Released Today: The CDC Guide to Managing Food Allergies in Schools

Today,October 30, 2013, the Centers for Disease Control & Prevention (CDC) published “Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs." It is the first national comprehensive guidelines to help schools manage food allergies in their facilities and with their students.

This guide was created for schools, but I think every parent should download it and read it. It will help parents with food allergic kids understand what you can expect from schools, and also help parents of kids who have no food allergies understand why these regulations are in place. It might even help a parent save a kids life.

A Quick Snapshot of the Guide

The guide was created with the help of a team of experts, including federal agencies with the expertise in food allergies, consumer organizations who give advice on the clinical management of food allergies (like FARE and The American Academy of Pediatrics), organizations who represnt professional groups who work in schools, like school nurses.  They also worked with one school district, one state education agency, and two parents of food allergic kids.

The guide also takes into account the emotional needs & symptoms of food allergic kids, as well as guidelines on how to deal with bullying. Emotional needs are important, as well, since "the peanut table" can be a very lonely experience, as can be being forced to eat in the nurse's or principle's office.

The guide describes the symptoms of a classic allergic reaction, and how to recognize it as such from a clinical perspective, including mental and emotional symptoms. A child, for instance might have a sudden mood change or have a "sense of impending doom." I've certainly experienced this as part of a food allergy reaction, and I'm super glad that they included emotional symptoms in the guide.

The guide also gives examples of how a kid might describe a classic allergic reaction (one that might result in anaphylaxis). Here are a few examples:

• It feels like something is poking my tongue.
• There’s a frog in my throat; there’s something
• stuck in my throat.
• My tongue feels full (or heavy).
• My lips feel tight.
• It feels like there are bugs in there
• (to describe itchy ears).

A very important component of the guide is the strategic planning and framework section. It helps the schools set up a system for the school so they can properly and quickly respond to an emergency, and document any emergency, so they can learn from any incident that might occur. This includes guidelines on professional development and training for any staff who has frequent contact with food allergic kids.

It also sets up a system for each child to help prevent and reduce the risk of any emergency, including child/parent education. How many times have we heard that a parent didn't realize that their food allergy posed such a risk for their child? The parent didn't learn from the doctor who diagnosed the child, but learned from an emergency room visit?

There are several sections that describe how to put these guidelines into practice, including checklists and recommended practices from the cafeteria to the bus, to field trips, to outside groups who use the school. 

Finally, the guide gives a clear description on the Laws that govern food allergies:

• Section 504 of the Rehabilitation Act of 1973 (Section 504)
• the Americans with Disabilities Act of 1990 (ADA)h
• Governing Statutes and Regulation for U.S. Department of Agriculture’s (USDA) Child Nutrition Programs (CNPs)
• Individuals with Disabilities Education Act (IDEA)
• Family Educational Rights and Privacy Act (FERPA) of 1974

...and a very comprehensive list of federal resourses to help schools and individuals find and understand the laws.  These are listed at the end.

This is an incredible resource with a great deal of information, that is very well organized. 

Download it here:  Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs.

You can also read more about this, and find other resources on the FARE website.

Love is In the Air… Valentine Ideas for Your Food Allergic Child

Great ideas from Guest Blogger, Melanie Potock of MyMunchbug.com.

Allergen-free Cookies from Cybele Pascal

Recipe from Cybele Pascal

This weekend,  kitchen tables everywhere will be piled high with home-made Valentine cards or frosted with flour and cookie cut-outs as everyone prepares for the traditional Valentine’s Day Party at school. For kids with food allergies or sensitivities, new ideas for alternative crafts or treats are plenty and I’d love to share some of them here with you!

Let’s get right to it: cookies, that is.  I mean, you have to have a heart shaped cookie on Valentine’s Day…I’m pretty sure there’s a law about that.  When I laid eyes on these delectable allergen-free “melt in your mouth” cookies from Cybele Pascal, I knew I had found the perfect little hearts to share with you. 

Fun Valentine Cards & Activities

MAMAGAGA

Speaking of little hearts, here’s a clever idea for a Valentine’s Day card that is not only from your child’s heart, but direct from his tiny hand!  Mamagaga.com created this easy tutorial where you take a photo of your child with their hand reaching toward the camera and then simply put the token of your choice in his hand as a special Valentine treat!  Allergy free options might include an organic lollypop, a Starbuck’s card (for teacher!) or a one-word, handwritten message in your child’s own lettering, such as “KISS”.

