Regulation 4250-6130R1

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Food Allergy   Regulation Code:   4250-6130R1

Contents

Introduction

Chatham County Public Schools are committed to providing a safe environment for all students, including those with life-threatening food allergies. These regulations were created to promote awareness and understanding of food allergies and to establish a detailed protocol for managing students with life threatening food allergies including education, prevention, emotional health and emergency response.

These County-wide regulations were created to:

  • Institute a proactive approach to managing students with life-threatening food allergies
  • Prevent anaphylactic reactions
  • Assure the child is included, and not excluded from activities
  • Outline detailed protocols for emergencies and daily management
  • Protect children from bullying by creating awareness among staff and children about food allergies
Food Allergy Prevalence
  • More than 12 million Americans have food allergies.
  • That’s one in 25, or 4% of the population.
  • One in 5 children with food allergies will have a reaction while in school *
  • Accidental ingestion of the offending allergen occurs most often at school.
  • One in 5 children with food allergies, have their first reaction while in school.
  • According to the Food Allergy and Anaphylaxis Network, three million school-aged children have food allergies.
  • Food allergy prevalence has increased 55% in the last five years *
  • Peanut allergy doubled in children over a five-year period (1997-2002) (Sicherer, et al. 2003)
  • Fatal food anaphylaxis is most often caused by peanuts (50-62 percent) and tree nuts (15-30 percent) (Keet and Wood, 2007).
  • Eight foods account for 90% of all food-allergic reactions in the U.S.: milk, eggs, peanuts, tree nuts (e.g., walnuts, almonds, cashews, pistachios, pecans), wheat, soy, fish, and shellfish.
  • There is no cure for food allergies.
  • Even trace amounts of a food allergen can cause a reaction.
  • Most reactions in schools occur from food in the classroom used for projects or celebrations.

For a more detailed review of food allergy basics, please see the Food Allergy Basics Training document.

Archives of Pediatrics and Adolescent Medicine

Emotional Impact

Many students with food allergies have experienced a life-threatening anaphylactic reaction and are aware of their own mortality. School policies and protocols must respect the physical safety and the emotional needs of these students.

According to a recent study by the Mount Sinai Medical Center, over 30% of students with food allergies have been bullied or teased because of their allergy. This is most often done by classmates, but over 20% were teased or bullied by their teachers or other school staff.

Over 40% of the bullying resulted in waving the allergen in the child’s face, and over 60% was verbal taunting. Following this bullying the students felt embarrassed and depressed.

Children with food allergies can feel an emotional impact, including:

  • Exclusion
  • Social isolation
  • Anxiety/fear
  • Nervous tics
  • Depression
  • Fears of rejection/embarrassment
  • Irritability and “melt downs”
  • Resentment/anger (that allergies are unfair)
  • Risk-taking behavior
  • Bullying
  • Disordered eating behaviors
  • Obsessive-compulsive behaviors (e.g., perfectionism and checking behaviors)

Teachers, parents and the school counselors should work together to detect and address these issues, should they arise.


Food Allergy Education

Staff

Chatham County will provide the NC Emergency Guidelines for Schools folder to all staff (food service, clerical, teaching staff, bus drivers, administration). Each year, staff will be asked to verify that they have a folder for their classroom or office. If not, one will be provided.

For those teachers who have a student with life-threatening food allergies in their classroom, a personal Epi-Pen instruction will be given annually to assure skills are adequate.

Instruction and related information may also be provided on a need-to-know basis to volunteers and parents involved in the supervision of students during activities where a student with a life-threatening or other serious allergy may be present.

For those teachers starting mid-year who have a student with a severe allergy, the school nurse will arrange a separate training.


Multi-Disciplinary Team Approach – Roles and Responsibilities

Each year, the school nurse, parent/guardian, student (if age appropriate), food service director/staff, teachers, specials teachers, school counselor, coaches, custodian, bus driver, principal and other support staff will work as a team to manage the food allergies and other medical conditions of each relevant student.

Each member of the team will maintain responsibilities. The guidelines below will help each team member know and assess their compliance of these responsibilities.

