**Background:** Coeliac disease (CD) is one of the most common chronic childhood diseases. Regular follow-up is recommended to ensure gluten-free diet (GFD) adherence and prevent complications, yet real-world data on pediatric CD follow-up practices are scarce. This study aimed to survey how follow-up care is conducted for children with CD in the Västra Götaland region (VGR) of Western Sweden.
**Methods:** Two web-based surveys were distributed to all 22 general pediatric outpatient clinics in VGR between January and February 2021. One survey targeted pediatricians (52 questions) and the other targeted dietitians (32 questions). Responses were received from 48 physicians (representing 18 clinics) and 12 dietitians (representing 12 clinics). The surveys covered follow-up timing and frequency, methods for monitoring dietary adherence, symptoms, growth, nutritional status, comorbidities, educational activities, and attitudes toward eHealth. Statistical analyses were performed using SPSS version 26, with categorical data presented as proportions and continuous data as median and interquartile range (IQR). The Kruskal-Wallis test was used for subgroup comparisons, with significance defined as p < 0.05.
**Key Results:** Among pediatricians, 94% (45/48) scheduled the first follow-up visit within 6 months of diagnosis. For patients in remission, 54% (26/48) scheduled the second visit at 10–12 months, while for those without clinical improvement, 54% (26/48) scheduled it at 0–3 months. Stable patients were typically followed yearly until age 18. All pediatricians assessed GFD adherence via unstructured interviewing combined with tissue transglutaminase (TTG) antibody tests; 52% (25/48) always used TTG, and 29% (14/48) almost always. Validated adherence questionnaires were rarely used. Gluten immunogenic peptides and point-of-care TTG tests were never used. A follow-up duodenal biopsy was considered only in selected cases by 42% (20/48) of respondents. Thyroid function tests were the most common comorbidity screening (always or almost always by 81% [39/48]), while other tests (e.g., vitamin D, iron, bone mineral density) were used only on clinical suspicion. Quality of life was assessed through dialogue at each visit by 52% (25/48), but 29% (14/48) never or almost never assessed it. A formal transition process to adult care was lacking for 13% (6/48) of physicians, with considerable variation across clinics (0–100%). Self-rated CD knowledge among pediatricians had a median score of 8.0 (IQR 5.3–8.8) on a 0–10 scale, but varied significantly between clinics (p = 0.002). Most pediatricians (54%, 26/48) received continuing education less often than every 3 years. eHealth use was rare, but 79% (38/48) considered it a good alternative for patients in remission.
Among dietitians, 73% (8/11) saw newly diagnosed patients within 0–3 months. In contrast to pediatricians, 55% (6/11) assessed GFD adherence through structured interviews. All dietitians believed a dietitian-led clinic should be offered to all or selected patients. Median self-rated CD knowledge was 9.0 (IQR 6.0–9.0), and 73% (8/11) received continuing education less than every 3 years. While eHealth use was low, 55% (6/11) indicated it could be used in up to 80% of visits.
**Clinical Implications:** Pediatric CD follow-up in Western Sweden largely follows current guidelines, but several areas for improvement were identified: implementing formal transition processes to adult care, adopting validated GFD adherence questionnaires, increasing the frequency of continuing education for clinicians, expanding the role of dietitians in follow-up, and exploring the integration of eHealth technologies. These findings highlight opportunities to enhance the quality and consistency of pediatric CD care.