DOTTY VALENTINE

Another option for cards takes a bit more time and definitely adult supervision, but I loved these “dotty valentines” using precision Q-tips™.  The Crafty Crow recommends acrylic or tempura paints (contains egg) but another option would be Allergen Free Non-toxic finger paints either homemade or from  India Tree Natural Decorating Colors , which are made from vegetables.  As always, check ingredients to ensure that your child is safe and consult with kidswithfoodallergies.org for craft supplies that may contain allergens.

DEVELOP MOTOR SKILLS

Continue to challenge your kiddo’s fine motor skills with this lacing activity! Looking for an inexpensive class activity that doesn’t involve scooping up as much sugar and candy as little fists can hold and then piling it all on top of a processed cookie in less than 15 seconds?  This Valentine craft will keep tiny hands busy and the poor teacher won’t have to deal with 25 kids in a sugar coma after the party has ended.

Cupcakes!  GF, DF, Egg-free, Nut-free, Soy-free

Let’s do the teacher, the kids and the other parents a favor and bring in a sweet pink treat that can’t be beat…wait for it…yes, “Beet-iful Cupcakes” by Gluten Free Gigi.  Bright reddish-pink cushions of heaven, thanks to the natural color of a roasted beet!  These are gluten, dairy, egg, soy and nut free, sweetened with honey and delish!

Gifts of Service

What I loved most as I explored all the options for Valentine’s Day, was this post that I felt gave the best examples of how we can express our love, even to those that we have yet to know.  Reach out to an army family, visit a nursing home, bring art supplies for Valentines to your local children’s hospital or write a message to the kids to help them heal... just like someone did here in the freshly fallen snow in Colorado!

It will warm your heart…and theirs.  

"Get Well Kids" written in the snow....

Happy Valentine’s Day Tender Foodies!

About Melanie

Melanie Potock, MA, CCC-SLPMelanie is speech language pathologist who specializes in feeding.  Her work brings her into the homes and schools of her clients, kids, who for various reasons have difficulty with food or with eating. She works with kids and their parents to develop effective strategies that help children become “more adventurous eaters”.  At least 50% of her clients have food allergies or intolerances, and for them, “adventurous eating” takes on a special meaning.  Melanie is also the author of Happy Mealtimes with Happy Kids” and the executive producer of “Dancing in the Kitchen.”

More Posts from Melanie

How Can Parents Feel Less Stress with a Food Allergic Child in School?

Review:  The Magic of the BellyFULL Kit from the Hopeful Company

Finding Balance with Food in the Classroom

Guest Tender Blogger, Melanie Potock of My Munch Bug, gives lend her advice on food in the classroom after reading a   recent news article about the latest debate in Plymouth, MA schools.  Melanie is the kid expert for The Tender Palate.

According to the article:  "The proposal triggered some of the most heated debate the School Committee has seen in years, with some advocating for the ban in the name of student health and others complaining that the district was overstepping its bounds."

Physics 101

I was never very good in Physics 101,  except for the unit on balance.   Maybe that’s because I have always understood the principles of balance in our daily lives.  Achieving it isn’t a simple task, but I know what it feels like. When life is in balance, it feels smooth, steady and easy.  When life is out of balance, it feels inconsistent, erratic and even chaotic.  Change makes us suddenly lose our balance and no one, absolutely no one, likes that feeling.

Recently, changes in school district policies regarding food being allowed in classrooms has created controversy and upset among parents, teachers and students.  The pendulum has swung from allowing ALL food in the classroom to the recommendation by some that NO food be allowed in the classroom.  Whoa!  That’s one big push in the opposite direction.  Time to find a little balance, but that requires effort.  That’s why many of us don’t like change; returning to balance takes effort on our part.  We’d rather just stay where we are.

Where is All of This Drama Coming From?

To find the balance, consider the following viewpoints that prompted the massive swing of the pendulum:

In Plymouth, Massachusetts,  the food ban “was proposed at the start of the year to reflect changes in state and federal nutritional guidelines for schools.” 

Anne Powers, the nurse leader of the Plymouth school district, had views that were not supported by the majority of parents.  She cited the following reasons for banning food in all elementary classrooms:

•    Increasing childhood obesity statistics
•    Increasing food allergies in the student population

When the school district surveyed the parents, it was clear that the  elementary school parents felt strongly that food should be allowed in their child’s classrooms:

•    80 percent of respondents were opposed to a ban on allowing food in classes for celebrations like birthday parties
•    Parents felt there should  be no ban on offering food as a reward and limiting  the number of parties during the school day
•    Respondents narrowly supported a policy that would establish an allowable food list for school celebrations

If nutrition, the national obesity epidemic and increasing food allergies require changes in our classroom to keep our children healthy and safe, yet most parents prefer little to no change in policy, what is the most efficient and effective way to find the balance? 

