Food Allergies and School

Just when you get used to managing your young child’s food allergies, celiac disease or other condition at home, it is time to start school. This can be scary at first. At home, you have complete control over snacks, meals, crafts and more. Sending your kids off to school means educating school staff and others about food allergies and or celiac disease and then trusting them to keep your child safe.

Here is what you will find in this document.

Safety in the Cafeteria
USDA School Lunch Program
Special Information for School Nutrition ad Food Services
Safety in the Classroom - Responsibilities of the Child, Parents and School Employees

Safety in the Cafeteria

Most kids with special food requirements bring their own lunch and snacks to school, which provides a parent some degree of control. Eating with friends is an important part of your child’s educational experience. It provides opportunities for socialization and helps your child to feel like he or she fits in. However, your child will most likely sit in a cafeteria surrounded by many other children eating foods that could cause a reaction.

So, it is important to develop a strategy that will give your child a chance to socialize, while at the same time keeping him or her safe. Some schools have a peanut/tree nut free table in the lunchroom, where kids who did not bring any foods with these ingredients can sit together. Some schools have a food allergy table, where all the kids with food allergies sit together. Other schools have a peanut table, where all the kids who are eating peanut products sit.

At my daughter Emma's primary school, the cafeteria is small. So the kids who bring peanut butter sit at one end of the long table, and the kids without peanut butter sit at the other end. When she was in kindergarten, she sat at the end of the non-peanut section. This year, she sits wherever she would like in the non-peanut section.

The kids are very helpful. Most of them take responsibility for knowing what is in their lunches, and make sure they sit in the right place. One beautiful girl in particular, now refuses to eat peanut butter even in her own home! Just to keep Emma safe!

USDA School Lunch Requirements

The USDA Child Nutrition Division in charge of school lunches requires public school food service to provide substitute meals to food allergic students. To qualify, the child’s doctor must send in written instructions certifying the child's condition, what foods are to be avoided and safe substitutions. If they do not comply, the school can lose federal funding. Learn more about USDA school lunch requirements and how food allergic kids are protected by federal law.

When Emma started school, we were concerned about the peanut butter cookies, "No-Bake" cookies and banana-nut bread our cafeteria baked and served, especially since she shouldn't even breathe peanut protein. Our school's head cook made a decision to eliminate all foods with peanuts or tree nuts as an ingredient, even though other schools in our area still serve these foods.

Even though Emma has life-threatening food allergies to eggs, peanuts, tree nuts and seafood, she eventually wanted to eat hot lunch like her friends. Here is how we handled this. I first met with our head cook, Miss Pat, and discussed menus, recipes, food products and ingredients, food handling practices, cleaning and sanitation practices, and the responsibility of various staff and or additional contract employees at school. We determined there were several safe meals for Emma to eat and decided to let her try it.

The first year, I always sat in the lunchroom while she ate. This year, I meet with Miss Pat once or twice a month. We go through the menu together and determine which meals are safe. As we go through the menu, Miss Pat pulls food packages out of the freezer and storage and we read ingredients together. We also call companies if we have any questions.

We create a schedule of when Emma will be eating hot lunch so Miss Pat always knows ahead of time. If there is a risk of cross-contamination in the service bins, she prepares Emma's Tray first and sets it aside. When Emma gets to the front of the hot lunch line, she says, "Miss Pat, I'm here", and she gets her tray. If Miss Pat has a day off and has a replacement, Emma does not eat hot lunch. This year, I do not sit in the cafeteria while she eats.

You might decide, that sending a packed lunch is the safest thing to do. Muffins and cookies from the Food Allergy Gourmet make a great addition to a lunchbox! For recipes, take a look at our new cookbook called "Let's Bake" For freshly baked cookies made to order, please see Cookies.

Managing the Allergy/Condition in the Classroom

The parents, the child, and the school all have responsibilities in managing the food allergy in the classroom and lunchroom. As a parent or caregiver, it is your responsibility to be proactive at the school.

This section contains some guidelines for responsibilities based on recommendations from FAAN and AAAAI. More detailed information and suggestions for creating specific and detailed food allergy action plans for individual students can be found in the FAAN School Food Allergy Program. Please call FAAN or visit their web site before your child starts school to learn more.

If you have any questions, comments or suggestions about sending kids with dietary restrictions to school, please write us.

The Child’s Responsibilities

Before the school year begins, teach your child that he has an important role to play in managing the food allergy, staying safe and communicating with a teacher if there is a problem or he thinks he is having a reaction.

Give your child simple rules, such as “Do not eat anything unless it came from home. Do not trade food. Do not use someone else’s eating utensils or napkin.” Also, ask your child to sit at the end of the lunch table with responsible friends.

Teach your child what a reaction might feel like. Tell your child who to talk to if he thinks he is having a reaction and what to say. Rehearse this with your child. Also, make sure your child knows where his or her medications are stored.

The Parents’ Responsibilities

Set up an appointment with your child’s immunologist or allergist before school starts. Most schools also require written documentation from a physician containing information on the allergy, instructions and necessary medications. You can also detail all the information about your child's food allergy in a one-page summary, have your doctor sign it, and then give it to the school nurse and your child's teacher. Include a photo on all forms.

