The question: Not only is my child a picky eater who loves pastas and white bread, but now he's developed a gluten intolerance. How do I get him to enjoy other foods that won't make him sick?
The answer: Food intolerances are common in children, and the response required will vary greatly from child to child.
Celiac disease, for example, is a severe form of gluten intolerance that is diagnosed by biopsy, obtained by passing a scope through the mouth and stomach and into the small intestine. Patients with celiac disease require a very strict gluten-free diet and can develop severe, often life-threatening, symptoms if the diet is not followed.
As you are likely aware, gluten is the protein found in certain grains including wheat, barley, rye and sometimes oats. Fortunately, true celiac disease is relatively rare. In my practice, I commonly see children who don't have the disease, but have symptoms that are nonetheless aggravated by wheat or gluten. These children are generally easier to manage, as their diet doesn't always need to be as strict as those with true celiac disease.
Fortunately, gluten free products are now easier than ever to find in grocery stores and health food stores. You can even find pasta and bread! I recommend referring to one of the many excellent books on living gluten-free to help with meal planning and navigating the grocery store. Books such as The Complete Gluten Free Diet and Nutrition Guide and The Essential Gluten Free Grocery Guide are just two examples. Gluten-free recipes are also abundant online, and there are helpful websites like www.celiac.ca.
For children with true celiac disease, I believe assessment and follow-up with a registered dietician is essential. I do warn parents that gluten-free products can taste different from their wheat-based counterparts and these subtle but noticeable differences in taste and texture can be an issue for some children. Be prepared to introduce these foods many times before they are accepted.
For children who are picky eaters, my advice is the same whether or not food intolerance is a factor. Avoid large or frequent snacks and drinks as these can diminish appetite at mealtime. As always, ensure your child is offered a variety of foods from different food groups at each meal.
Although children, like adults, can be resistant to dietary changes, most will eat at least some of what is offered on their plate. Despite the grumbling and complaining that may come with the introduction of a new food, children do look to parents for guidance on issues of portion size and food choices. Be a good role model! Persistence is key. Don't be discouraged if your child rejects a new food the first time it is introduced. Expect to offer a new food choice multiple times before your child will brave even more than a bite.
Implementing dietary changes for children who are experiencing symptoms of a food allergy or intolerance is not as difficult as you might think. The child themselves is usually very interested in doing whatever it takes to reduce their symptoms, especially if they involve pain, diarrhea, or vomiting.
Although true celiac disease is a lifelong problem, many of the other food intolerances can be outgrown over time. Consult with your family physician or pediatrician to determine if and when foods can be safely reintroduced.
Dr. Michael Dickinson is the head of pediatrics and chief of staff at the Miramichi Regional Hospital in New Brunswick. He's a staunch advocate for children's health in Atlantic Canada through his involvement with the Canadian Paediatric Society.
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