1. School Guidelines
Sending a child to school can be frightening for a parent who has been devoted to watching and caring for the safety of their allergic child. For very young children, it is critical to select a preschool that is receptive to you and your concerns. Find a school that will let you make a presentation to the children. Find a school where the teachers are in close communication with parents and each other. The risk of accidental exposure to foods can be reduced in the school setting if schools work with students, parents, and physicians to minimize risks and provide a safe educational environment for food-allergic students.
- Notify the school of the child's allergies.
- Meet with the teachers and other caregivers. Plan to give them an action plan detailing what to do in the event of an emergency. Bring an EpiPen® trainer to demonstrate the correct use of the EpiPen® and review what foods are safe and not safe. Work with the school team to develop a plan that accommodates the child's needs throughout the school including in the classroom, the gym, the cafeteria, in after-care programs, during school-sponsored activities, and on the school bus.
- Tour the kitchen and note the snacks they will feed the children. Make a list of safe and not-safe products.
- Make a presentation to the children explaining your child's allergies and how they can help.
- Provide properly labeled medications and replace medications after use or upon expiration.
- Educate the child in the self-management of their food allergy including: determination of safe and unsafe foods, strategies for avoiding exposure to unsafe foods, symptoms of allergic reactions, how and when to tell an adult they may be having an allergy-related problem, and how to read food labels (age appropriate).
- Check the school's emergency supplies, and provide alternatives to offending foods (i.e. soynut butter or sunbutter instead of peanut butter).
- Provide emergency contact information.
- Place a “safe snack box” in your child's classroom. Pack a variety of non-perishable safe snack treats, like candy or cookies. Your child can have a treat from home if there is an unexpected celebration or snack at school.
- Be knowledgeable about and follow applicable federal laws including ADA, IDEA, Section 504, and FERPA and any state laws or district policies that apply.
- Review the health records submitted by parents and physicians.
- Include food-allergic students in school activities. Students should not be excluded from school activities solely based on their food allergy.
- Identify a core team including, but not limited to, school nurse, teacher, principal, school food service and nutrition manager/director, and counselor (if available) to work with parents and the student (age appropriate) to establish a prevention plan. Changes to the prevention plan to promote food allergy management should be made with core team participation.
- Assure that all staff who interact with the student on a regular basis understands food allergies, can recognize symptoms, knows what to do in an emergency, and works with other school staff to eliminate the use of food allergens in the allergic student's meals, educational tools, arts and crafts projects, or incentives.
- Coordinate with the school nurse to be sure medications are appropriately stored, and be sure that an emergency kit is available that contains a physician's standing order for epinephrine. In states were regulations permit, medications are kept in an easily accessible secure location central to designated school personnel, not in locked cupboards or drawers. Students should be allowed to carry their own epinephrine, if age appropriate, after approval from the student's physician/clinic, parent and school nurse, and allowed by state or local regulations.
- Designate school personnel who are properly trained to administer medications in accordance with the State Nursing and Good Samaritan Laws governing the administration of emergency medications.
- Be prepared to handle a reaction and ensure that there is a staff member available who is properly trained to administer medications during the school day regardless of time or location.
- Review policies/prevention plan with the core team members, parents/guardians, student (age appropriate), and physician after a reaction has occurred.
- Work with the district transportation administrator to assure that school bus driver training includes symptom awareness and what to do if a reaction occurs.
- Recommend that all buses have communication devices in case of an emergency.
- Designate a lunch table that is peanut free. (see peanut-free easel), and enforce a policy for kids to wash hands after meals.
- Enforce a “no eating” policy on school buses with exceptions made only to accommodate special needs under federal or similar laws, or school district policy. Discuss appropriate management of food allergy with family.
- Discuss field trips with the family of the food-allergic child to decide appropriate strategies for managing the food allergy.
- Follow federal/state/district laws and regulations regarding sharing medical information about the student.
- Take threats or harassment against an allergic child seriously.
- Should not trade food with others.
- Should not eat anything with unknown ingredients or known to contain any allergen.
- Should be proactive in the care and management of their food allergies and reactions based on their developmental level.
- Should notify an adult immediately if they eat something they believe may contain the food to which they are allergic.
