Food Allergy Management & Education ADMINISTRATORS/PRINCIPALS/TEACHING FACULTY ADMINISTRATORS/PRINCIPALS CHECKLIST Follow state and school district food allergy policy and procedure Participate and schedule team planning meeting for food allergy students Be aware of: Schedule teacher/staff training drills including substitutes at least annually and as needed Practice best practice Consider providing emergency communication devices (two-way radio, intercom, walkie-talkie, cell phone) for all school activities. (sample substitute plan). Educate students on: hand washing, not trading/sharing food, food allergy and symptoms. Educate the child with food allergies the importance of taking responsibility for their food allergies. Be sensitive to the social and emotional needs of the child with allergies. Always notify parent/guardian of changes in personnel. Review Which food(s) the student cannot eat Compliance with state and school district policy/procedure Emergency protocol Days scheduled for training and drills Prevention Education/Training Conduct all staff in-service training and emergency response drills Discipline specific training may include: food label reading, proper cleaning/hand washing, and avoiding cross contamination Provide community education as appropriate, this may include: letters to parents, food allergy workshops, parent presentations/discussion
Food Allergy Management & Education ADMINISTRATORS/PRINCIPALS/TEACHING FACULTY TEACHING FACULTY CHECKLIST Follow school district food allergy policy and procedure Participate in team planning meeting for food allergy students Practice best practice Avoid food in your lesson plans; for special projects evaluate for possible food allergens (sample substitute plan) Encourage hand washing or use of hand wipes before/after eating Educate children not to share food Don t use food as an incentive or reward Consider possible allergies to the animals, its food, and its habitat needs Be sensitive to the social and emotional needs of the child with food allergies Monitor peer interactions Review What food(s) the student cannot eat Child s Food Allergy Action Plan (FAAP) School district s emergency protocol Prevention Education/Training What to do if an allergic reaction occurs School district s emergency response protocol How to use an EpiPen
MEDICAL INFORMATION RELEASE Student Date of birth Address City State Zip I, the (parent/guardian) of the student named above, to release the necessary confidential health information to the appropriate school representatives including nurse, principal, teacher(s), food service staff, emergency personnel, and applicable volunteers who have a need to know my child s health information to provide safety at school. Information to be released to include the following (check if applicable): Health record Psychological/psychiatric evaluation Parent contact information Social worker/counselor report I understand that signing this form is voluntary, and it will be used only for the specific information
SUBSTITUTE PERSONNEL PLAN As you begin today, please be aware a student in this classroom has Anaphylaxis is a rare life threatening allergy to certain substances such as foods, bee stings, chemicals and medications. It occurs rapidly and can close off the breathing passages. It can be fatal if instant treatment is not provided. Adequate plans to handle severe allergic reaction can save the life of a child. Place Student s Photo Here emergency response procedures. Your anticipated cooperation is Personal Data Student Effective date Parent/guardian Birth date Teacher Doctor Allergy History Has a severe allergy to Symptoms include, but not limited to: Feeling of throat closing Sweating Itching/hives Shallow respirations Apprehension Weakness Words the child may use if they are experiencing a reaction Describe specifics for the child
GOAL: To respond quickly and appropriately to any possible reaction and provide intervention(s) to decrease the effects of the reaction. If anaphylaxis does occur, the teacher/staff member with the child shall: school direction Identify personnel in your Substitute Plan who will: a life-threatening allergic reaction is occurring and/or allergy specialist direct to the respective student If you have questions, please contact the following school staff members trained in emergency prevention/response procedures: Name Title Phone/ext Name Title Phone/ext Name Title Phone/ext
FIELD TRIP RISK ASSESSMENT Questions for Coordinator of the Field Trip Destination Child s name Child s teacher/grade Child s allergy(ies) Check all that apply: Contact Ingestion Airborne/cooking vapors Conversation with parents/guardians: Yes Date? Will you attend the field trip? Yes If yes, do you want to be responsible for a whole group of children? Yes Teacher in charge Nurse attending: Yes Field trip date Field trip time Field trip destination Destination contact name and phone number Questions Any food displayed or demonstrations? Any hands on activities involving food (eg. feeding animals)? 2. How will snack/lunches be stored on the bus ride to the fieldtrip destination? If necessary, 3. Where will the children eat snack and/or lunch?
