Special Diet Requests in Schools

Special Diet Requests in Schools PRESENTED BY: Rayona Baker, RD, LD Outline Disability vs. Special Diet Need Food Allergies Gluten Free Diets Diabetes Gordon Food Service Resources Other Resources Disability vs. Special Diet Need Disability: Physical or mental impairment which substantially limits one or more major life activities including caring for one s self, walking, seeing, hearing, breathing, learning and working. The following body systems may be affected: Heart and circulatory system Eating and your digestive system Breathing and respiratory system The determination of whether a student has a physical or mental impairment that substantially limits a major life activity must be made on a case by case basis according to individual school district guidelines and the student s physician. http://americanceliac.org/for-families/ 1

Disabilities USDA regulations require substitutions or modifications in school meals for children whose disabilities restrict their diets. A child with a disability must be provided substitutions in foods when that need is supported by a statement signed by a licensed physician. The physician's statement must identify: the child's disability an explanation of why the disability restricts the child's diet the major life activity affected by the disability the food or foods to be omitted from the child's diet, and the food or choice of foods that must be substituted. http://www.fns.usda.gov/sites/default/files/special_dietary_needs.pdf Disability vs. Special Diet Need Other special diet need: The school food service may make food substitutions, at their discretion, for individual children who do not have a disability, but who are medically certified as having a special medical or dietary need. Such determinations are made on a caseby case basis. These may be children who have food intolerances or allergies but do not have lifethreatening reactions (anaphylactic reactions) when exposed to the food(s) to which they have problems. Lactose intolerance Celiac disease http://americanceliac.org/for-families/ Special Diet Needs Each special dietary request must be supported by a statement, which explains the food substitution that is requested. It must be signed by a recognized medical authority. The medical statement must include: an identification of the medical or other special dietary condition which restricts the child's diet; the food or foods to be omitted from the child's diet; and the food or choice of foods to be substituted. http://www.fns.usda.gov/sites/default/files/special_dietary_needs.pdf 2

Food Allergies: disability or special diet need? It depends... Are food allergies a disability? Generally, children with food allergies or intolerances do not have a disability and the school food service may, but is not required to, make food substitutions for them. However, when the licensed physician's assessment states: food allergies may result in severe, lifethreatening (anaphylactic) reactions, the child's condition would meet the definition of "disability," and the substitutions prescribed by the licensed physician must be made. Click here to access booklet 3

Statistics Allergies in Schools Food Allergies affect 4 6% of US children Studies show that 16 18% children have reaction at school 25% of the severe reactions reported happened in children with no previous diagnosis of food allergy School staff should be ready to respond to their needs What is a Food Allergy? An immune system response to a food protein The body mistakenly reacts to a food as if it were harmful The food that causes the reaction is called an allergen Eating even a tiny amount of a problem food can cause a severe reaction which can be fatal Top 8 Food Allergens Peanuts Tree Nuts Wheat Eggs Soy Milk Fish Shellfish Accounts for 90% of all Allergies 4

Symptoms of allergic reactions to food Red watery eyes Itchiness Nausea/vomiting Swollen lips or tongue Trouble swallowing, numbness around mouth Wheezing or difficulty breathing How children may describe symptoms It feels like something is poking my tongue My lips feel tight There s a frog in my throat It feels like a bump is on the back of my tongue My tongue itches My throat feels thick My mouth feels funny Anaphylaxis a serious allergic reaction that is rapid in onset and may cause death 5

School Access to Epinephrine November 13, 2013 President Obama signed into law the School Access to Emergency Epinephrine Act Encourages states to adopt laws requiring schools to have on hand stock epinephrine auto injectors Anaphylaxis Food Allergies account for 35 50% of all cases of anaphylaxis in ER for 50 62% of fatal or near fatal reactions In the US, peanuts account for 50 62% of fatal or near fatal reactions Where do you start? 1. Policies and Procedures 2. Menu 3. Products 4. Training Staff 6

The Menu Label Reading 2 ways to list the MAJOR allergens in simple terms: A parenthetical statement in the list of ingredients e.g. albumin (egg) OR The word Contains followed by the name of the major allergen. All major food allergens used as ingredients must be identified in that statement (e.g. contains milk and egg). Label Reading Food Allergen Labeling & Consumer Protection Act (FALCPA) January 1 st, 2006 Declare the presence of a major food allergen for all FDA regulated foods in simple terms on its ingredient list. 7