More detailed suggestions for implementing these objectives and creating a specific plan for each individual student in order to address his or her particular needs are available in The Food Allergy & Anaphylaxis Network's (FAAN) School Food Allergy Program. The School Food Allergy Program has been endorsed and/or supported by the Anaphylaxis Committee of the American Academy of Allergy Asthma and Immunology, the National Association of School Nurses, and the Executive Committee of the Section on Allergy and Immunology of the American Academy of Pediatrics. FAAN can be reached at: 800/929-4040.
following organizations participated
in the development of this document:
American School Food Service Association, National Association of Elementary School Principals, National Association of School Nurses, National School Boards Association, The Food Allergy & Anaphylaxis Network
primarily based and reprinted
with permission from The Food
3. Travel Guidelines
You've packed your bags and are ready to go visiting and adventuring! While there's no substitute for vigilance and preparedness when traveling with severe food allergies, here are some helpful tips to ensure safe travel while exploring the world or visiting grandparents. Always consult your allergist to help you avoid the riskiest situations and to come up with an appropriate action plan in the case of emergency.
Helpful tips when traveling with food allergies:
- Contact the hotel in which you will be staying. Make sure your room has a refrigerator.
- Speak with the kitchen about meals available from room service and the restaurant. You will have a better experience if you feel they are willing to work with you.
- Bring safe foods (snacks and treats) as a back-up.
- Carry a sign in the appropriate language with an English translation indicating the food allergy and its severity to show to the restaurant staff.
- When buying packaged goods and snacks in foreign countries, consider buying international brands, like Nabisco® and Nestle® where there is an English listing of ingredients and you are familiar with the products.
- Be wary of packaged goods made from local companies, even when there is an English translation of the ingredients. A packet of animal crackers in China listed “natural flavoring ingredients” as an item on the label, which happened to be peanuts.
- Consider staying away from Americanized versions of foods in foreign countries where the ingredients are not clear. In China, chocolate cake contained peanut powder.
- Pack safe snacks and take 1-2 with you when sight-seeing, like allergen-free energy bars, to satisfy hunger in case safe food is not readily available.
- Countries/regions in which peanuts/tree nuts are liberally used in cooking: Thailand, South Indian food, Gujrati food in Western India,
- International foods with peanuts/tree nuts: Mexican mole, Turkish delight, pesto, egg rolls, marzipan.
- Carry a letter outlining your allergies, the need to carry the epipen, and food and drink. (Check on quarantine regulations at the other end as part of your travel plans.)
- Carry at least two EpiPens® on board when flying and any other first responder treatment that you may have discussed with your allergist.
- Wipe down the seating area of the airplane with baby wipes.
- Fly airlines that are peanut free by checking with the airline upon making your reservations.
- Before boarding the plane, speak with the airline agent at the gate to ensure that they do not serve peanuts on your particular flight, in addition to speaking with an airline host after you board the airplane.
- If nearby passengers are eating something with peanuts, politely ask them to put the food away.
- Carry your own food on the airplane.
- Children with allergies should not be allowed to wander in the aisles.
- Take non-sedating antihistamine
for a few days prior to and during the travel period.
4. Letting Go
Letting go can be a challenge for most parents. When faced with a life-threatening allergy, it feels safer to protect your child by utterly managing his/her life. But, teaching a child about her allergy, and how to take responsibility for it, is an important step in creating a capable and functional adult. From the outset, children need to understand their allergies and treatment in case of an emergency. Here are a few guidelines…
- Try to maintain a matter-of-fact demeanor. “Avoid talking about your child's allergies as if the child is not present, and be careful how you present the dangers of your child's food allergy to others.”*
- Young children can be taught with pictures. Create a scrapbook or flashcards depicting safe and not safe foods with photos cut from packaging and magazines.
- From an early age, start to teach your child the importance of asking questions about food, of not accepting food from anyone other than Mom or Dad, of being a careful label reader, and how to identify offending foods.
- Use accurate words for safe food substitutions to avoid confusion. For example, say “soy milk” not just “milk”
- Show your child her safe shelf in the pantry and refrigerator
- Develop a list of foods that are most likely to be served at daycare or school, and explain what is safe and not-safe.
- Identify high-risk foods, like cookies and muffins. Prepare these foods at home, so your child has the opportunity to have them in a safe environment. This teaches the child that he or she isn't being denied foods, but instead is simply avoiding risky situations.
- Help your child learn how to politely, but firmly, refuse to eat certain foods. Emphasize that he or she must always think about his or her food allergies. Explain that there will always be people that don't “get it”, so it's up to your child to take responsibility for avoiding risky foods.
- Teach your child how to recognize a reaction.
- Insist your child never leaves the house without an EpiPen® and Benadryl. Waistpacks (see EpiPen® carriers) are a popular way to ensure safety for young children.
Excerpt from “Letting Go: Teaching a Child Responsibility,” by Anne Munoz-Furlong