Do some research into Federal and State Laws that apply to your child, such as Section 504 of the Rehabilitation Act of 1973, a civil rights law that prohibits discrimination on the basis of disability. You may need to create a 504 Plan for your child.

Call the school and set up a meeting with the members of your child’s “team” who will be responsible for his or her safety and well being while at school. This team should include the child’s teachers, school administrators, counselors, nurses, cafeteria personnel, school bus driver and office staff.

At the meeting, politely and calmly explain and discuss the following with your child’s “team.”

How to read labels.
What foods cause reactions.
How a reaction can occur (through eating, touching, inhaling, etc.).
What precautions should be taken to prevent a reaction.
How to identify a reaction.
How a child might describe a reaction.
What emergency procedures to follow. Provide the school with three emergency contacts.
How lunch time should be handled.
Who to contact if there is a problem.

Work with the team to develop a daily plan that accommodates your child’s needs and keeps him or her safe at school, in the cafeteria, during school-sponsored activities and on the school bus. Also develop and Emergency Food Allergy Action Plan, and rehearse the plan before an emergency actually occurs. Document everything that is discussed, agreed and disagreed upon at the meeting(s), sign and date the document and send a copy to everyone involved.

Since your child will spend the most time with the teacher, here are some ideas of for additional topics to discuss with this special person.

How does the teacher prefer to communicate with the parents? Some like to use the phone or email. How often will you talk to the teacher?
Ask your teacher if there is a schedule of parties or other food-related activities, including food crafts. Plan to review this with him or her monthly in case there are any changes.
If you can, volunteer to help the class with snacks and party treats. If you can’t, send a treat for your child to eat.
Are there any field trips scheduled? How can you participate?
Where can you keep a fresh supply of snacks at school for your child?
Is it possible to teach the class about food allergies by showing a video such as Alexander, the Elephant Who Couldn't Eat Peanuts?
Send a thank you card to the teacher when something goes well.

The School’s Responsibilities

Students with life-threatening food allergies are protected by federal law. Some states have also passed state laws and district policies as well. Federal Laws that may apply in your child’s case may include ADA, IDEA, Section 504, and FERPA. It is the school’s responsibility to be knowledgeable about these laws, and include food-allergic students in all school activities. Food-allergic students should not be excluded from school activities based on their allergies.

In addition, schools should also do the following.

Review the written documentation from parents and physicians containing information on the allergy, instructions and necessary medications.
Identify a “team” who will be responsible for the child’s safety and well being while at school, on field trips and on the school bus. This team should meet with the parents to establish a prevention plan and an emergency food allergy action plan. This plan should be practiced before an emergency actually occurs.
Make sure everyone who interacts with your child understands what food allergy is, what your child is allergic to, what foods can cause a reaction, can identify the symptoms of a reaction and how a child might describe the onset of one. The team should also practice the food allergy plan and know what to do in case of emergency.
Work with other school staff members to eliminate the use of food allergens in the allergic student’s meals, educational tools, arts and crafts projects and special occasion or party snacks.
Make sure medications are stored appropriately and are accessible at all times. The emergency action plan and physicians orders should also be stored with the medications. State regulations determine where medications can be stored and whether or not age-appropriate students can carry their own epinephrine.
Train designated school personnel to administer emergency medications in accordance with state Nursing and Good Samaritan Laws. The school should ensure that there is always someone available who is trained to administer emergency medication.
If the child rides the bus, the bus driver should meet the child and be provided with appropriate information about the food allergies. The driver should be able to recognize the symptoms of a reaction and know the emergency procedures to take. All buses should have a cell phone. A “No Eating on the Bus” policy should be instituted and enforced on all buses, except in the case of special needs.

Environmental Allergies

Children with food allergies often have environmental allergies as well. Before school starts, tour the school to identify potential allergy or asthma triggers in the classrooms. These might include dust mites, chalk dust, animal dander, pollen and molds.

Dust mites can be found in carpeting, drapes and stuffed animals. Ask how often the carpet and curtains are cleaned. Make sure your school keeps them clean. If pollen and mold are an issue, ask your teachers to keep windows closed to prevent pollens and mold spores from coming indoors. An air conditioner and an air purifier can help to cool and clean the air. I have a friend who purchased an air purifier for her child's classroom. It can be run on High overnight, and Low during class.

Even with the windows shut, indoor molds can be a problem. They are usually found in dark, warm, humid places such as basements, bathrooms, or near leaky pipes. If indoor mold and mildew are discovered, ask that they be eliminated with a detergent cleaning solution.

Animal dander can make its way into a classroom in a variety of ways. Some schools have classroom pets. If a child has an allergy to animal dander, the furry pets should be removed. They can be replaced with turtles, hermit crabs, fish, snakes or any animal that does not have hair and dander. Enclosed coatrooms may pose a threat because dander can also be transported on coats. Ask if the allergic child’s coat can be stored away from the other coats.