Question: We have a seven-year-old girl who has been recently diagnosed with coeliac disease. She has started on a new gluten-free (GF) diet. There has been lots of progress, and the improvements in health have been amazing, so we have been very pleased.
My question is about how to keep her on a different diet from her brother and sister without her feeling excluded or, worse still, developing long-term food issues. For example, at a recent restaurant visit, she got a GF pizza and her sister got a burger and chips. She became quiet and upset and it turned out she wanted chips (though she knew there were not GF). She is well-behaved and was not going to make a fuss. She asked her sister for a chip and I allowed her to take one or two. I did this knowing they were bad for her, but I worry about whether denying her what is normal will create bigger problems down the line.
Obviously, in the home we cook all GF meals and we go to great lengths to keep her on a full GF diet, including meals out and takeaways, but wonder if occasional lapses are okay and also what long-term implications are.
Answer: Most people with coeliac disease see the restrictive gluten-free diet post-diagnosis as a small price to pay for the enormous health improvements they experience. They may miss some of the old foods but they don't miss the sickness they experienced and the memory of this is enough to put them off returning to the old food.
However, it of course takes time to adjust to a new diet and this can be particularly challenging when other people around you are eating different foods. Many social situations are built around shared food experiences and it can feel awkward to negotiate these when you have a different diet. Of course, this is particularly challenging for a young child, who is only beginning to understand the implications of the disease and who is trying to adjust to new eating habits while ‘fitting in’ with siblings and friends on different diets.
Whether to occasionally break the GF diet?
You ask the interesting question as to whether small lapses in the GF diet will have any long-term implications for your daughter. Not being a dietician, I can’t comment on this from a health perspective, but I would imagine that most health professionals would recommend you keep strictly to the diet (do check in with your GP or a specialist dietician to confirm this).
However, from a psychological perspective, it could be problematic for a number of reasons. For some people, having a blanket ban on certain foods just works better for them and is simpler to manage. Making exceptions and letting your daughter eat a small amount of a food perceived as a treat can make her crave more of that treat and make her feel more deprived when she does not have it. Put simply, having ‘one chip’ can make having another one more desirable. Whereas, if your daughter never eats chips then they become less desirable over time as her new eating habits are established. Over time, the goal is help your daughter identify new desirable foods within her new GF diet.
When your daughter wanted her sister’s chips, instead of letting her have one or two, you could try and support her to maintain the diet. For example, you might acknowledge “it’s a pity they are not GF, but don’t worry, we will sort something out later for you”. Or you might focus her on what she is eating – “good thing you have your GF pizza – it looks nice”. Or you could offer her support more generally, “it is hard getting used to a new diet, but you are getting there”.
Helping your daughter manage social food situations
Growing up with coeliac disease will mean your daughter will have to deal with many social situations where other people are eating different foods and where people are offering her foods she can’t eat. The goal is to help her deal with these social situations in a confident manner that does not make her feel awkward or in any way socially isolated. Help her come up with a positive story that she can tell others – “I am a coeliac, so I can only eat . . .” Helping her talk about it in an upbeat humorous way can help – “Bad news is I can’t eat . . . but I get to eat lots of chocolate! (or another desirable food)”.
At times, your daughter might feel burdened by having coeliac disease. You can help her by acknowledging her feelings and focusing her on some of the positives – “we are lucky that we got the diagnosis early, you used to be so sick eating food before and now you are much healthier” or “do you know a GF diet can be much healthier as you get to eat more vegetables and fruit”.
Your daughter is also likely to get a lot of support from hearing about other children who have coeliac disease. This could be by reading stories from a book or online and meeting other children informally or in a support group. Do contact organisations such as coeliac.ie to see what supports and resources are available.
– John Sharry is founder of the Parents Plus Charity and an adjunct professor at the UCD School of Psychology. He is author of several parenting books including Parenting Teenagers. See solutiontalk.ie