Let's Simplify

What if we prioritized the individual issues?  Perhaps by classroom rather than by school?  If teachers are allowed to set the rules for their students’ needs, then the pendulum doesn’t need to swing so dramatically.  By setting ground rules based on the distinct needs of the children in each class, teachers, parents and students can adjust classroom rules accordingly if they consider these two questions:

#1 Does it keep the classroom safe for all?
#2 Does it foster learning in the classroom?

It’s not a perfect solution to a complicated problem.  It’s a reasonable solution.  It’s one that a smaller group of parents can ultimately support for 9 months of the year, until their child moves to another classroom.  Life is about compromise for the good of all.  That’s called being a good neighbor.

In her article on achieving balance, Terri Trespicio  writes: “Balance comes when we adapt to change, rather than try to resist it.” 

Adapting to new situations or challenging issues in our society such as childhood obesity and keeping children with food allergies safe requires effort and collaboration.  That feels achievable on a classroom by classroom basis.  No two groups of kids are alike and one, district-wide, sweeping rule “NO FOOD IN THE CLASSROOM” certainly does not foster collaboration among the community.  It creates resistance.

About Melanie

Melanie Potock, MA, CCC-SLP, of www.mymunchbug.com.  Melanie is speech language pathologist who specializes in feeding.  Her work brings her into the homes and schools of her clients, kids, who for various reasons have difficulty with food or with eating. She works with kids and their parents to develop effective strategies that help children become “more adventurous eaters”.  At least 50% of her clients have food allergies or intolerances, and for them, “adventurous eating” takes on a special meaning.  Melanie is also the author of Happy Mealtimes with Happy Kids” and the executive producer of “Dancing in the Kitchen.”

Other Articles & Opinions On This Subject

Schools adapting, banning foods, for students with allergies

Why I Don't Believe Food Allergens Should Be Banned From Schools

How Can Parents Feel Less Stress with a Food Allergic Child in School? Interview with Melanie Potock, MA, CCC-SLP

This is a first in a series of posts about how do deal with food allergies in social situations. Over the series, I am reaching out to a few experts to help guide us through the many lifestyle conflicts confronting Tender Foodies as children, teenagers and adults. 

Stress For Parents

School has started, and for parents of young kids with food allergies, this can be an extremely stressful time.  Important questions crop up that seem strange to others, even family members.  Questions like:  Will other kids bring peanut butter sandwiches into the class or lunchrooms?  Will he be teased?  Will she feel left out?  Will my child remember what foods will make him sick?  Does she know to reject any food that is offered?   Will the teacher, nurse or counselor know how deadly one microscopic allergen in the air can be?  Will my child have a life threatening reaction?  Will school staff know how to handle it, if that happens?

School Awareness

Some schools are very aware of the dangers of food allergies and have strict policies to protect allergic kids.  Knowing that your school “gets it” helps a great deal.   On the other hand, there are many schools that have not educated their staff nor have they implemented policies.  In a recent study (released Sept. 8, 2011), The Food Allergy and Anaphylaxis Network and Galaxy Foods addressed the emotional impact of food allergies.  According to their data, the majority of parents surveyed (54%) indicated that teachers had a “good” or “excellent” understanding of food allergies, and 53% of these parents indicated that administrators also had a good understanding.  We can take heart that overall awareness is improving.  But that also means that 47% of schools where food allergic kids are at higher risk.

Whether you are in a highly aware school or not, the question still remains:  how do parents deal with the emotional and social impact of food allergies in a school setting?

Interview with Melanie Potock, MA, CCC-SLP 

Melanie Potock, MA, CCC-SLP of MyMunchbug.comTo start this conversation, I spoke with Melanie Potock, MA, CCC-SLP, of www.mymunchbug.com.  Melanie is speech language pathologist who specializes in feeding.  Her work brings her into the homes and schools of her clients, kids, who for various reasons have difficulty with food or with eating. She works with kids and their parents to develop effective strategies that help children become “more adventurous eaters”.  At least 50% of her clients have food allergies or intolerances, and for them, “adventurous eating” takes on a special meaning.

TF: What type of clients do you work with?  Tell me more about the work that you do.

MP: The majority of my clients are referred to me by gastroenterologists because they are having difficulty eating a variety of foods.  At least 50% of the kids that I see have food intolerances or allergies and often, severe GI conditions including FPIES (Food Protein-Induced Enterocolitis Syndrom) or EoE (Eosinophilic esophagitis).  These children have learned over time that food makes them feel uncomfortable, which leads to food selectivity and often, a fear of trying new foods. Delayed oral motor skills and sensory processing difficulties can be part of the big picture. 