(and by whom?) or do they need plastic tablecloths? monitor to ensure that the offending allergen is not given to the child? 7. Who will privately discuss with all attending adults, teachers, and parent chaperones, that under no circumstances is the child to be allowed to eat or touch or given any food or drink by any other distributed to the child by the teacher/nurse in charge. 8. Will it be discussed that the EpiPen Jr. must be with the child on all fieldtrips, both long and short? teachers for all medically involved students when leaving the school grounds for any reason? and give it to the classroom teacher and/or the bus driver prior to the day of the field trip?, inhaler) in an emergency situation? emergency after the child has received the EpiPen?
PARENT LETTER Dear Parents/Volunteers of (insert school name): threatening reaction may occur. Even small amounts on surfaces can lead an emergency reaction. risk of exposure please: lunchroom, or on the playground. c) Do not send in food items without checking with the principal and/or classroom teacher first If your child has any life-threatening allergy please contact the school principal, nurse and/or teacher. Sincerely,
PRINCIPAL LETTER Dear Parents, You ve all read the headlines and seen the news stories: food allergies are a growing concern in schools across America. Millions of children children who are perfectly healthy and normal in every other way must watch every single bite they eat, or risk suffering a severe or even life-threatening reaction. each year. A major health issue such as this one needs to be taken very seriously, and it has always been the policy of this school to make the safety and well-being of our students our top priority. A student in your child s class has a serious peanut allergy the food allergy that claims more lives each year than any other. A child with a serious peanut allergy can suffer a reaction merely by touching be eaten as snacks in the classroom. It is fine to send these products for lunch, which is eaten in the cafeteria. shells (art projects). Please do not send any of these projects into the classroom with your child. If you would like to send in baked goods, please be careful about the ingredients. Please list the utensils and preparation surfaces be carefully washed after each food is touched. It would be especially helpful if you could let your child s teacher know a few days ahead of when you d like to celebrate your child s birthday, so that the food-allergic child can provide his/her own safe treat. extremely careful about the ingredients in all of the food items. Please do not enclose candy or other treats with holiday cards. butter or peanut products for lunch use a wipe to clean their hands when they return from the cafeteria. Similarly, if your child ate peanut butter for breakfast, we would greatly appreciate your making sure that his/her hands are washed with soap and water before leaving for school. Water respect and adhere to these guidelines. If throughout the course of the year you have any questions or concerns about food-allergy-related issues, please do not hesitate to contact either one of us. Wishing you and your family a safe and healthy school year. Sincerely, For more information, please visit www.foodallergyinitiative.org or email Info@FoodAllergyInitiative.org
CLASSROOM LETTER Dear Parent/Guardian, school setting requires the active support of parents/guardians and classmates. Please note: a food products is the only way to prevent a life-threatening allergic reaction. We are asking for your help to make a safe learning environment for all students. Please send any food items to eat in the classroom containing (this does not include food brought for lunch.) Since lunch is eaten in the cafeteria/lunchroom, your child may bring food containing these items. However, if your child brings any unsafe food allergens, eating or touching a small amount of any allergen product could result in a life-threatening reaction, even death. Please remind your child: remove the food allergen. We encourage parents to celebrate birthdays and special events with non-food items such as stickers, pencils, themed erasers, or other trinkets, rather than food. Any food sent in to share with students must be pre-packaged and contain an ingredient label. Please give these items to your child s teacher to handout. We must be very careful! learning environment for all students. After reviewing this letter, please complete and return the form below. If you have any questions regarding food allergies, please contact any one of us. Sincerely, I/We have read and understand the procedures not to allow the above listed food allergens in the classroom. I agree to do my part in keeping food allergens out of the classroom. Child s Name
Food Allergy Information 8 Most Commmon Food Allergens can cause a reaction Know the Difference Food Intolerance when the body has difficulty digesting a certain food the immune system is not affected Food Allergy an immune system response to a certain food Anaphylaxis a sudden, severe allergic reaction that can cause difficulty breathing, tongue and throat swelling What Does an Allergic or tongue blood pressure) Give Epinephrine then Call 911 Food Allergy & Management Education
