08192017Headline:

Gluten-Free for Children With Sensitivities, and Without

By KJ DELL’ANTONIA“Eat no wheat.”

That succinct summary of the popular gluten-free diet that began Kennneth Chang’s “Gluten-Free, Whether You Need It or Not” in the Health section caught my attention for its stark declaration of what’s obvious about living gluten-free: you’re ruling out an entire category of food, although not an entire food group (there are plenty of whole grains without gluten).

“Eat no wheat” struck me because it cuts against the advice most parents heed when it comes to feeding our children: a little bit of nearly everything, not too much of any one thing. It’s one thing for an adult to choose to avoid a swath of foods, but the calculus is often different for a growing body. Would a gluten-free diet, I wondered, be a healthy choice for a child without any need to avoid foods with gluten, or are there risks in eliminating gluten from a child’s diet?

Gluten-free is the obvious choice for the approximately one-in-a-hundred Americans with celiac disease, but it is becoming a common choice for many others as well, from people with specific maladies like irritable bowel syndrome and autoimmune conditions to those hoping to lose weight and feel healthier after a change in diet. As adults choose gluten-free for themselves, many are choosing it for their children as well.

I asked Lauren Graf, a clinical dietitian at the Children’s Hospital at Montefiore in the Bronx, how she would respond to a parent who had decided to make his child’s diet gluten-free. First, she said, she would want to know more.

“I’d ask the parent what triggered the decision,” she said. “Because if a parent suspects celiac disease, they should definitely get a diagnosis and know. If you just think a gluten-free diet is healthier, you can stray from time to time, but if a child has celiac disease, it’s really important that they actually stick to that diet as closely as possible.”

Otherwise, Ms. Graf said, if a gluten-free diet is healthy, she’s all for it — but just because a meal is gluten-free doesn’t mean it’s good for you.

“You can be on a diet that’s very healthy, that’s gluten-free, or very unhealthy,” she said. “You could be on a gluten-free diet that’s loaded with gluten-free cupcakes and apple juice and other foods that are high in refined sugar that are not good for you, or you can be eating tons of vegetables and fruit and beans and quinoa.”

Are there any nutrients that a child might miss out on by leaving out the gluten? Ms. Graf said she didn’t think so. “There’s no risk to not eating certain grains,” she said. What is important in a gluten-free diet is the same thing that is important for everyone: eating whole foods rather than processed ones.

“It’s not just going out and buying a bunch of gluten-free cereals and cupcakes,” she said.

Ms. Graf did raise one warning flag when it comes to children and a gluten-free diet. Teenagers (perhaps influenced by celebrities like Lady Gaga) might announce a decision to go gluten-free for health or weight loss, but the diet can be a cover for an eating disorder.

“If you suspect an eating disorder, then a child who’s using gluten-free to avoid eating certain foods in certain social situations is a risk,” Ms. Graf said. Avoiding certain foods can serve to mask avoiding food altogether.

Has your family gone gluten-free in response to a health condition? Is it harder, or easier, to help a child eat healthy without gluten? Do some family members worry that a diet that excludes a food is a diet that puts a child at risk?

What Next?

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