Gluten challenge for Coeliac Disease in children

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A gluten challenge involves testing whether a child is still sensitive to gluten in a safe and controlled way. You should only follow this information if advised to by your child’s Paediatrician or Dietitian.

Introducing gluten into your child’s diet may be necessary to confirm the need for continuing a gluten free diet for life. It is important that an adequate amount of gluten is being consumed by the child for the tests for coeliac disease to be accurate.

A diet containing sufficient gluten for a minimum of six weeks is recommended to maximise the likelihood of a clear diagnosis. Occasionally this may not be possible because of severe reactions to gluten containing foods. If this occurs, please contact your Paediatrician or Dietitian to discuss. Patients should contact their clinician to arrange a blood test at the end of the trial and they should continue with the challenge until this has been done.

Recommended Intake

 Typically, 10-15g of gluten per day is required for an adequate intake in most children (see guidance below). Aim for your child to have at least two (preferably three) gluten containing meals per day, containing approximately 5g of gluten per meal.

It may be impossible to achieve intakes of 10g of gluten daily in younger children. Aim for two gluten containing meals per day, where gluten containing carbohydrate foods form the base of the meal. Please note – using low gluten containing foods alone, such as gravy on a meal is insufficient.

The following foods contain 2-3g of wheat protein (gluten) when eaten in the stated amounts: Please check packaging for exact amounts as brands may differ. 

1 medium slice bread, ½ pita bread or small chapati. 1 wheat biscuit cereal or 1 bowl of puffed wheat based cereal 3 medium-sized biscuits or cream crackers. 2 digestive biscuits or rusks.
1 croissant, crumpet, brioche roll or tea cake. 1 slice cake (30g) or portion of sponge pudding (50g). 45g Pastry. 30g flour or 20g raw semolina.
4 tablespoons (60g) cooked/tinned spaghetti or pasta. 3 fish fingers (in breadcrumbs or batter). 2 large or 3 chipolata sausages (Check ingredients contain wheat based rusk). 200g (7oz) tinned semolina pudding (½ large tin).

(The advice in this sheet is based on the “Guideline for the diagnosis and management of Coeliac disease in children” A Coeliac Working Group of BSPGHAN. 2012)