{
  "abstract": "Maintaining strict adherence to a gluten-free diet is the only effective treatment for Coeliac Disease (CD). However, maintaining consistent adherence can be challenging for many Children and Young People (CYP), particularly as they become increasingly independent. 1 Adherence is known to be influenced by a range of practical, psychological and social factors.2 Understanding these barriers within paediatric populations can inform tailored medical, dietetic and psychological support. Although there are national guidelines for the management of CD, these do not yet fully integrate psychological care for CYP.A questionnaire study was conducted with 60 CYP diagnosed with CD attending clinics within a Paediatric Gastroenterology Service. CYP were divided into two age groups: 8–12 years and 13–17 years. Participants completed self-report measures assessing adherence to a gluten-free diet and the impact of a range of potential barriers, including psychological, social and practical. Correlational analyses were conducted with each age group to explore associations between barriers and adherence scores.Statistical analyses showed there were differences in the key barriers associated with adherence across the two age groups, and the extent to which these impacted the CYP. In younger children (8–12 years), adherence was significantly associated with practical barriers. Poorer adherence was significantly associated with practical barriers, particularly the high cost of gluten-free foods and limited availability or choice. In contrast, among adolescents (13–17 years), poorer adherence was significantly associated with psychological and social barriers. Those reporting poorer adherence described greater feelings of frustration, sadness and exclusion, and reported being more affected by others’ comments or discussions about food. This group appeared more influenced by peer relationships and emotional factors surrounding dietary restrictions.These findings suggest there is a developmental shift in the factors influencing adherence to a gluten-free diet in CYP. While practical barriers influence adherence in younger children, psychological and social factors play an increasingly significant role during adolescence. These differences have implications for service delivery, suggesting that psychology support should be both routinely available and tailored to the CYP’s development.Integrating psychological assessment and support into paediatric CD services is therefore essential to support the evolving developmental needs of CYP. For younger children, family-based support focused on practical management may improve adherence, whereas adolescents may benefit more from interventions targeting emotional coping, social inclusion and self-management skills. A multidisciplinary model embedding routine psychological input alongside medical and dietetic care could enhance adherence and wellbeing, thereby optimising long-term outcomes. Although current guidelines emphasise dietetic and medical follow-up, structured psychological intervention remains an area for development. Our findings provide support for integrating age-appropriate psychological support as a routine component of paediatric CD services.References Czaja-Bulsa G, Bulsa M. Adherence to gluten-free diet in children with celiac disease. Nutrients. 2018 Oct 4;10(10):1424.White LE, Bannerman E, Gillett PM. Coeliac disease and the gluten-free diet: a review of the burdens; factors associated with adherence and impact on health-related quality of life, with specific focus on adolescence. J. Hum. Nutr. Diet. 2016 Oct;29(5):593–606.",
  "authors": [
    {
      "affiliations": [
        "Leeds Children’s Hospital"
      ],
      "name": "Lou Maclean"
    },
    {
      "affiliations": [
        "Leeds Children’s Hospital"
      ],
      "name": "Cathryn Evans"
    },
    {
      "affiliations": [
        "Leeds Children’s Hospital"
      ],
      "name": "Charlotte Hewitson"
    },
    {
      "affiliations": [
        "Leeds Children’s Hospital"
      ],
      "name": "Robert Bridle"
    },
    {
      "affiliations": [
        "Leeds Children’s Hospital"
      ],
      "name": "Nicole Russell"
    },
    {
      "affiliations": [
        "Leeds Children’s Hospital"
      ],
      "name": "Ashleigh Blood"
    },
    {
      "affiliations": [
        "Leeds Children’s Hospital"
      ],
      "name": "Veena Zamvar"
    }
  ],
  "title": "OC68 Age-related barriers to gluten-free diet adherence in children and young people with coeliac disease: implications for integrated psychological care",
  "uid": "710771af-b5fb-5301-8837-cbc573c712c9"
}