TF:  What do you see as the main social dynamic around school lunch?

 MP:  Many kids learn to eat well at home, but need additional support learning to negotiate the hustle and bustle of the school cafeteria, where they are expected to get their lunchbox, find a seat, open the containers, eat and then put it all away in as little as 20 minutes.  My role is to learn the culture of the individual school lunchroom and offer suggestions to parents and school staff on how to set the child up for success so they can focus on what is most important to kids: their friends.  Parents tend to focus on nutrition at lunchtime; kids tend to focus on friendship. 

TF:  What are the top 5 things that mothers and dads tend to worry about when sending a food allergic child off to school?

 MP:  In my experience as a feeding therapist, the most prevalent worry is that...

A)   their child will ingest a food that they are allergic to and

B)    help will not arrive in time. 

Naturally, these issues are troublesome to parents.  Others on the list include “Is he getting proper nutrition?” and “Will other kids tease him if he can’t join in on a special treat at school?” coupled with, most importantly, “…and how will that make my child feel?”

TF:  What can parents do to alleviate those fears? 

 MP:  Communication is always the key.  Here are three steps you can take right away.

1. Have a face-to-face conversation with teachers and administrators and write down your concerns, giving everyone a copy. 
   
2. Include simple bullet points that are easy to refer to, such as list of allergens, symptoms, emergency steps, the specific location of the epi-pen, how and when to administer them and any other medications and contact phone numbers. 
3. Form a school team:  A face-to-face meeting can alleviate fears and it establishes that your child's food allergies is an issue for everyone on the team – you child’s team!  Be sure to periodically thank a staff member, teacher or administrator for their extra efforts.  It not only makes them feel appreciated, but it gently reminds them of your fear and their role in keeping your child safe.

TF:  What if you find that teachers and the school are resistant to forming a team for your child?

MP:  There are so many nuances. 

First of all, just like with any other situation, it is more difficult for someone to understand food allergies if they haven’t experienced it themselves, first hand.  Teachers are overwhelmed, today.  If you keep this in mind, it will help keep the conversation (and food allergy education) going.  It is a delicate dance – being respectful of your child’s teachers and wanting to protect your child.  

Second: it is a temptation to overwhelm the school with a long list of detailed requirements for the school environment itself.  Meet with the teacher and the principal and try to keep your list of requirements short – condensed into most essential action steps.  If you can reduce your child’s needs to say, 3 overall school requirements, it is easier for the teacher to remember and the school to follow. 

Third:  If serious change is needed, you could approach the School Board.  School Boards usually set up budgets and policies one year in advance.  There are groups that will do a formal “in-service” education or policy setting session.  If you can find a local resource to do in-school training for free, food allergy training might be adopted more immediately. 

Another option:   you can research your school district’s disability laws, like Section 504 of the Rehabilitation Act of 1973*.  School districts have an obligation to provide reasonably safe environments for all students.  Some schools include food allergies under Section 504.

TF:  How do parents balance their child’s needs and their own desire for nutrition when packing a lunch?  

MP:  For kids in the school cafeteria, lunchtime is about friendship.  As parents, we are focused on nutrition, but kids just want to fill their bellies and laugh with their friends over lunch!  They need to let off a little steam, just like you and I taking a break for lunch and to get away from the pile of paperwork on our desks.   So, pack nutritious finger foods in easy to open containers.  I always recommend Easy Lunchboxes (www.easylunchboxes.com) to my clients, because the lid is so easy for little fingers to pop off.  Instantly, lunch is served!  When kids have to fumble with a bunch of different containers, food often never gets eaten at all.  If you can pop off one lid and instantly see what Mom and Dad have offered you for lunch, you have more time to socialize and chill-out.  Choose easy to eat foods – simple, fresh, finger foods so your kids can “grab and gab” for the next 20 minutes before the bell rings.

TF:  How can parents best help their kids "remember" all of the things that they are allergic to? 

MP:  There is typically no sharing in the school cafeteria (theoretically!) but other opportunities to eat foods other than those brought from home arise during a school week, which can become more of a problem.  **

1. Laminate a picture list of allergens (or a word list if your child can read) and attach it with a ring to an inside pocket of his or her backpack.  It’s an easy referral source for your child to take a peak if he/she forgets.  
2. Ask the teacher to attach the same list somewhere on her desk and to give your child special permission to check it any time.  That way, it is a quick reference for both of them.
   
