Lately, gluten free diets are getting a lot of attention. Going gluten free has been rumored to increase energy and concentration, cure digestive ills, and even improve symptoms of autism and ADHD in children. With so much hype it’s hard not to wonder if your child might not benefit from a gluten free diet.

Gluten is a protein found in certain grains like wheat, barley and rye that gives baked goods their texture. Because gluten helps make foods taste better and improves their texture, it's also added to everything from deli meats to French fries. For most children gluten is completely harmless, with two exceptions. "Children should be following a gluten-free diet if they've been diagnosed with celiac disease or with non-celiac gluten sensitivity," says Tricia Thompson, MS, RD, co-author of Easy Gluten Free: Expert Nutrition Advice with More than 100 Recipes.

What exactly are celiac disease and non-celiac gluten sensitivity? Celiac disease, also known as celiac sprue, is an autoimmune condition that affects one in 133 people. For children with celiac, even the slightest morsel of gluten can mean trouble, triggering the release of antibodies which mount an assault on the intestines. These attacks damage the intestine, making it difficult to absorb many of the nutrients children need to grow and thrive. They also cause many unpleasant symptoms such as gas, bloating, diarrhea and weight loss or weight gain. Untreated, celiac can also lead to complications such as anemia, neurological disorders and osteoporosis. Non-celiac gluten sensitivity (or NCGS) is believed to be more widespread than celiac, affecting an estimated 18 million Americans. It's similar to celiac in that it also involves an immune reaction to gluten. But unlike celiac disease, that reaction doesn’t cause the body to produce damaging antibodies. So while a child with NCGS may have many celiac-like symptoms, he or she won’t experience the same intestinal damage, nutrient deficiencies or long term complications.

Currently, the only treatment for celiac disease or non-celiac gluten sensitivity is a gluten free diet. "A gluten free diet is extremely restrictive so it can be difficult for a child to follow," says Dee Sandquist, MS, RD, a spokesperson for the Academy of Nutrition and Dietetics. "It can also be psychologically and socially challenging." Birthday parties, sleepovers, eating out and even snack time at school can be difficult to navigate. But the good news is that when children with celiac disease do give up gluten their growth returns to normal and their symptoms quickly improve according to a 2008 article in the Journal of the American Dietetic Association (now known as Journal of the Academy of Nutrition and Dietetics).

If you suspect your child has celiac or NCGS, experts recommend having your child screened by your health-care provider before going gluten free. In fact, testing for these conditions only works if your child is eating a gluten containing diet. Because gluten is found in so many foods, unnecessarily restricting it can actually cause your child to miss out on important nutrients like iron and B vitamins children normally get from enriched and fortified foods like cereals, bread and pasta. If, after testing, you do find that your child needs to go gluten free, working with a registered dietitian nutritionist can help develop a plan that ensures he or she gets all the nutrients needed for optimal health.

Should people without Celiac Disease eat a gluten-free diet?

Many on Gluten-Free Diets Don't Have a Celiac Diagnosis
Lack of a doctor's diagnosis hasn't deterred people from trying gluten-free diets, which have gotten high-profile plugs from celebrities and talk show hosts. The market research firm Mintel estimates Americans will spend $7 billion on gluten-free foods this year. The market for gluten-free products has grown 27% between 2009 and 2011.

Among 55 people in the study who said they were on gluten-free diets, 53 tested negative for celiac disease. That led researchers to estimate that 96% of people on gluten-free diets may not need to be on them.

While experts say it's not necessarily dangerous to eat gluten-free -- many people who try it find they eat more fresh fruits and vegetables and less junk food, for example -- it's not recommended to self-test with a gluten-free diet. You should check with a health care provider first.

"If you suspect you have some intolerance to gluten, it's VERY important that you get tested for celiac disease to confirm or rule out a diagnosis," says Rachel Begun, RD, a dietitian who specializes in celiac disease and is also a spokeswoman for the Academy of Nutrition and Dietetics.

Begun says people who try gluten-free diets on their own may also miss out on key nutrients, like iron and B vitamins. And a new study suggests that going gluten free may actually raise your risk for type 2 diabetes. The gluten-free diet, meant for a small population of people who have celiac disease or a gluten intolerance, became popular despite lack of evidence that it was healthy for most people.