FOOD ALLERGY RESOURCES Local Resources St. Louis Children s Hospital Answer Line St. Louis Children s Hospital Family Resource Center St. Louis Gateway FEAST: Food Allergy, Eczema and Asthma Support Team Support Group Online Resources American Academy of Asthma, Allergy and Immunology (AAAAI) http://www.aaaai.org http://www.aaaai.org/patients/gallery/foodallergy.asp American Academy of Pediatrics http://www.aap.org Center for Chronic Disease Prevention and Health Promotion: DASH Healthy Youth Food Allergies http://www.cdc.gov/healthyyouth/foodallergies/ DHSS Food Allergy Power Point Presentation Food Allergy and Anaphylaxis Network http://www.foodallergy.org Food Allergy Initiative Includes links to helpful allergy friendly companies/restaurants Kids with Food Allergies http:/kidswithfoodallergies.com/ Missouri State Guidelines for Allergy Prevention and Response For more Food Allergy resources refer to St. Louis Children s Hospital FAME Manual
Food Allergies, Self Image and Social Factors Positive Social and Emotional Tips Having food allergies can cause social and emotional responses that could include: harassment* * with food allergies is common Food Allergy & Management Education
EPIPEN /EPIPEN JR. COMPETENCY SKILLS CHECKLIST Name School in the box, if the skill is attained. 1 2 3 4 5 6 7 8 9 10 Identify five signs and symptoms of anaphylaxis then call) from package and protective carry tube by flipping the yellow or green cap Make a fist around the EpiPen Auto Injector Hold the EpiPen with the orange tip pointing toward the middle part of the outer thigh area at a EpiPen straight out of injection site Patient has received the correct dose of the medication if the orange needle tip is extended and the window is obscured. If not, repeat steps 4-9. SCORE FOR NUMBER OF SKILLS CORRECTLY PERFORMED 10 Signs and Symptoms of Anaphylaxis around the eyes Storage Efficacy When do effects wear off? 10-20 minutes. Call 911 immediately after using the EpiPen. When do you use EpiPen versus EpiPen Jr? EpiPen if >66 lbs / Jr if 33-66 lbs
LAWS PERTAINING TO LIFE-THREATENING FOOD ALLERGIES State and federal laws provide protection for students with life-threatening allergies. School districts are legally obligated by these laws to ensure students with life-threatening allergies are safe at school. School districts must have and follow their own policies and procedures for the health and well-being of such students. Missouri State Laws Section 167.208, RSMo, requires each school district to adopt a policy on allergy prevention and response with priority given to addressing potentially deadly food-borne allergies; the policy and Section 167.627, RSMo, addresses possession and self-administration of medications in schools. Section 167.621, RSMo, Section 167.630, RSMo, addresses the ability to obtain and maintain an adequate supply of epinephrine pre-filled auto syringes for emergency use by school nurses. Federal Laws Section 504 of the Rehabilitation Act of 1973 (Section 504) (FAPE) for students with disabilities. A student with a life-threatening food allergy qualifies as a http://www.ed.gov/about/offices/list/ocr/504faq.html. The Americans with Disabilities Act (ADA) of 1990 allergy is identified as a physical disability that substantially limits one or more major life activities. See http://www.eeoc.gov/policy/ada.html. The Individuals with Disabilities Education Act of 1976 (IDEA) IDEA is a federal law that governs how states and public agencies provide early intervention, special education, and related services. IDEA district procedures must be followed if the student is determined to be eligible for special education services.
Accommodating Children with Special Dietary Needs in the School Nutrition Programs Child Nutrition Program Regulations: 7 CFR Part 15b; 7 CFR Sections 210.10(i)(1), 210.23(b), 215.14, 220.8(f), 225.16(g)(4), and 226.20(h) threatening food allergy when supported by a statement signed by a licensed physician. However, the federal guide, see http://www.fns.usda.gov/cnd/guidance/special_dietary_needs.pdf. The Family Education Rights and Privacy Act of 1974 (FERPA) parental rights regarding access to student records. In schools, student specific information and records may be shared with school personnel only under certain circumstances. See http://www.ed.gov/policy/gen/guid/fpco/ferpa/index.html. From Missouri Guidelines for Allergy Prevention and Response
STUDENT ALLERGY PREVENTION AND RESPONSE POLICY increase awareness, provide education and training, reduce the chance of exposure and outline of the allergen. auditory processing and attendance. In addition, healthy students are better learners. In addition to posing health risks, allergies can be potentially deadly for some individuals. to implement this policy. Identification Each school will attempt to identify students with life-threatening allergies, including food allergies. An allergic reaction is an immune system response to a substance that itself is not harmful but that the body interprets as being harmful. Allergic reactions range from mild to severe, even life-threatening. At enrollment, the person enrolling the student will be asked to provide information on any allergies the student may have. Prevention Students with allergies that rise to the level of a disability as defined by law will be accommodated in accordance with district policies and procedures pertaining to the identification and accommodation (EAP), ed for students with allergies that do not rise to the level of a disability. EAP will be disciplined, and such discipline may include termination. Staff members shall not use air fresheners, oils, candles or other such items intended to add fragrance that contain added fragrance, but the principal may require staff members to refrain from the use of personal care items with added fragrance under particular circumstances. Staff members are prohibited from using cleaning materials, disinfectants, pesticides or other chemicals except those provided by the district. district as part of the district s nutrition program, including food provided during the school day and