SCHOOL GUIDELINES FOR MANAGING STUDENTS WITH ALLERGIES

Food Allergies can be life threatening. The risk of accidental exposure to foods can be reduced in the school setting if schools, students, parents, and physicians work together to minimize risks and provide a safe educational environment for food-allergic students.

Family’s Responsibility

  • Notify the school of the child’s allergies.
  • Work with the school team to develop a plan that accommodates the child’s needs throughout the school including the classroom, in the cafeteria, in after-school programs, during school sponsored activities, on the school bus, and on the Food Allergy Action Plan.
  • Provide written medical documentation, instructions, and medications as directed by a physician, using the Food Allergy Action Plan as a guide. Include a photo of the child on the written form.
  • Provide properly labeled medications (i.e, EpiPen®).
  • Educate the child in the safe management of their food allergy including:
  • safe and unsafe foods
  • strategies for avoiding exposure to unsafe foods
  • symptoms of allergic reaction
  • how and when to tell an adult they may be having an allergy-related problem
  • how to read food labels (age appropriate)
  • Review policies/procedures with the school staff, the child’s physician, and the child (if age appropriate) after a reaction has occurred.
  • Provide emergency contact information.

School’s Responsibility

  • 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 of, 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 emergency medical plan to promote food allergy management should be made with core team participation.
  • Staff who interact with the student on a regular basis should be trained to understand food allergy issues, recognize symptoms, know what to do in an emergency, and work 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.
  • Medications are kept in an easily accessible secure location central to designated school personnel. Students should be allowed to carry their own epinephrine, if age appropriate after approval from the students 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. First responders are properly trained to administer medications during the school day regardless of time or location. First responders are identified by the principal and trained by the school nurses.
  • 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 drivers receive a copy of the NC Emergency Guidelines for Schools folder for their bus. The folder will be discussed at the annual school bus driver training.
  • Recommend that all buses have communication devices in case of an emergency.
  • 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.
  • Determine appropriate strategies with the family for managing the food allergy when a field trip is planned.
  • Follow federal/state/district laws and regulations regarding sharing medical information about the student.
  • Take threats or harassment against an allergic child seriously.

Student’s Responsibility

  • Students should eat their own food and not trade food with others.
  • Students should be careful what they eat and should not eat anything with unknown ingredients or ingredients known to contain any allergen.
  • Students 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.


Adapted from a document developed by the following organizations:

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

It will be the building principal’s responsibility to assign the appropriate staff to satisfy the requirements identified in the School’s Responsibility section of this document.

Emergency Response Protocol

In the event of a student having a severe allergic reaction, these steps should be followed by all school staff:

  1. Staff member present will assess the emergency at hand.
  2. If epinephrine is with the student, have the student or staff member administer immediately. If the epinephrine is not with the student, notify the school nurse or first responder who will immediately administer the epinephrine (note time of administration).
  3. Notify the emergency medical services. – CALL 911 ASAP.
  4. Send someone to meet the EMS.
  5. School nurse, first responder or other trained staff member will monitor time between initial administration of the EpiPen® and if 15-20 minutes has elapsed and if affected individual is still at school repeat EpiPen® dose if available.
  6. Notify school administration so they may notify the parent/guardians.
  7. Arrange for another staff member to attend to student’s classmates.
  8. Assure child is accompanied by either the parent/guardian, nurse, principal or staff member to the emergency care facility.

A trained staff member should remain with the student until the emergency is resolved.

Following a reaction, assist student’s re-entry into school and set an appointment with parents, teacher, principal and school counselor to discuss what happened, prevention, and any changes that need to be made to the student’s daily activities.

Prevention Plans

Protecting a student from an exposure to an allergen is the best way to prevent life-threatening anaphylaxis.

Exposure to an allergen is typically via ingestion, although reactions can occur by touch or inhalation as well. The amount of food needed to trigger the reaction will vary by child, type of allergen, and even vary within the same child. Success depends on avoidance.

Adhere to these tips for each aspect of the child’s school day.