According to Dr. Geng Zong from the Harvard University Department of Nutrition T.H. Chan School of Public Health, gluten free foods are often less nutritious because they lack dietary fiber as well as vitamins and minerals. They also tend to be more expensive. His study looked at the health effects of a gluten free diet on subjects that did not medically need to follow one. In a long term longitudinal study scientists observed that most subjects consumed 12 grams of gluten or less per day. In those that consumed higher amounts of gluten the risk of type 2 diabetes over a 30 year span was lower. Cereal fiber intake was lower in subjects on a gluten free diet, which is important to note as it is a protective component for the development of type 2 diabetes. After accounting for the effect of cereal fiber those in the highest 20% of gluten ingestion experienced a 13% lower risk of diabetes development than those with the lowest intake of gluten.

The bottom line is that if you don’t need a gluten free diet don’t follow it. Include gluten-containing high fiber whole grains in your diet daily. The Dietary Guidelines for Americans advise 20-25 grams of dietary fiber daily for women and 35-38 grams of dietary fiber for men. Below is a list of whole grains and their fiber content:

  • Barley (1/2 cup cooked): 3.1 grams
  • Bran cereal (3/4 cup): 5.9 grams
  • Brown rice (1/2 cup cooked): 2 grams
  • Oatmeal (1/2 cup cooked): 4.1 grams
  • Rye bread (1 slice): 1.5 grams
  • Quinoa (1/2 cup cooked): 2.75 grams
  • Whole wheat bread (1 slice): 3 grams
  • Whole grain pasta (1/2 cup cooked): 5-6 grams


Andrews, Lisa C. “Can a Lack of Gluten Raise Your Diabetes Risk?” UP4Nutrition, 20 July 2017,

Ansel, Karen. “Does My Child Need a Gluten Free Diet?”, American Academy of Nutrition and Dietetics, 21 Jan. 2014,

Doheny, Kathleen. “What's Behind the Gluten-Free Trend?” WebMD, WebMD,

“Celiac Disease.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services,

“Going Gluten Free?” National Institutes of Health, U.S. Department of Health and Human Services, 19 July 2017,


Reprinted with permission

Recently released U.S. Department of Education Office of Civil Rights data show that expulsion and suspension are widely used in early childhood programs and that there are gender and racial disparities (United States Department of Education, 2016). These data include:

▲ 6,700 children attending public preschool were suspended at least once in 2013-2014.

▲ Black preschool children are 3.6 times more likely to receive one or more out-of-school suspensions as white preschool children.

▲ While boys represent 54% of preschool enrollment, they represent 78% of preschool children receiving one or more out-of-school suspensions.

▲ Black boys represent 19% of the male preschool enrollment, but represent 45% of male preschool children receiving one or more out-of-school suspensions.

▲ Black girls represent 20% of female preschool enrollment, but 54% of female preschool children receiving one or more out-of-school suspensions.

These data are particularly troubling given that research suggests that expulsion and suspension practices are associated with negative short- and long-term outcomes. Young students who are expelled or suspended experience greater academic failure and grade retention, hold more negative attitudes about school and are less engaged, have higher rates of dropout, and face increased rates of incarceration than those who are not. Discipline practices that remove children from early learning environments and enriching experiences that contribute to healthy development and academic success have the potential to result in pervasive gaps in school success and overall quality of life.

The Federal Response

In recognition of the severity of the issue, the US Departments of Education and Health and Human Services issued a Policy Statement on Expulsion and Suspension Policies in Early Childhood Settings in 2014 (U.S. Department of Health and Human Services and U.S. Department of Education, 2014) that provides recommendations to States and local early childhood programs to prevent and severely limit expulsions and suspensions in early learning settings. One of the recommendations to address suspension and expulsion was that early learning programs use evidence-based practices and approaches to promote social emotional competence in young children and address challenging behavior, and that staff engage in self-reflective practice that can help prevent and eliminate potential biases in their practice

Additionally the Department of Education recently released a “dear colleague letter” (DCL) emphasizing that schools must provide behavioral supports to children with disabilities, including preschool children with disabilities, who need such supports and that the repeated use of disciplinary actions may be an indication that children are not receiving appropriate behavioral interventions and supports,

To support states and early childhood programs in this effort, The Departments of Education and Health and Human Services have funded the Technical Assistance Center on Positive Behavioral Interventions and Supports (PBIS) at the University of Oregon in partnership with the University of South Florida and the University of Colorado Denver to implement the Pyramid Equity Project with Preschool Development Grant national activity funds, http://www2.

