A child with celiac disease is on dietary management. Which statement by the mother indicates a need for further teaching/intervention?

1. A

   Avoid wheat

2. B

   Avoid rye

3. C

   Avoid milk and milk products

4. D

   Give high protein vegetables

Appeared in: NORCET 10 Mains

Explanation

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• The question asks to identify the statement that shows a misunderstanding of the dietary needs for a child with celiac disease.
• Celiac disease is an autoimmune reaction to gluten, a protein in wheat, rye, and barley; it is not an allergy to milk or an intolerance to lactose (SRC_1583).
• The statement to avoid milk and milk products is incorrect as a primary rule. While secondary lactose intolerance can occur due to intestinal damage, it is not universal and often resolves as the intestine heals on a gluten-free diet (SRC_1583).
• Unnecessarily eliminating dairy can lead to significant nutritional deficiencies, particularly calcium and vitamin D, which are critical for a growing child's bone development.

Why Other Options Were Wrong

• Option A: This statement is correct. Wheat is a primary source of gluten, and its avoidance is a cornerstone of managing celiac disease.
• Option B: This statement is correct. Like wheat, rye contains gluten and must be strictly avoided by individuals with celiac disease.
• Option D: This is a positive and healthy dietary recommendation. High-protein vegetables are naturally gluten-free and contribute to a balanced diet, so this statement does not indicate a need for further teaching.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Dietary management of celiac disease in children and identifying parental knowledge gaps to guide bedside assessment, documentation, and the next nursing action.
• Nurses are pivotal in educating patients and families about managing chronic conditions like celiac disease. Correcting misconceptions, such as confusing celiac disease with lactose intolerance, is crucial for adherence and preventing nutritional deficiencies.
• Patient safety is at risk if key food groups are unnecessarily restricted. In a growing child, avoiding dairy without medical necessity can lead to poor bone mineralization, increasing the risk of rickets and future osteoporosis.
• What if the child does experience bloating and diarrhea after consuming milk, even after starting a gluten-free diet? The nurse should advise the mother to consult the pediatrician. The child may have a temporary secondary lactose intolerance. A trial of lactose-free milk products might be recommended while the intestine heals, rather than complete dairy avoidance.

How to Approach the Question

• First, identify the core concept of the question: the correct dietary management for celiac disease.
• Recall the pathophysiology of celiac disease: it is an immune reaction to gluten, not lactose.
• Identify the primary sources of gluten, which are wheat, rye, and barley.
• The question asks which statement indicates a 'need for further teaching,' which means you are looking for the incorrect or misguided statement made by the mother.
• Evaluate each option: 'Avoid wheat' and 'Avoid rye' are correct actions. 'Give high protein vegetables' is a healthy, unrelated action.
• The statement 'Avoid milk and milk products' incorrectly conflates celiac disease with a milk allergy or primary lactose intolerance. This reveals a knowledge gap and is the correct answer.

Concept Tested & Keywords

• Concept Tested: Dietary management of celiac disease in children and identifying parental knowledge gaps.
• Stem keywords: celiac disease, child, dietary management
• Lead-in keywords: indicates a need for further teaching/intervention
• Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
• Negative lead-in flag: false

Question ID

Qmh3PK8dpKthPrgW3uhbtr

Copy ID

Reference Book

E6 Nutrition Kumud Khanna 2e p. 257-259

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 320-322