Classroom
  • The classroom should have easy communication with the school nurse or administration by either intercom, walkie-talkie or cell phone.
  • Foods should not be used in class projects, arts and crafts, science experiments, etc. without the teacher notifying all parents of students who have food allergies.
  • If food will be used in a celebration, inform parents of allergic children (by letter or email) well in advance to assure safety and allow adequate time for them to provide a safe snack.
  • Consider having the parent of the allergic student create an “allergen safe” suggested snack list to send home with class parents.
  • For birthday celebration, consider a once-a-month celebration, with a non-food treat (see Appendix F for ideas)
  • School staff and volunteers will be informed of the child’s food allergy on a need to know basis. See Appendix B for example letter to parents.
  • All students will wash their hands with soap and warm water before and after lunch.
Field Trips
  • The school nurse will discuss with staff safety considerations for the student with life-threatening food allergies at the beginning of the school year or as soon s the school nurse is made aware of the allergy.
  • Notify parents well in advance of any field trips so they can make the staff aware of any safety concerns for the student.
  • In the event of an emergency, staff will access emergency services by calling 911.
  • Medications and a copy of the students Emergency Medical Plan should accompany the student on the trip.
  • If the field trip plans to stop at a restaurant for food, the needs of the student with food allergies should be considered.
  • Cell phones or other communications devices must be available during the trip.
  • Parents of a student at risk for anaphylaxis should be invited and encouraged to accompany their child on school trips, in addition to the chaperone.
  • In the absence of a parent/guardian, the teacher would be assigned the task of watching out for the student’s welfare and for handling an emergency.
  • Hand wipes or hand washing should be done by the students and staff before and after consuming food (hand sanitizer kills germs but do not get rid of allergens).
Physical Education and Recess
  • Teachers and staff responsible for Physical Education and recess who have a student with life threatening allergies will be trained to recognize and respond to exercise-induced anaphylaxis, as well as anaphylaxis caused by other allergens (i.e. insect stings, etc.).
  • Staff in the gym or playground should have access to emergency communication devices (i.e. cell phones, walkie-talkies, etc.)
  • An epinephrine auto-injector supplied by the parent should be easily obtained , and ready for use by a trained adult.
Specials Teachers and Special Activities at School
  • School counselors, media specialists, reading specialists, art and music teachers and other staff members working with students individually, in small groups, and in classroom groups will meet the same expectations as those for the classroom teacher.
  • A list of all staff who have received training will be maintained.
School Bus
  • Eating food is prohibited on school buses, unless it is deemed necessary by a student’s medical need.
  • All school bus drivers will be provided with the N. C. Emergency Guidelines for Schools
  • The school bus must have a cell phone or other means of communication for emergency calls. Phones will be provided by school Transportation Department.
Cafeteria
  • The cafeterias at the elementary level and the middle school level may have a designated nut restricted/allergy area (preferably at the end of the class table) to reduce the chance of exposure to allergens. No peanuts or tree nuts or products containing peanuts or tree nuts should be opened, consumed, or otherwise present in that area. A designated nut restricted area may be provided at the high school if required by an individual student’s condition.
  • Separate tables for food allergic children should not be labeled with signs since this may increase feelings of isolation and exclusion.
  • Custodial staff will follow the protocol suggested by the Chatham County Public Health Department listed below.
Custodial Staff
  • Table & Bench Cleaning for All Tables
Method
  • Use properly diluted, warm (at least 70º) soapy water and clean towel over all tables prior to breakfast. Properly diluted soap removes food and grease and prepares surface for disinfectant. Clean edges and under the tables and benches as well.
  • Wash table with Quaternary Ammonia (200 – 400 ppm sanitizing solution). Clean edges and under the tables and benches as well. Disinfect every two hours after initial treatment. Allow time for the solution to air dry per manufacturer’s recommendation.
  • Wash the tables with hot soapy water between classes using a clean towel.
  • At the end of the last lunch, wash the table with hot soapy water and sanitize with Quaternary Ammonia.
After School Activities
  • Afterschool programs should be consistent with Chatham County Food Allergy Regulations.

   

Appendices

Appendix A - Allergy Emergency Action Plans (26.2 MB, pdf)
Appendix B - Letter to All Parents in a Class of a Child with a Food Allergy

On School Letterhead


Date

Dear Parents,

This letter is to ask your help in providing a safe environment for a student in your child’s classroom who has a severe peanut/nut allergy. Strict avoidance of peanut/nut products is the only way to prevent a life-threatening allergic reaction. We are asking for your assistance in providing the student with a safe environment.

