Sunday, 17 March 2013

A coeliac in childcare: she's been throwing her food on the ground!

When Alexandra was diagnosed with coeliac disease I was working four days a week and Alex was in a day nursery. She had three meals a day there, so they were going to have a huge role to play in maintaining her gluten free diet. The nursery had always been great for food- they had a dedicated cook and a very varied menu, prepared fresh every day.

Before Alexandra returned to nursery I sat down with her key worker and went through exactly what the dietician (the proper paediatric one, not the ditsy one) had told us. We had been given a list of what plants, grains and cereals have and haven't got gluten in them and nursery took a copy of this. We did have a shorter cheat sheet, but the more comprehensive guide can be found on the American Celiac Association website here :  (they spell 'coeliac' without the 'o' in the US!)

Initially, things were looking up and Alex was eating well, putting on weight and getting back to walking and playing with her little buddies. We did have the odd few 'blips' along the way though. I want to point out that our nursery was fantastic on the whole, and we were very happy with them. I am highlighting the mistakes that were made in the hope that others can pre-empt and avoid them completely.

Is it a fair substitution?
When the babies are young at this particular nursery, the parents always get a list of what the child has eaten that day. I don't know why I didn't ask, but for some reason I just assumed that Alex was eating pretty much the same as the other kids with one or two substitutions. It was only when I was told that she had thrown her pudding on the floor and it was not the first time that it had happened that I wondered. Very apologetic for her behaviour I asked what it was that she had thrown on the ground. 'Orange slices' I was told. Oh right- and what did the other children have for pudding I asked, my heart starting to sink. 'Chocolate chip cookies' I was told. Hmmm, that might be part of the cause of her 'irrational behaviour' I suggested, there's quite a difference between orange slices and chocolate chip cookies. I'm sure some saintly 2 year olds would choose the fruit, but not my sugar lover! 'Our cook bakes the puddings fresh and there isn't always an equivalent substitute' I was told. Well, I went to Asda and bought a box of mini gluten free muffins and a packet of gluten free biscuits and asked for them to be kept in the cupboard and given to Alexandra if the kids were having a sweet treat, and to be informed when they run out so I could replace them. I was never asked to bring in more food, and Alexandra was always given a similar meal/ pudding from then on. Sometimes the nursery bought treats in, but also their cook started baking batches of GF cakes and freezing them.

They were also really good in consulting with me regarding Alexandra's choice of cereal, and always had her favourite Doves Farm GF chocolate stars for breakfast.

Let's swap food:
There were more challenges when Alex was 2 ish and the kids started eating from each other's plates. After a few 'incidents', the nursery decided to assign a nursery worker to watch Alexandra at meal times to ensure there wasn't any 'swapping' going on. We then had some issues with staff/ supply workers who weren't familiar with Alex's situation giving her the wrong food, so the nursery implemented a system where 2 permanent members of staff had to check and sign each meal she was given to ensure it was ok for her. I know this probably sounds complicated, but it worked. As we became more confident with the GF diet, so did the nursery staff and the number of accidents reduced.

Inclusiveness is important:
The nursery also made other changes, such as making playdough out of gluten-free flour so it didn't matter if Alex put her hands in her mouth before washing them. (It doesn't matter if coeliacs handle gluten containing products, but young children have a habit of putting their hands in their mouths and commercial play dough contains gluten.) When I discovered that they were putting Alexandra in a group that was doing a different activity on 'baking days', I provided some easy GF recipes and the staff were happy to include her in the baking group.

Another area that could have been fraught with difficulty was other children's birthdays at nursery. Parents would often bring in cakes or sweets to celebrate their little one's big day. The nursery never gave these out during the day anyway, handing the treat to parents to dole out when they came to collect their child. As Alex got older and realised that other children were getting 'something nice' the nursery started giving me one of her 'special' treats, wrapped in tinfoil, the same as everyone else's, so she didn't feel excluded.

Communication is key:
When managing a child with coeliac disease in a nursery setting, I think the main thing is communication, discussing the fears, concerns or questions of all staff (not just managers and keyworkers) in an open way and setting out what your expectations and concerns as a parent are. I feel it's important not to jump to blame when an incident occurs, but to look at a solution. Myself and my husband have certainly made the odd mistake (pulling the wrong fish fingers from the freezer-oops!), and have had to find systems that work to protect Alexandra in the same way that the nursery did. I can't believe that any nursery worker or carer, having seen the effect that consuming gluten can have on a child, would not do everything in their power to prevent it happening again and would be open to any suggestions or ideas that a parent can offer.

Alexandra no longer attends day nursery, she has started at nursery school, which has been another eye opener, and has fantastic child minders who are fully comfortable and able to manage her condition.

Please feel free to share your experience of  how your nursery coped with a gluten-free kid or any tips on how to manage a gluten free diet in a childcare setting?


1 comment:

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