Gluten-free schooling: Navigating challenges and triumphs for children with celiac disease.

Objectives: Celiac disease (CeD), an autoimmune disorder triggered by gluten ingestion, induces intestinal inflammation and varied symptoms. Treatment entails a strict gluten-free diet (GFD), posing challenges for students, especially in schools with limited food choices. Nonadherence worsens symptoms, yet research on CeD's impact on students is scarce.

Methods: The CeliacKIDS study, conducted across 11 United States academic medical centers, evaluated gluten exposure risk in pediatric CeD patients via a cross-sectional survey from August 2020 to August 2021. Participants recruited from treating institutions were approved by respective Institutional Review Boards.

Results: One hundred and sixty children aged 5-18 (65% female, 34% male, 1% other) participated. Only 12% had GF food options at school, 31% brought their own for celebrations, and 41% lacked gluten free (GF) snacks after school. Thirty-six percent lacked a 504 plan, with 5% misinformed. Hand hygiene concerns included 24% using sanitizer and 10% rarely washing hands before eating. Sixty-two percent disclosed CeD, 35% when prompted, and 3% refused, mainly 13-year-old males. Two percent hesitated to request GF options, and 2% consumed potentially gluten-containing food from friends.

Conclusion: Many US schools provide GF accommodations under the Americans with Disabilities Act (ADA) but lack national standards. Diverse GF options and education on GF-safe practices are crucial for GFD adherence. Discrepancies in parent-child perceptions emphasize the need for better communication. Adolescents, particularly females aged 12-13 with 2+ years on a GF diet, face higher risks. Transparent family-school communication is vital for optimizing the school experience and ensuring GFD adherence. Comprehensive nationwide school training is essential for celiac patients' well-being.