If exposed to peanuts/nuts, the student may develop a life-threatening allergic reaction that requires emergency medical treatment. The greatest potential for exposure at school is to peanut/nut products. Please refrain from sending any peanut or nut-containing products for your child to eat during snack-time in the classroom. Any exposure to peanuts or nuts through contact or ingestion can cause a severe reaction. If your child has eaten peanuts/nuts prior to coming to school, it would be helpful if your child’s hands and face have been thoroughly washed prior to entering school.

Since lunch is eaten in the cafeteria, your child may bring peanut butter, peanut, or nut products for lunch. In the cafeteria, there will be a designated peanut-free area. This plan will help to maintain safety in the cafeteria while allowing non-allergic classmates to enjoy peanut/nut products in a controlled environment. Following lunch, the children will wash their hands prior to going to recess (or returning to class). The tables will then be cleaned with soap and water,

We appreciate your support of these procedures. If you have any questions, please contact me.

Sincerely,


Principal or Classroom Teacher


Appendix C - Notice to All Substitutes

IMPORTANT


Our building has several students who have severe, LIFE-THREATENING food allergies. For these students, eating or touching any nuts or products containing nuts or other food allergens such as dairy or shellfish could result in a potentially fatal allergic reaction.

As you begin today, immediately check with the office professionals or person to whom you report to learn about life-threatening allergies or students with other health concerns with whom you will work. If you are a substitute, check the appropriate sub folder for further information. All health information is CONFIDENTIAL.

Our staff is trained in how to respond to students with food allergies in the event of an accidental exposure, but prevention is the most important action we can all take. To help reduce the risk of exposure for students with severe allergies, please:

  1. Wash your hands after eating or touching any foods.
  2. Do not eat or bring any food items into classrooms or specials classrooms without first checking with the teacher of that room.
  3. Observe the signs posted outside ALL rooms or areas that indicate that no nuts or other allergens are allowed in those areas.
  4. Do not offer food to any student.
  5. Children should not engage in sharing of food.
  6. Do not let students take food out to the playground.

Please call the front office if you suspect a student is having an allergic reaction or any medical emergency.

Thank you for your cooperation in this important matter.


Questions?

Contact school nurse:_____________________________Pager:______________

Appendix D - How a Child Might Describe a Reaction

Children have unique ways of describing their experiences and perceptions, and allergic reactions are no exception. Precious time is lost when adults do not immediately recognize that a reaction is occurring or don’t understand what a child is telling them.

Some children, especially very young ones, put their hands in their mouths or pull or scratch at their tongues in response to a reaction. Also, children’s voices may change (e.g., become hoarse or squeaky), and they may slur their words.

The following are examples of the words a child might use to describe a reaction:

  • "This food's too spicy."
  • "My tongue is hot [or burning]."
  • "It feels like something’s poking my tongue."
  • "My tongue [or mouth] is tingling [or burning]."
  • "My tongue [or mouth] itches."
  • "It [my tongue] feels like there is hair on it."
  • "My mouth feels funny."
  • "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)
  • "It [my throat] feels thick."
  • "It feels like a bump is on the back of my tongue [throat].”
  • "My stomach hurts.”


Source: [Foodallergy.org]

Appendix E - Research on Cleaning Products and Allergens

Scientists investigated how effective cleaning agents were in removing peanut allergens. The study was published in the Journal of Allergy and Clinical Immunology.

Surfaces

Researchers looked for cleaning methods for removing peanut allergens from surfaces (Ara h 1). They found that common household cleaning agents, such as Formula 409®, Lysol® Sanitizing wipes and Target® brand cleaners with bleach, removed peanut allergen from tabletops. However, dishwashing liquid left traces of the allergen on 25% of the tables. Do not use dishwashing liquid to wash surfaces.

Hands

To test the efficacy of cleaning methods for removing peanut allergens from hands, researchers applied peanut butter to the hands of non-allergic volunteers and then removed the allergen by using different cleaning methods.

