A camp's guide for supporting campers with celiac disease

Please note that the resource is intended as a guide to support camp counsellors, camp leaders and camp administrators in their understanding of celiac disease. These suggestions are not mandated camp rules. It is up to parents or caregivers to evaluate the risk of their child attending camps, inform camp staff about their child's diagnosis of celiac disease and support their child in safely attending camp.

Children and families living with celiac disease may be excited and nervous about camp, even if they are seasoned campers. You can help them to have a memorable and positive camp experience by learning about celiac disease and the strict gluten-free diet and working with campers and their families to understand how to provide a safe camp environment.

What is celiac disease?

Celiac disease is a lifelong 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. The damage also 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 common name of a family of proteins found in grains that cause intestinal damage in 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 of gluten, is the only treatment for celiac disease. While some sources of gluten are obvious, such as wheat-based breads, pastas and baked goods, others can be hidden in things like soups, ice creams or personal care items (e.g., hand creams). Some craft items, such as playdough or wheat-based paper mâché, can also contain gluten. Carefully read labels to determine what foods and products are gluten-free.

It is also important to avoid gluten cross-contact. Cross-contact occurs when gluten is transferred from one food or object to another food or object, making it unsafe for people with celiac disease. In a camp setting, gluten cross-contact can happen through shared table surfaces or the use of gluten-containing art supplies. Hand washing and cleaning surfaces with soap and water can help to prevent gluten cross-contact.

Watch the Celiac disease and Gluten-free diet modules from AboutKidsHealth's Celiac disease learning hub to learn more about how to best support your campers with celiac disease.

Creating an inclusive environment at camp

The key to creating an inclusive and safe environment for campers living with celiac disease is clear communication and collaboration among campers, parents/caregivers and staff members.

Here are some suggestions to support a camper with celiac disease:

• Prepare meals, snacks and camp activities that do not include foods and products containing wheat, barley, rye or other related grains, such as triticale.
• Speak with the camper's parents/caregivers in advance to discuss what crafts and activities will be planned during their time at camp, and brainstorm gluten-free safe alternatives. Parents/caregivers may be able to supply the camp with safe alternatives.
• If the camper's parents provide gluten-free snacks or treats for camp, make sure they are clearly labelled for the camper and are stored away from gluten-containing items, such as wheat flour.
• Ensure all campers practice good hand hygiene by washing their hands with soap and water before and after eating, and after crafts and activities that involve gluten. Hand sanitizer WILL NOT remove gluten.
• Clean work and eating surfaces with soap and water before and after eating gluten-containing foods or after crafts and activities using gluten-containing supplies. Use plastic place mats or thick plastic tablecloths if furniture or surfaces are exposed wood. Gluten can become stuck in the pores of wooden furniture or kitchen tools such as cutting boards even if these items are cleaned. Prevent gluten cross-contact by covering the exposed-wood surfaces and not using wooden tools or utensils in the kitchen.
• Create a "no sharing food" policy for your campers to prevent gluten exposure and accidental gluten cross-contact.
• Encourage inclusivity among campers and be on alert for any incidents of bullying.
• Notify the camper's parents if there is an incident of gluten exposure.
• If a camper is exposed to gluten and is experiencing symptoms, provide them with near and unrestricted access to the bathroom. Also allow time to rest with recommendations to avoid participating in camp activities until they are well.
• If you are not sure if a food or product is gluten-free, do not provide it to the camper. It's better to be safe than sorry!

Overnight camps

If your camp is an overnight camp and serves food to campers, additional care and consideration will be needed to help campers with celiac disease stick to a strict gluten-free diet. Here are some tips to ensure a safe overnight stay for a camper who has celiac disease:

• Provide the camper's parents/caregivers with the weekly or monthly gluten-free menu to review in advance.
• Meet with the camp's cook, food service staff and/or medical staff (e.g., doctor, nurse, dietitian) to discuss the camper's dietary needs for celiac disease and how the camp will support the camper with maintaining their strict gluten-free diet.
• Create a system with your camp's cook or food service staff to safely identify and provide gluten-free meals and snacks to campers with celiac disease (e.g., use different-colour plates or utensils to indicate a gluten-free meal, have a specific gluten-free snacks cupboard).
• Store gluten-free foods or items for crafts and activities provided by parents/caregivers safely away from gluten-containing foods or items.
• If the camp serves meals and snacks in a family-style or as a buffet, serve the camper with celiac disease their food before other campers to prevent gluten cross-contact and mixing of unclean utensils.
• Support campers during meals and snacks to prevent sharing of foods or gluten cross-contact.

Common sources of gluten at camps

Camp crafts, activities and foods can sometimes contain gluten and pose a risk to a camper with celiac disease. Even exposure to the smallest amount of gluten can make some campers feel very sick. Although gluten cannot penetrate the skin, gluten cross-contact can still occur if a camper puts their hands in their mouth or nose or touches food that they eat after contact with a surface, utensil, food or product that contains gluten. Here are some common gluten-containing camp crafts, activities and foods and easy substitutions to help create a safe camp experience:

• Campfires. Enjoying activities around a campfire can be a memorable experience for campers. Some traditional campfire foods, such as s'mores (chocolate and graham crackers) or hotdogs and hotdog buns, can be a source of gluten. It is important to read food labels to identify if there are any ingredients that contain wheat, barley, rye or other hidden sources of gluten. In addition to foods, grills placed over campfires, roasting sticks and condiments used for campfire foods can be sources for gluten cross-contact. To avoid gluten cross-contact:
• Add tinfoil over the campfire grill to cook the camper's gluten-free foods. Heat does not "burn off" gluten. Grills that have been previously used to make gluten-containing foods, such as hotdog buns or grilled cheese sandwiches, will become contaminated and unsafe for campers with celiac disease. Tinfoil can protect the camper's gluten-free foods from gluten cross-contact on campfire grills.
• Use clean metal roasting sticks at the campfire. Tell the campers not to share their roasting sticks and consider adding stickers or name tags to the roasting sticks to avoid any mixing and gluten cross-contact.
• Use squeeze bottle condiments. If using squeeze bottles, tell campers never to touch the tip of their bottle to their food to prevent gluten cross-contact.
• Sunscreen or lotions. Some sunscreens and lotions may contain gluten ingredients. Placing sunscreen or lotion on a camper's hands or face may lead to accidental ingestion of gluten. Speak with the camper's parents/caregivers to check for safe, gluten-free sunscreens/lotions, or use the sunscreens/lotions that the camper's parents/caregivers provided. If the campers need help applying their sunscreen, apply the sunscreen to campers with celiac disease before helping the other campers.
• Face paint can sometimes contain wheat or oats. Make sure to carefully read the labels to make sure there is no gluten.
• Arts and craft supplies such as playdough, modelling clay, glue or craft paste, or pasta art can sometimes contain wheat, which is a source of gluten. Read the ingredients list to make sure the arts and craft supplies are gluten-free.

Children living with celiac disease deserve to have a positive camp experience just like any other child! Learning more about celiac disease and the strict gluten-free diet, along with making small changes to create a safe and inclusive camp environment, can make you an important ally for your camper with celiac disease.