Dear Teacher,

A student in your class has been diagnosed with an autoimmune disorder called celiac disease (CD). While this will affect some aspects of classroom and school management, patience and understanding can bring about the necessary changes that will quickly become a natural part of the school experience for all involved.

What is celiac disease?
Also known as celiac sprue or gluten-sensitive enteropathy, CD is a genetic disorder that can affect both children and adults. In people with CD, eating certain types of grain-based proteins sets off an autoimmune response which causes damage to the small intestine. This, in turn, interferes with the small intestine's ability to absorb the nutrients found in food, leading to malnutrition and a variety of other complications. The offending proteins are collectively called gluten and are found in wheat, barley, rye and, common oats (WBRO) and all of their derivatives.

What are the symptoms of CD?
Exposure to WBRO may result in a variety of symptoms which may include diarrhea, abdominal distention, anemia, fatigue and inability to concentrate. For a small number of people with CD, the disease manifests itself in small itchy blisters on the skin called dermatitis herpetiformis (DH). Because no two celiacs exhibit exactly the same symptoms, however, please refer to the back cover of this booklet to see a list of those particular to this student. Contact the parent/guardian or CSA for a more extensive list of possible symptoms.

How is CD treated?
This is a lifelong disease and currently the only known treatment is the total elimination of WBRO from the diet. This may sound like an easy solution at first. WBRO is hidden, however, in things like food additives, flavorings, personal care products, school supplies and more. Therefore, some adjustments may need to be made in the classroom and other areas of the school to reduce the risk of inadvertent contact.

Whose responsibility is it?
Ultimately, it is the responsibility of the student to decide what he or she will eat and touch while at school, knowing the consequences of those decisions. However, a newly-diagnosed celiac may need help to reinforce the prescribed lifestyle change. Intercession should rarely be necessary for older children. In younger children, however, who may be unable to read label information, it is vitally important for members of the school staff to encourage self-management skills by reading the ingredients to the child. The goal is to help provide the child with adequate information in order to help him or her gain confidence living a lifestyle that is free of WBRO.

The grieving process
As with many other forms of loss, a child diagnosed with CD must give up many of his or her favorite foods and may thus experience some level of grief. During this period, you may see signs of sadness, denial, shock, confusion, anger, irritability, loss of appetite, physical complaints, loss of concentration, depression and/or withdrawal from friends. Occasionally, as part of the denial process, the child may take risks with foods or other products known to contain WBRO (this is especially true in the teen years). It is important to remember that such action might dramatically impact present and future health. All research indicates that even a small amount of exposure to WBRO can evoke an undetectable immune reaction, increasing a celiac's chances for future health problems and conditions including other autoimmune diseases, osteoporosis, and cancers such as T-cell lymphoma.

It is important for a child with celiac disease to be able to share the feelings and frustrations he or she might have because of the disease. By sharing, other students will be able to learn about similarities and differences in people.

Family and close friends, striving to help the newly diagnosed child, may also experience some stages of grief. Patience and understanding are needed to move those involved from these feelings of loss to a place of acceptance. Feel free to contact the child's parent/guardian if you have questions or concerns in this area.

How will this disease affect the classroom?
Attendance:
Depending on how recently a child has been diagnosed, attendance can be an issue. Although a child with CD should maintain attendance, some emergencies may occur that keep him or her out of class at times. Medical appointments with specialists and dietitians might also be necessary and will sometimes need to be held during school hours. It is also understood that the child may come into contact with WBRO during the course of the school day which possibly will cause disruptive symptoms. Feel free to contact the child's parent/guardian if you have questions or concerns in this area.

Cafeteria:
There are definite challenges involved in the cafeteria. The food service staff has been or will be educated about this disease to ensure that, when possible, safe options are available for the child with CD. When this is not feasible, the parent/guardian may provide a packed lunch. Lunchroom supervisors might need to remind the child not to swap food or touch other foods which could cross-contaminate his or her meal. It is also important that table surfaces are clear of crumbs or other residue from WBRO .

Off-site Events/Field Trips:
When a student with CD is involved in off-site events, it is important that the chaperones be informed of the special needs that may be involved.