The Pyramid Equity Project

The Pyramid Equity Project (PEP) will develop, demonstrate and disseminate an effective approach for the promotion of social competence in young children and the prevention of suspension, expulsion, and discipline disparities in early learning programs. The Pyramid Equity Project will develop tools, materials, and procedures to explicitly address implicit bias, implement culturally responsive practices, and use data systems to understand potential discipline equity issues. These practices will be implemented within the Pyramid Model for Promoting the Social Emotional Competence of Infants and Young Children (Fox, Dunlap, Hemmeter, Joseph, & Strain, 2003) – a multi-tiered framework of evidence based teaching practices that promote social and emotional skills of all children, prevent challenging behavior of children at risk of challenging behavior, and provides individualized interventions for children with persistent challenging behavior. Two randomized trials have been conducted on the Pyramid Model (Hemmeter et al., 2016, April; Hemmeter et al., 2016). These studies have demonstrated that teachers learn to use the Pyramid Model practices with higher levels of fidelity when they receive systematic coaching over time. Teachers’ use of the Pyramid Model practices is associated with improvements in children’s social skills and challenging behavior.,

The Pyramid Equity Project is partnering with two Preschool Development Grant programs: Clifton Early Learning Academy in Clifton New Jersey, and Cambridge Early Learning in Antioch Tennessee, to implement the Pyramid Model and address implicit bias. This partnership will help to develop national models and resources for addressing disproportionate discipline practices in early learning programs within the Pyramid Model framework that will be available to other states and programs.

Principal staff for the Pyramid Equity Project

▲ University of Oregon – Rob Horner and Kent McIntosh

▲ University of South Florida – Lise Fox, Jolenea Ferro, Denise Perez Binder, Myrna Veguilla

▲ University of Colorado Denver – Phil Strain, Rosemarie Allen, Barbara Smith


▲ University of Nevada Reno – Glen Dunlap

▲ Vanderbilt University – Mary Louise Hemmeter

For more information

Contact Lise Fox,



Fox, L., Dunlap, G., Hemmeter, M. L., Joseph, G. E., & Strain, P. S. (2003). The Teaching Pyramid: A model for supporting social competence and preventing challenging behavior in young children. Young Children, 58 (4), 48-52.

Hemmeter, M. L., Fox, L., Snyder, P., & Algina, J. (2016, April). Research on the Pyramid Model: Findings, issues and implications. Paper presented at the 13th Annual National Training Institute on Young Children with Challenging Behavior, Tampa, FL.

Hemmeter, M. L., Snyder, P., Fox, L., & Algina, J. (2016). The efficacy of the Pyramid Model: Effects on teachers, classrooms and children. Topics in Early Childhood Special Education. Published online ahead of print.doi:10.1177/0271121416653386

U.S Department of Education Office for Civil Rights (2016). Data Snapshot: Early Childhood Education. Retrieved from https://

U.S. Department of Health and Human Services and U.S. Department of Education (2014). Policy statement on expulsion and suspension policies in early childhood settings. Retrieved from suspension_ final.pdf

The CACFP meal patterns are undergoing many changes starting in October, 2017. One of the exciting new improvements is that tofu will be creditable on the Food Program for the first time since the program began in 1968! Below are facts on tofu and tips on how to use it.


  • Tofu is made from soybean curds, it’s naturally gluten-free and low calorie; it contains no cholesterol and is an excellent source of protein, iron, and calcium, especially for vegans, vegetarians, and those looking to move toward a more plant-based diet.
  • Tofu is a bargain. It usually costs less than just $2 for a portion which should serve several people, depending on how you are using it. It's a great source of protein if you're cooking and eating on a budget!
  • Tofu maybe help lower LDL cholesterol It may offer relief for certain symptoms of menopause
  • Half a cup of tofu contains 94 calories

Possible health benefits of consuming tofu

Countless studies have suggested that increasing consumption of plant-based foods like tofu, decreases the risk of obesity and overall mortality, diabetes, and heart disease. It also promotes a healthy complexion and hair, increased energy, and overall lower weight. Recent studies have shown that due to its high levels of isoflavones, tofu consumption is associated with a lower risk of several age and lifestyle-related diseases, such as:

  1. Cardiovascular disease Consuming tofu as an alternative to animal protein lowers levels of LDL cholesterol, which is also referred to as "bad" cholesterol; this, in turn, decreases the risk of atherosclerosis and high blood pressure.
  2. Breast and prostate cancer Genistein, the predominant isoflavone in soy, has antioxidant properties that inhibit the growth of cancer cells. Previously, there has been confusion regarding the safety of consuming soy after a breast cancer diagnosis. This is because isoflavones have a chemical structure that looks similar to estrogen However, moderate amounts (less than two servings a day) of whole soy foods are known not to affect tumor growth or a woman's risk of developing breast cancer. In fact, regular soy intake may decrease breast cancer recurrence. Although evidence is not strong enough to recommend soy to all breast cancer survivors, evidence is mounting.
  3. Type 2 diabetes People who have type 2 diabetes often experience kidney disease, causing the body to excrete an excessive amount of protein in the urine. Evidence from a recent study has indicated that those who consumed only soy protein in their diet excreted less protein than those who only consumed animal protein The authors of the study concluded: "The findings indicate that isolated soy protein consumption improves several markers that may be beneficial for type 2 diabetic patients with nephropathy [damage to the kidney]."
  4. Osteoporosis Soy isoflavones are known to decrease bone loss and increase bone mineral density during menopause and have also been reported to reduce some other menopausal symptoms.
  5. Liver damage Studies have suggested that tofu of all types that has been curdled with various coagulants can be used to prevent liver damage caused by free radicals.
  6. Age-related brain diseases Based on geographic epidemiological findings, it has been observed that populations that consume greater amounts of soy have, in general, less incidence of age-related mental disorders.

A half-cup serving of tofu contains:

  • 94 calories
  • 2 grams of carbohydrate
  • 5 grams of fat
  • 10 grams of protein

Tofu provides:

  • 44 percent of daily calcium needs
  • 9 percent of magnesium
  • 40 percent of iron


Potential health risks of consuming tofu

Possible risks in consuming soy foods have been heavily debated recently, especially regarding breast cancer. There is not enough evidence from human clinical trials to substantiate the claim that the isoflavones in soy contribute to breast cancer risk.

The soy and cancer study that started the controversy concerned only those with a specific type of breast cancer (estrogen receptor positive). Some early studies suggested possible increased tumor growth in rats with a high intake of soy. As more advanced research was done, scientists found that rats metabolize soy completely differently from humans, making the earlier studies invalid.

Now we know that moderate amounts of whole soy foods do not affect tumor growth or a woman's risk of developing breast cancer. In fact, at least 10mg of soy per day can decrease breast cancer recurrence by 25 percent.

Findings from animal models have also suggested that there exists a positive correlation between tumor growth and the degree to which an isoflavone-containing product has been processed. Therefore, it is better to consume tofu and other soy foods that have undergone minimal amounts of processing, like soybeans or edamame, tofu, tempeh, and soymilk.

If anyone has concerns regarding consuming genetically modified soy or products processed with hexane gas, go organic. The USDA National Organic Standards prohibit the use of GMOs and hexane. You can also look for products with the Non-GMO Project Verified seal. Some brands with this seal include Silk, Amy's, Back to Nature, and West Soy. For a complete list of products with the verified seal, visit

It is the total diet or overall eating pattern that is most important in disease prevention and achieving good health. It is better to eat a diet with a variety than to concentrate on individual foods as the key to good health.


On the Food Program, only commercially prepared tofu is creditable. A serving is one quarter cup or 2.2 ounces with at least 5 grams of protein of firm, extra firm, soft or silken tofu. It must be recognizable on the plate, in other words, not incorporated into smoothies or baked into desserts. Also, tofu products such as links and sausages are only creditable when they have a CN label or Product Formulation Statement from the manufacturer showing how the product meets the CACFP requirements.

Tofu comes in several different consistencies: extra firm, firm, soft, or silken.

  • Firm and extra firm tofu is denser than soft or silken tofu and retains more of its shape when cooked. This makes it suitable for grilling and stir-frying.
  • Soft tofu works well in casseroles and soups.
  • Silken tofu is best for puddings and dips, and can also be blended into smoothies for added protein. Its neutral flavor allows it to be easily incorporated into any recipe, and many meat substitutes comprised of tofu are made to taste and feel like the meat they are imitating (for instance, tofu sausage and tofu burgers).

