A teacher's guide to celiac disease

With increased awareness and a few considerations about celiac disease and the gluten-free diet, you can create an inclusive learning environment that allows students living with celiac disease to thrive in the classroom.

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 a need for frequent bathroom breaks, and extra-intestinal symptoms, such as fatigue. This 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 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 crafts, 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. Within the classroom, 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 can help to prevent gluten cross-contact in your classroom.

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 students with celiac disease.

Creating an inclusive and safe environment for students with celiac disease

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

Here are some tips to support a student with celiac disease in the classroom:

• Prepare classroom activities and events that do not involve foods and products that contain wheat, barley, rye and other related grains, such as triticale.
• Provide advance notice to the student's parents about upcoming events and celebrations, such as pizza days, field trips, semi-formals or graduations, where gluten-containing foods may be served. Providing advance notice will allow your student's family to prepare gluten-free foods so that they can safely participate in the event or celebration.
• If a student's parents provide gluten-free snacks or treats to be used at celebratory events, make sure that they are clearly labelled for the student and are stored away from gluten-containing items or foods.
• Consider sharing non-food items, such as pencils and erasers, colourful notebooks or stickers, for birthdays or celebrations.
• Ensure all students practice good hand hygiene by washing their hands with soap and water before and after eating, and after art activities that may contain gluten. Hand sanitizer WILL NOT remove gluten.
• Clean work and eating surfaces with soap and water before and after eating or class activities that use gluten-containing foods or supplies.
• Arrange a classroom seating plan for nutrition breaks and lunch that allows adequate space to prevent cross-contact with gluten.
• Create a “no sharing food” policy in your classroom to prevent gluten exposure and accidental gluten cross-contact.
• Encourage inclusivity in your classroom and be on alert for incidents of bullying.
• Notify your student’s parents if there was an incident of gluten exposure.
• If a student has been exposed to gluten and is experiencing symptoms, contact the family and discuss if there is a need for pick-up.
• Provide all students with celiac disease unrestricted access to the bathroom.
• Provide academic accommodations when needed if the student requires more time to complete assignments or take a test due to feeling ill after exposure to gluten.
• If you are not sure if a food or product is gluten-free, it is best not to provide it to your student. It’s better to be safe than sorry!

Common sources of gluten in the classroom

School supplies and classroom activities can sometimes contain gluten and pose a risk to students with celiac disease. Although gluten cannot penetrate the skin, gluten cross-contact can still occur if a student puts their hands on 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 supplies and classroom activities and easy substitutions to ensure a safe classroom environment:

• Playdough or modelling clay products can be made using a wheat base. Choose gluten-free doughs or modelling clay that uses gluten-free bases, such as rice flour or corn starch.
• Paper mâché is often made with wheat flour. Using wheat flour in the classroom is a high-risk situation as it can easily disperse in the air and come in contact with other surfaces. Use corn starch or rice flour instead of wheat flour when doing paper mâché arts and crafts activities.
• Pasta art. Pasta is made from durum semolina, a product of wheat. Swap gluten-containing pasta for gluten-free options, such as dry and natural/unprocessed corn, quinoa, beans, lentils or rice, or choose any other pasta that is labelled as gluten-free.
• Sensory tables or sand trays are a great tool to build children’s fine motor skills. However, sometimes items used in sensory tables or sand trays, such as gluten-containing cereals (for example, Froot Loops* from Kellogg’s®), oats or pasta, are not gluten-free and pose a risk to small children who may put these items or their hands in their mouth. Use other gluten-free foods or non-food objects, such as pipe cleaners, pom-poms or shaving cream.
• Moldy bread experiment is a popular science class activity where gluten-containing bread is rubbed on surfaces such as hands, tables, chairs, keyboards, cell phones or toilet seats to demonstrate where microorganisms (e.g., bacteria, fungi) are present. This activity is not safe for students with celiac disease as it poses a high risk of gluten exposure and gluten cross-contact. To safely demonstrate this science experiment, use gluten-free breads or glo-germ gel.
• Solar oven experiment is another popular science class activity where students re-purpose a used pizza box to cook foods such as s'mores or a grilled cheese sandwich. The science experiment poses several risks to students with celiac disease as the students may be exposed to gluten from a used pizza box and/or the gluten-containing foods cooked in the solar oven. To overcome these risks, use clean boxes and provide gluten-free foods to cook in the solar oven. Alternatively, allow the student with celiac disease to cook their gluten-free foods in the clean pizza box first before the other students cook their gluten-containing foods.

Providing a safe and inclusive environment for a student living with celiac disease can help them reach their full academic potential without the worry of gluten exposure. By following these tips and taking the time to learn more about celiac disease, you can be an important ally to your students living with celiac disease.