  • 25 percent of the hands cleaned using water only still had detectable levels of allergen (peanut butter). Do not use water only to wash hands.
  • 50 percent of the hands cleaned using antibacterial hand sanitizer still had detectable levels of allergen (peanut butter). Do not use antibacterial hand sanitizer to wash hands.
  • All hands cleaned using commercial wipes (Wet Ones®, Tidy Tykes® flushable wipes) were free from the allergen (peanut butter).
  • All hands cleaned using liquid soap or bar soap were free from the allergen (peanut butter).

Summary

Surfaces

  • Do not use dishwasher liquid to wash surfaces.

Hands

  • Do not use water only to wash hands.
  • Do not use antibacterial hand sanitizer to wash hands.
  • Do not use surface wipes like Lysol® sanitizing wipes or Target® brand cleaners to wash a student’s hand or face. Wet wipes manufactured for the use on skin should be the only wipes used on a student.


(Perry, T.T., Conover-Walker, M.K. Journal of Allergy and Clinical Immunology)

Appendix F - Non-Food Reward Ideas
Elementary School Students
Stuffed Animal Day
Job – Line Leader
Job – Messenger
Job – Board Cleaner
Extra Time at Recess
Visit School Counselor/ Special Person
Extra Time in Centers
BINGO Celebration
Grade-level Game Day
Fine Dining in the Cafeteria
Call Home from Special Phone (e.g., cartoon character)
All Students
Homework Pass
Homework Extension
Less Homework
Lunch with the Teacher
Lunch in Special Location
Library Pass
Sit at Teacher’s Desk
Write in Ink Color of Choice
Sit in Desired Spot
Bring Something Special to School
Free Time
Talk Time
Pajama Day
Hat Day
Game Day/ Hour
Donations from Local Businesses
Middle/ High School Students
Tardy Pass
Cell Phone Use Pass
Special Parking Spot
Teacher for the Day
Re-Gifted Items Donated by Faculty and Staff
Special Activity Period
Go to Lunch Early
Trading Cards
Items ―Free with Purchase‖ from Perfume Counter
Gas Coupons
Life-Size ―Cut Outs‖ from Store Displays
Pass to Sporting Event
Pass to Dance
Sitting in Teacher’s Chair
Go to the Head of the Lunch Line
Recess during Lunch


Non-Food Treat Ideas
Pencils
Pens
Erasers
Notepads/notebooks
Boxes of crayons
Stencils
Stamps
Bookmarks
Highlighters
Chalk (e.g., sidewalk chalk)
Markers
Coloring books
Rulers
Glitter
Pencil sharpeners, grips, or boxes
Key chains
Flashlights
Cups
Magnets
Crazy straws
Books
Whistles
Stickers
Yo-yos
Rubber balls
Finger puppets
Plastic or rubber figurines
Toy cars, trucks, helicopters, or airplanes
Plastic sliding puzzles or other puzzle games
Slinkies
Gliders
Magnifying glasses
Spinning tops
Marbles
Jacks
Playing cards
Stretchy animals
Silly putty
Bubble fluid with wand
Balloons

 

Resources and References

Resources & Support

Food Allergy and Anaphylaxis Network (www.foodallergy.org)
NC FACES (Food Allergic Children Excelling Safely) (http://www.ncfaces.org/)


References

Articles and Reports

Clayton Food Allergy Policy (http://www.clayton.k12.mo.us/4036108714743200/lib/4036108714743200/Clayton-Food-Allergy-Policy.pdf)
Massachusetts Department of Education – Managing Food Allergies in Schools
Perry, T.T., Conover-Walker, M.K. Journal of Allergy and Clinical Immunology.)
Guidelines for Managing Life-Threatening Food Allergies in Illinois Schools - Illinois State Board of Education and Illinois Department of Public Health
Caring for Students With Food Allergies in School – Loudoun County Public Schools

Books

The School Food Allergy Program – The Food Allergy & Anaphylaxis Network
Wood, R.A. (2007). Food allergies for dummies. New Jersey: John Wiley & Sons.


Food Allergy Subcommittee Members:

George Greger-Holt, Director of Student Services

Susan Brannum, School Nurse

Denise Jones, School Nurse

Sonya Dunn, Head School Nurse

Jamie Detze, Parent

Sam Foy, Parent

Lisa Morgan, Chatham County Health Department

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