Reading labels INGREDIENT LISTS When reading ingredient labels, look for allergen statements at the end of the ingredient listing. This is what it might look like: CONTAINS WHEAT, MILK AND EGG INGREDIENTS GORDON FOOD SERVICE Training GFS Whipped Butter Obtain ingredient information 8

Gordon Experience Food Allergen Awareness Sample lngredient label May Contain Statements Allergen advisory statements FALCPA does not regulate Trace amounts of other ingredients are in a product Processed on shared equipment with Manufactured in a plant that also produces Incidental additives = pan release spray 9

May Contain Statements Assume Nothing Read the label every time you purchase it. Ingredients change many times without warning. Manufacturers may change food items to adhere to the new fad or regulation. Food handling policies and procedures Clean and sanitize all surfaces that come in contact with food in kitchens, classrooms and other locations Clean and sanitize food preparation equipment before and after use Prepare food separately for children with food allergies Use appropriate hand washing procedures 10

Avoid cross contact Food surfaces/utensils Use the same knife that you used for peanut butter for the jelly Use the same parchment paper that was used for peanut butter cookies for the chocolate chip cookies Serving it safe Avoid cross-contamination Wash, rinse, and sanitize everything Strainers, condiment utensils Separate cleaning solutions Wash your hands and change gloves between foods Assign specific equipment for prepping food for students with allergies Toasters Color-coded system GORDON FOOD SERVICE Training Best Practices 1. Use cycle menus 2. Organize food labels by cycle: Breakfast/Lunch K 5, 6 8, 9 12 3. Cross off foods that contain allergens 4. Send to modified and dated menus to cooks 5. Purchase gluten free/allergen free chicken nuggets, beef patties, turkey burgers Amy Klinkoski, MS, SNS - Grand Rapids Public Schools 11

Best Practices 6. Offer vegetarian and allergen free choices as alternates i.e. salad with legumes, no croutons or cheese 7. Do not serve fish or nuts in K 5 8. Keep it simple substitute with foods on hand Amy Klinkoski, MS, SNS - Grand Rapids Public Schools More Best Practices 1. Physician s food allergy form is on district website 2. The school s main office provides FS with student s name with allergy 3. Parents of students new to district will receive menu, go over ingredient binder 4. School kitchens are required to save ingredient labels for each week s cycle menu 5. Parents are encouraged to call the kitchen directly if they have questions Gluten Free: disability or special diet need? Special diet need 12

Gluten Free Diets Celiac disease An autoimmune disorder where the ingestion of gluten leads to damage in the small intestine Affects ~1% of the population Gluten sensitivity/intolerance Symptoms similar to celiac disease that improve when gluten is eliminated from the diet Does not cause intestinal damage Affects ~6% of the population Gluten free as a healthy diet No medical diagnosis Believe it will aid in weight loss, reduce inflammation, curb fatigue, or ease other conditions Many say they simply feel better! Gluten: the basics What is gluten? A protein found in wheat, rye, and barley and their derivatives Couscous, triticale, semolina, spelt, graham, farina, durum, bulgur, kamut, kasha, matzo Oats are controversial; often contaminated during growing process Where is it found? Breads Candy Cereals Crackers Cookies Cakes Cosmetics Deli Meat/Sausage/Hot Dogs Dried Fruit Frosting Gravies Imitation meat Meat extenders Medications Pasta Pies Play dough Sauces Snack foods Stamps/stickers Label reading for gluten GF symbol voluntary Wheat required to be listed on label (top 8 allergen) Other words that indicate gluten: malt graham spelt semolina breading matzo farina oats triticale seitan rye brewer s yeast durum farro kamut kasha barley 13

Gluten Labeling Law On August 5, 2013, FDA issued a rule defining the term gluten free for voluntary use in the labeling of foods. The compliance date for the rule was August 5, 2014. Food products bearing a gluten free claim labeled on or after that date must meet the rule's requirements. The rule defines "gluten free" as meaning that the food either is inherently gluten free or does not contain an ingredient that is: 1) a gluten containing grain (e.g. wheat) 2) derived from a gluten containing grain that has not been processed to remove gluten (e.g. wheat flour) 3) derived from a gluten containing grain that has been processed to remove gluten (e.g. wheat starch), if the use of that ingredient results in the presence of 20 parts per million (ppm) or more gluten in the food. Any unavoidable presence of gluten in the food must be less than 20 ppm! http://www.fda.gov/food/guidanceregulation/guidancedocumentsregulatoryinformation/allergens/ucm362880.htm How to build a gluten free meal How to build a gluten free meal 1 Cheese Pizza Corn on the cob Green Beans 100% fruit juice Milk 2 Chicken Nuggets Mashed Potatoes with gravy Apple slices Cookie Milk Chicken and Rice casserole GF Chicken Nuggets or Chicken Breast No gravy GF cookie or pudding 14

