you will be away.
For children living with celiac disease, gluten-free meals and snacks are essential to their well-being. As a childcare chef or cook, you have an important role to play in their health and safety.