3. Make up a silly song or jump rope rhyme that helps kids remember, such as “Oh boy, I can’t eat soy!  Oh Mary, I can’t eat dairy.  BUT, I can eat everything, everything, and everything else!” 
4. At home, play table games that include “I am thinking of something that contains soy and it rhymes with “So new! (Tofu)” to practice what foods contain the allergen.  My friend Marika, who has 4 year old twins with food allergies and/or intolerances, always uses a trip to the zoo to teach about peanuts.  “The elephants can eat peanuts, but they can’t eat hamburgers, because that would make their tummies sick.  You can eat hamburgers, but you can’t eat peanuts, because those make you feel sick.”  She is really great about casually teaching very important facts in a fun way whenever she finds the opportunity to remind the twins of what they can and cannot eat to stay healthy.

TF:  How can parents best help their kids stand up for themselves when faced with other kids, temptations and ignorant teachers/school authorities? 

MP:  Teach them to keep their reply simple and move on.  The less attention given to the situation/person the better – that is true in any situation where someone is trying to convince our children to do something that is not good for them.  For example, “No thanks, I’m allergic.  I have crackers for my snack today” or “No thanks; I’m going out to recess.”  With or without allergies, helping all kids listen to that little voice in their head that tells them “this is not safe” is so important!  In my professional opinion, I think children who learn this skill early on make better choices throughout life.

TF:  Could you recommend a lunch that leaves out all 8 big allergens (seafood, fish, gluten, dairy, soy, tree nuts, peanuts, eggs) + the next big 3 (oats, rice, corn) that kids actually like?  

MP:   I love to send a healthy, frozen home-made smoothie to school, because you can customize it for specific dietary needs and it is quick and easy to eat.  Any container with a lid or flip top will do and kids can add a wide straw or just drink it right out of the container, as it typically thaws just in time for lunch.  Then, a bento box of simple finger foods is always a snap!  Allergen-friendly mini muffins are filling and easily fit into these types of containers and are so quick to eat.  They can be made with vegetable purees to ensure good nutrition.  

TF:  Can you speak a little more toward the social aspect of school lunchtime and how you can help your kids adapt?

MP:  When I visit school cafeterias with my little clients, I sit right at the tables with all the other kids and watch and listen.  Without fail, kids open their lunchboxes and begin to talk about what they have in their lunch that day:   “I have pudding!” or “I have yogurt”, holding it up for their friends to see.  Honestly, the funny thing is it’s not really about the food.  It’s about opening up a conversation with their friends, much like saying “cheers” before we enjoy a beverage together.  So, whether it’s coconut yogurt or milk-based, the kids don’t typically say that.  They just say “yogurt”.  Now, they might say “I love Dora!” and hold up a yogurt with Dora the Explorer on the package, but I’ve observed that they love a Spiderman sticker stuck on their coconut yogurt just as much as a pre-printed package photo of the super hero.  So, add a few stickers here and there for your kids to hold up and show their friends.  Make gluten free sandwiches with dino cookie cutters so they can proudly bite off the head of the T-Rex in front of all their buddies.  Throw in a photo of your family garden (or your kid picking out carrots at the local farmer’s market) so he can show it at the table and say “I bought these with Grandma at the Farmer’s Market!”    Get the conversation started…that’s the key.

Many thanks to Melanie for sharing her time and insights with the Tender Foodie Community.

REFERENCES

* Along with Section 504, other Federal laws such as ADA and FERPA could address food allergies.

**According to the U.S. Peanut and Tree Nut Registry, 79% of recorded allergic reactions to nuts occurred in the classroom, usually as a result of contact with peanut butter during class projects, rather than the cafeteria (12%).   Other studies have shown a similar weighting toward classroom allergic reactions because of birthday parties, shared treats and art projects using molding dough (Playdough, for instance, contains wheat).

Other RESOURCES

The University of Michigan Food Allergy Program:  http://www.med.umich.edu/foodallergy/community.htm

(check universities near you for school programs)

The Food Allergy and Anaphylaxis Network (FAAN)

www.foodallergy.org

American Academy of Allergy, Asthma and Immunology. (AAAAI). http://www.aaaai.org

National Association of School Nurses. http://www.nasn.org

Kids with Food Allergies Foundation:  http://www.kidswithfoodallergies.org/community.html

Update on Wednesday, September 14, 2011 at 10:27AM by Elisabeth Veltman, The Tender Foodie

New Resource

Kids with Food Allergy Foundation:  http://www.kidswithfoodallergies.org/community.html