Three-Day Gluten Free Menu GORDON FOOD SERVICE Training Gluten & cross contact Cross contact: When an allergen is transferred from a food containing an allergen to a food that does not contain the allergen Cooking does not reduce or eliminate the chance of a person with a food allergy from having a reaction Think about preparation, cooking, and serving If possible, designate a separate area of the kitchen to prepare gluten free items Use separate equipment, utensils, cookware, cutting boards, cooking areas & counters may be needed Best Practices 1. Food items on the menu are labeled with GF 2. Each kitchen offers a list of gluten free entrees that parents can pre order; there are items that cost more and the parents will be notified that the cost of lunch will be higher 3. Parents can contact the Food Service Office to ask for product ingredients Marla Ernst - Nutrition Services Director, Lake Orion Schools Rye Wheat Barley 15

Diabetes: disability or special diet need? Disability Diabetes What is it? The sugar (or glucose) levels in the blood are higher than normal because: o Body is unable to produce enough insulin (Type 1) o Body produces weak insulin (Type 2) Insulin is a hormone produced by the body which helps the body to use sugar (carbohydrate) for energy Carbohydrates are found in: o Breads, crackers, and cereals o Pasta, rice, and grains o Starchy vegetables like potatoes, corn, and peas o Beans and legumes o Milk, soy milk, and yogurt o Fruits and fruit juices o Sweets such as cakes, cookies, ice cream, jam, and jelly Diabetes Everyone needs carbohydrates Diabetics just need to be careful how MUCH carbohydrate they eat Consistency is key! o Plan the same amount of carbohydrates each day for meals & snacks o One carb serving = 15 grams carbohydrate 1 slice bread ½ c. mashed potatoes 1 small apple 17 grapes 1 cup milk 3 ginger snaps o Most people eat 3 4 carb servings (45 60g) per meal and 1 2 carb servings (15 30g) at snacks 16

Carb counting Cheese Quesadilla, 1 piece 1 oz eq grain, 1 oz meat alternate 16g carb Salsa, ¼ cup ¼ cup red/orange vegetable 4g carb Refried Beans, ½ cup ½ cup beans/peas 16g carb Vanilla Yogurt, 6 oz 1 ½ oz meat alternate 25g carb Banana, 1 each ½ cup fruit 27g carb 1% milk, 8 floz 1 cup milk 13g carb 101 grams ~ 7 carb servings How many carbs in that meal? 85 grams ~ 5.5 carb servings ~ 3.5 carb servings 55 grams Label Reading Labels are your best source for carb info 1st: Look at the serving size 2nd: Look at Total Carbohydrate 1 serving has 22g carbohydrate 22g carb = 1.5 carb servings 17

Label Reading Gordon Food Service Ordering www.gfs.com > log in Carbohydrate content available for stocked products Item specific information Making Substitutions 1 oz roll 14g carb 2 oz roll 27g carb Chicken nuggets 14g carb Chicken nuggets 10g carb Recognizing high/low blood sugar For students using insulin, diabetes must be managed 24/7, including the many hours spent at school! High blood sugar: Increased hunger Increased thirst Nausea Blurry vision Medical attention is required Low blood sugar: Shakiness Sweating Dizziness Weakness Extreme hunger Fast heartbeat Carbohydrate is needed 18

Gordon Food Service Gordon Food Service Responding to Special Diet Requests: Part One & Responding to Special Diet Requests: Part Two Gordon Food Service 19

Gordon Food Service Gordon Food Service Does Gordon Food Service create allergen free lists (peanut-free, soy-free, etc.)? No - we are unable to create these because manufacturers can change their product formulation without notifying GFS. In Review Know your district or school food allergy policy Be familiar with each student s medical statement Read ingredient labels to check for allergens Avoid cross contact when preparing and serving food 20

A good investment Serving healthy, reimbursable meals is good for the budget, and good for growing healthy kids. GORDON FOOD SERVICE Training 61 Questions? Nutrition Resource Center nrc@gfs.com 800 968 4426 21