Restroom Usage:
It is important to remember that if a child with celiac disease should come into physical contact with any of the offending grains, it will be necessary to remove all protein residue as quickly as possible. There also may be an urgency to use the toilet due to the possible onset of uncontrollable diarrhea. His or her instant reaction may be to "run" to a sink or toilet without asking for permission. Because of this, special restroom privileges may be needed.

Perhaps a special code or signal can be created for use in such circumstances, as well as a seat near the door for quick emergency exits. The soap available in school restrooms will also need to be free of WBRO. If this is not possible in every one, please designate which one will have the appropriate supplies, and allow access to it as needed.

Early childhood & elementary settings
Art:
Many of the popular brands of clay, crayons, pastes and paints contain WBRO . Please contact the parent/guardian or CSA for an up-to-date list of safe alternatives.

For those with DH, latex gloves and balloons may cause difficulty. Check with the parent/guardian regarding the needs of this student.

Substitutions will also need to be made if any craft projects involve pasta, cereal rings or other food items containing WBRO . Corn or rice pastas can be used for stringing activities, sorting and patterning and there are available alternatives to most other items.

Cooking and Baking:
Many popular items can be created using alternatives that are free of WBRO . Contact the parent/guardian or CSA for recipes and acceptable ingredient substitutions.

Health Lessons:
When lessons are presented on health-related topics, such as hand-washing or tooth brushing, it will necessary to contact the parent/guardian to ensure that appropriate products are available that do not contain WBRO .

Sensory Tables:
Safe items include cornmeal, rice, beans, sand or water.

Snacks:
There are many popular snack items which do not contain WBRO. Contact the parent/guardian or CSA for a list of appropriate snacks. Because there will be times when treats are provided by outside sources, a supply of safe alternatives will be provided by the parent/guardian to allow the celiac student to participate. It may be helpful to arrange that a "stash" be kept in the room for such times.

Stickers and Envelopes:
Most stickers and envelopes that need to be licked contain gum arabic, which can be a hidden source of WBRO . At this time there are no alternatives. It is best to avoid giving these to small children who have CD or contact the manufacturer to determine if the item is safe.

Upper elementary & secondary settings
Drama:
Materials used in some types of make-up may be derived from WBRO. Also, if the student has DH, it is possible that he or she is also sensitive to Latex which is sometimes found in costuming and masks. Contact the manufacturer to determine if an item is safe, or contact the parent/guardian or CSA for sources of possible alternatives if needed.

Visual Arts:
Many of the popular brands of clay, crayons, pastes and paints contain WBRO . Please contact the parent/guardian or CSA for an up-to-date list of safe alternatives.

For those with DH, latex gloves and balloons may cause difficulty. Check with the parent/guardian regarding the needs of this student.

Health Education:
Consideration should be taken in any lessons on diet management or hygiene to note the exceptions necessary for those with CD.

Physical Education:
Unless the child with CD has symptoms such as anemia, short stature, fatigue, aches and pains, dental irregularities, osteoporosis, or various neurological symptoms, he or she will be able to participate completely in these classes.

Science:
Special consideration needs to be given when conducting laboratory experiments. All supplies and materials containing WBRO (and possibly Latex and Iodine, for those with DH) should be avoided. When this is not feasible, the child with CD could be assigned to serve as a recorder or observer.

Family and Consumer Sciences:
Cooking

The student with CD will benefit from this class by learning how to prepare popular foods using appropriate substitutions for ingredients containing WBRO . Often recipes can easily be altered. Contact the parent/guardian or CSA for information on conversion possibilities and recipes. Note that some dish and dishwasher detergents contain WBRO.

Sewing

Starches, sizing and laundry detergents can contain WBRO and should be investigated prior to use.

Additional Information
The information contained in this material is not intended to be all-inclusive. It is provided to help you understand the importance of caution and preparation when working with a person with CD. Additional information is available in other areas of this Web site. Feel free to browse as you see need.

The goal is to provide an environment where the child with CD can learn self-management skills without being consumed by the illness. An atmosphere designed to foster responsible decision making will ultimately help the child perform well both in and out of the classroom.

Thank you for your help and support.