This is part 2 of my interview with Food Allergy Hero and expert, Maria Acebal, founder of Safe@School Partners.
From my experience, school awareness of the severity of peanut allergies is increasing. But how well equipped are schools to accommodate children with multiple allergies? As a parent, how do you reach out and educate schools? What can you ask for — from the classroom teacher, the nurse, the cafeteria worker, the bus driver, the gym/music teacher? What is it reasonable to expect them to provide?
While it is wonderful that awareness of the peanut allergy has increased tremendously, it is often frustrating for parents of kids with multiple allergies, or with allergies to foods other than peanuts, to face what sometimes feels like an exclusive focus on this one food allergen (eg, the “peanut-free” lunch tables). It is therefore paramount that parents educate all school staff that supervise the child on the seriousness of all his or her food allergies. The one page “Allergic Reaction Action Plan” I mentioned earlier can help as it should have all food allergies listed clearly at the top.
As far as what is reasonable to expect, this again is a tough question! The strictly legal answer is that pursuant to Section 504 of the Rehabilitation Act of 1973, all schools that receive any form of federal funding (ie, all public schools and many private schools) are prohibited from excluding or otherwise discriminating against a student with a “disability” solely on the basis of that disability. What this means for students with life-threatening food allergies (generally a recognized “disability”) is that schools are required to provide a “free appropriate education” (“FAPE”) designed to meet the educational needs of that student as adequately as it meets the needs of nondisabled students. Often, a FAPE for food-allergic students will include the provision of “related aids and services” such as administration of medication, changes to the classroom environment, menu substitutions, or other health-related needs that require attention during the school day. (Similar protections are offered by the American with Disabilities Act which applies to all public schools and all private, non-religious schools).
Now, that still only begins to answer the question because, for example, the determination of what “changes to the classroom or lunchroom environment” are appropriate are usually made on a case by case basis, and some adjudicative bodies have answered this question differently, so it is hard to generalize. For example, the Office for Civil Rights in the Saluda School District (South Carolina) case, decided that an appropriate change to the school environment included eliminating all peanut products from the school’s menu. Most other cases I am familiar with did not go so far and included other changes such as having a table where the student could eat without the presence of food allergens.
At a minimum, I believe it is reasonable to expect that all adults who supervise your food-allergic child in school receive annual training on food allergy safety; that access to epinephrine at all times is secure and swift; and that reasonable steps to reduce the risk of allergen exposure are consistently applied.
This brings up the sometimes thorny question of what restrictions, if any, schools should have on foods that can be brought into lunchrooms or classrooms. As a food allergy educator, I remain agnostic on this question. With all the schools I work with, I tell them that whatever approach they choose, I will recommend how to implement safety protocols accordingly. So, for example, for schools that are “peanut free”, I stress the importance of having a checking mechanism that ensures food labels are read carefully each and every day to ensure that the environment is in fact “peanut free.” I also stress the importance of clarifying to the entire school community – in writing - what “peanut free” means so that everyone is on the same page and parents of food-allergic kids can plan accordingly. Does “peanut free” mean that no products with peanuts as ingredients as well as no products that “may contain peanuts” or are “processed in a facility with peanuts” are permitted? Or, does it mean that the school will not serve peanut products, but children can bring in peanut products from home for individual consumption? Or, does it mean . . . . You get the point: clarification and control mechanisms are key.
For schools that have no restrictions on foods that can be brought in to the classroom or lunchroom, I stress the importance of reducing the risk of cross-contamination from table surfaces and hands and on being vigilant of the foods made available to the food-allergic child for consumption, particularly the very young children.
Within the school environment, what poses the greatest risks for the food allergic child — e.g. the cafeteria? The bus? Contact reactions on a playground or a shared computer? Something else? Are there ways that we as parents can work with schools to reduce these risks? How should we educate our children to prepare them to recognize and minimize risks?
I believe FAAN sponsored a study that showed that the primary source of risk for reactions in school was classroom celebrations. As parents advocating for our children, we must remember that the most serious reactions almost always occur from ingestion. While a few very serious contact reactions have been discussed in the medical literature, all the leading allergists I’ve spoken with, including Dr. Woods of Johns Hopkins and Dr. Burks of Duke, stress that the greatest risk to kids come from ingestion. (Of course, with younger children especially, who often put their fingers in their mouths, eyes and nose, contact with the hands can lead to ingestion). So, there are levels of precaution: first and foremost, we need to put in place steps to ensure that the food our children will eat in school, be it for a classmate’s birthday celebration or for snack, are allergen-free (this includes food free of any cross-contamination, which is why I advise schools to limit food to be shared in the classroom to store-bought food with ingredient lists since home-baked items are more likely to run the risk of cross-contamination problems). Second, we can then worry about the contact issue by teaching schools that cleaning thoroughly with hand wipes or soap and water after eating are important ways to reduce the risk of cross-contamination via hand and table surfaces.
As our children get older, they will begin to recognize the risks for themselves. I believe the most powerful teaching tool is for us parents to model the behavior we want our kids to adopt. For me, this includes teaching her the right balance between caution and overreaction – I want her to have a healthy respect for the seriousness of her allergy but not a crippling fear of it. So, while I admit that I was tempted to wipe down all the monkey bars and slides with handwipes at the local park, especially when the food allergy diagnosis was still new, I resisted the urge because I did not want my daughter to fear going down a slide or sitting on a swing. That said, I do ask the counselors at my daughter’s camp to please make sure that her classmates who eat peanut butter for lunch wash their hands before going out for recess.
