Monday, November 2, 2009

Preventing Food Allergy Emergencies

I am in the midst of an occasional series on food allergies for classroom teachers. I hope to eventually put the posts all together for a presentation at a conference next year, but I’m having trouble deciding what teachers need to know. As a parent of food allergic children, I know a lot more than teachers should be expected to remember or take care of. I need to find the right balance of information. I’d love to have specific feedback on these posts in order to make them accurate, understandable, and helpful. Other topics were/will include: Food Allergy Basics, How to Handle Food Allergy Emergencies, and Instructional Implications for Food-Allergic Students. Thanks for your input!

How can I avoid an allergy emergency?
Planning! Assess the times when children in your care will be around food in order to manage their exposure.

1. Lunch. If a child has an allergy that requires epinephrine, consider creating an allergen-free zone at a table with signs. Only children who do not have that food in their lunches can sit there. It takes teacher support for this to work without becoming alienating.  Some schools make this a special treat for the non-allergic kids.  There’s nothing sweeter to a parent’s ears when their kid comes home and beams, “The peanut-free table was PACKED today!”  You do not need a separate table for each allergy, just the ones that may be lethal.  For example, my own son has multiple allergies, but there’s only a peanut-free table at school.  That’s totally reasonable, since, in his case, he’s unlikely to go into anaphylactic shock with his other allergies.

As children age, the “free” zone should be re-evaluated, depending on the allergy.  A kid with a severe contact sensitivity to something that can easily be spilled (like milk) may have to be separated for quite awhile.  And though peanuts are often a severe allergy, since they don’t tend to spill you may be able to eliminate the separate table once all the children are aware of good etiquette depending on the allergic response.  The age will depend, but my personal feeling is that somewhere around second or third grade is a good time to start moving to shared tables.  You can even talk to children that age about allergies and let them know to get a teacher immediately if they think a classmate has been exposed by accident.  You may want to make a strict “no sharing food” rule at lunch.  Make sure you enforce it.

For preschools, if an adult will be sitting at the table with the children you can share the table.  Just make sure the food-allergic children will be unlikely to come in contact with the allergen.  If you are lucky enough to use several small tables for snacks or meals, then it’s easier to quietly designate one where the allergen won’t be served.  The children don’t even have to know about it.

If your school has children wipe the tables (a good, responsibility-teaching job), make sure any allergic students clean tables that are unlikely to have their allergen, wear protective gloves (which may be problematic socially), or do another, similar chore.  Do not let them get out of doing work or other children will notice and they will feel as though they aren’t good enough to contribute.  Don’t make a big deal about it, but make sure they do something so no one feels it’s unfair if you’re asked.

2. Snack. Provide safe snack foods. If you don’t have control over what’s served, make sure your food allergic students have a safe backup snack you can serve them on days when the provided snack isn’t safe for them.  Learn to read labels (and do it every time, even for things you’ve served before) or have the parent of a food allergic child do it for you if that’s practical.  Another alternative is to request that each child bring in his or her own snack and don’t permit sharing.  If parents bring snack, remind them to bring in any packaging that came with the snack or ingredients for the snack.  I remember one nice family making chocolate chip cookies for my son’s class using a recipe that didn’t include any of my son’s allergens.  They gave me the recipe so I could check it, but didn’t bring the package for the chocolate chips so I couldn’t let my son have the cookies.

For both lunch and snack, it is advisable to wash hands not only before but after eating when an allergen has been consumed by the rest of the class. Allergens are not washed away with hand sanitizer. Mechanical removal is required. Hand wipes are acceptable if the children are taught to wipe the fronts, backs, fingers, and between fingers. Ask for wipes as part of your supply list if you know a food allergic student will be in your class or arrange for the parent of the food allergic child to supply them. Some wipes have allergens, so ask for brand recommendations.

3. Class Events. Let the parent of the food allergic child know IN ADVANCE that there will be a class event that involves food and what that food will be if you know. Ask the parent to provide something similar for the food allergic child. If possible provide food that everyone can eat so you don’t have to think about it. Parents of food allergic children are happy to provide recipes! Even if all the food you will be providing is safe, parents of food allergic children like to know that an event will occur so they can be available in case the worst happens by accident. If you plan to leave the classroom and food will be involved, bring the epinephrine with you as well as an antihistamine if it is in the child’s action plan.

The reality is that a food allergic student is much more likely to have a reaction in times and places that are not normal food times.  Parties, field trips, and class treats can turn into a nightmare if you’re not prepared.  Plan a little in advance, communicate with parents and helpers, and you can make sure everyone has a good time.

4. General Measures. Communication and practice are the keys to prevention. As a school you should have procedures in place to ensure that all adults who are responsible for the well-being of children are ready to provide emergency assistance. Your communication plan should include classroom teachers, aids, specials teachers, office staff, field trip chaperones, substitute teachers, extended care providers, cafeteria personnel, and cafeteria helpers.  Do a run-through of an emergency.  Remind specials teachers at least once during the school year who has what allergies.  Since specials teachers deal with many more students each week than a classroom teacher does they tend to forget unless they are especially sensitized to allergy issues.

In regards to the food allergic children themselves, remind to ask “Is this safe?” of any food they don’t normally eat.  Children trust the adults in their lives, but they need to learn to look out for themselves.  Even the most diligent parent of a food allergic child has accidentally given that child an allergen.  You can’t expect more from a teacher with more children to take care of.  Food allergic children should always question the caregivers in their lives and their caregivers should encourage this without getting annoyed.  The 130th time you are asked may be the time you forgot to check the ingredient list and the manufacturer just happened to change the ingredients.  Being asked may remind you to check, so encourage it.

Questions?  Comments?  Post them here!

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