How to Cook with Tofu

Tofu is amazingly versatile and adaptable. It absorbs the flavors of the ingredients it’s cooked with, from sweet to savory. It works in a variety of cooking methods.

  • Add it to salads and soups
  • Stir-fry it
  • Roast it
  • Cook it in place of eggs in tofu scramble
  • In tacos with tomatoes, spinach and spices
  • Mashed with veggies in quiche or muffins
  • Bake it into tofu nuggets instead of chicken nuggets.

More Cooking methods

Marinated tofu: Tofu will soak up flavorful marinades like a sponge, particularly if you cut it into bite-sized pieces first. Try a simple marinade of soy sauce and rice wine to begin with, and then play around with things like hot sauce, minced ginger, garlic, and brown sugar.Let it marinate for at least 15 minutes. The longer you can let the tofu marinate, the more flavorful it will be.

Pressed tofu: Even extra-firm tofu can still contain a fair amount of water and end up soft. When making something li8ke tofu-loaf or pad thai, press the tofu between two plates to squeeze out the water. The resulting tofu is nicely compact.

Baked tofu: Diced into small pieces and baked in a low oven, tofu slowly dries out and becomes chewy. These bites are perfect for snacking, adding to salads, or rolling up in a veggie burrito.

Crispy seared tofu: You can sear tofu just as you would sear meat. Place it in a single layer in a hot pan and let it cook without stirring. The bottom becomes golden and crispy, a wonderful contrast to the custardy middles. Shake the pan every few minutes until all sides are golden.

Diced or crumbled tofu: The way you cut tofu also changes the experience of eating it. For soups, dice the tofu into tiny cubes, but leave them larger for stir-fries and noodle dishes. Crumbled tofu does well in things like casseroles and dumplings where a more uniform texture is desired.

Below is a link for 52 tasty tofu recipes:



Family routines can help things become more organized, get more accomplished and keep things from becoming chaotic. Children as well as adults can benefit from routines at home. Children need the predictability and regularity that routines can bring. However, some need more or less routine structure than others.

Routines that are appropriate to the children’s developmental stages can promote self-confidence, independence and feelings of empowerment.

Consistency is key to making a successful routine work. For younger children, it may be helpful to create a visual chart that has photos of the steps involved in completing the routine. Be sure to keep the steps simple and try not to list too many. Stick to the routine as much as possible, but remember to be flexible when unexpected changes to your schedule come up.

Maybe it’s a morning routine that your family is in need of to get each day started on the right foot. Remember, keep it simple. First a positive wake-up, not everyone is a morning person, so make sure to leave enough time for each child to wake up as they need to. Rushing first thing in the morning can be stressful and make some less willing to be as helpful. Next step could be bathroom and brush teeth. Follow this by getting dressed. (It can save a lot of time in the morning if clothes get picked out the night before.) Once dressed, it’s time for breakfast.

Nighttime routines can help bedtimes go more smoothly. When children know what the steps are and that the steps are followed consistently each evening it helps them to feel safe and secure. They are able to predict what is next. Try using these few steps each night to ease into bedtime:

  • Pick up toys
  • Have bedtime snack
  • Get pajamas on
  • Brush teeth
  • Read bedtime stories
  • Time to say good night

Just like the morning and nighttime routines are helpful for very young children, there are other routines that can be helpful for school-age children. School-age children need routines that are also appropriate to their age and the tasks that need to be completed. They can have routines for putting away their own laundry, helping to care for the family pet and getting their homework done or preparing their backpack for the next day of school.

How about a meal time routine? Depending on the age of your children, there could be some things that they can do to help with meal times, especially dinner time in the evenings as that is usually the best time for the whole family to get together. Be sure to choose age-appropriate tasks for children. Have children set the table. When dinner is ready, have everyone sit at the table together. This is a great time to see how everyone’s day went, share stories and just communicate with each other. Once dinner is finished, children can help clear the table. This makes clean-up time go much quicker, leaving time for other things in the evenings.

It’s pretty clear that routines are important for children of any age. But how are routines helpful for parents? Everyday life can be less hectic when routines are followed, which will lower stress levels. As children improve on doing the routines by themselves, they will need fewer instructions and constant reminders from the grown-ups in the home. And, you’ll be reassured as a parent that you are teaching your children to be capable and confident at any age.

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