Prepackaged items used in concessions, fundraisers and classroom activities must include a list of ingredients on the package. If the package does not contain a list of ingredients, the list of ingredients must be available at the location where the package is sold or provided. Education and Training All staff members will be regularly trained on the causes and symptoms of and responses to allergic Age-appropriate education on allergies and allergic reactions will be provided to students as such include potential causes, information on avoiding allergens, signs and symptoms of allergic reactions and simple steps students can take to keep classmates safe. Confidentiality Information about individual students with allergies will be provided to all staff members and others who need to know the information to provide a safe learning environment for the student. Information about individual students with allergies will be shared with students and others who do not have a Response epinephrine premeasured auto-injection devices to be administered in accordance with Board policy. Note: The reader is encouraged to check the index located at the beginning of this section for other pertinent policies and to review administrative procedures and/or forms for related information. Adopted: Revised: Cross Refs: AC, Prohibition Against Illegal Discrimination and Harassment EF, Food Services Management IGBA, Programs for Students with Disabilities Legal Refs:
STUDENT ALLERGY PREVENTION AND RESPONSE POLICY Explanation House Bill 922 (2009) requires school districts to adopt a policy on allergy prevention and response Department of Health and Human Services (DHSS) also provided input. threatening allergies are to foods, but environmental, fragrance and chemical allergies may management of people with life-threatening allergies is avoidance. By law, this policy must do the following: 1) Distinguish between building-wide, classroom and individual approaches to allergy prevention and management. 2) Provide age-appropriate education on allergies and prevention. 3) Describe the role of staff members in determining how to manage an allergy problem. 4) Describe the role of other students and parents in cooperating to prevent and mitigate allergic reactions. 5) Address confidentiality issues, including when parental permission is required to make medical information available. 6) Coordinate with the School Health Advisory Council (SHAC), local health authorities and other appropriate agencies. Training of Staff Staff training need not be lengthy, but should cover the various types of allergic reactions and how to identify and respond to a life-threatening reaction. Staff members who have responsibility for students and assistance are available on the Missouri Department of Health and Senior Services (DHSS) be trained, but presumably training should be frequent enough that all staff members have at least been introduced to the subject. dying from an allergic reaction because the district did not get around to providing training. Response Epinephrine is the treatment of choice for anaphylaxis and should be administered as soon as possible. It is the most important action the district can take to save a student.
Student Education discussion of allergies. A district may require that information on allergies be included in the curriculum more frequently. parts of the policy. Staff allergies should be addressed by adhering to the Americans with Disabilities Act (ADA). See also MSBA policies AC and GBE and form GBE-AF or similar policies and form. PLEASE NOTE that this model policy assumes the district has epinephrine premeasured auto-injection devices available for use in an emergency (see MSBA policy JHCD or similar policy). If this is not the life-threatening allergies should supply the school with epinephrine premeasured auto-injection devices Resources www.foodallergy.org Journal of School Health 67 www.foodallergy.org/school/guidelines/schoolguidelines.pdf.
STUDENT ALLERGY PREVENTION AND RESPONSE PROCEDURES food service director, the School Health Advisory Council (SHAC), the wellness committee, the transportation director, local health authorities and, where appropriate, the special education Definitions Allergen: A substance that triggers an allergic reaction. Allergic Reaction: An immune system response to a substance that itself is not harmful but that the body interprets as being harmful. Allergic reactions trigger inflammation in the skin (hives, itching, a (vomiting, diarrhea, stomach pain); and the cardiovascular system (lowered blood pressure, irregular heartbeat, shock). Anaphylaxis is another type of allergic reaction. Anaphylaxis: and hives. Anaphylaxis may result in shock or death. Emergency Action Plan: An EAP is a written plan for students who have life-threatening conditions, to respond. Individualized Health Plan: An IHP is a document created by the district in cooperation with the parents and, when appropriate, a student s health care provider for students who have specific health care needs. It is a nursing care plan that has student-centered goals and objectives, and describes the nursing interventions designed to meet the student s short and long-term goals. Life-Threatening Allergy: An allergic reaction that is severe enough to potentially cause death. General In accordance with Board policy, the nurse or designee will provide training to all staff members Pursuant to Board policy, students may carry medication for the treatment of allergies. In addition, epinephrine premeasured auto-injection devices are available in each building and stored in the following locations: Building Building Building
OR does not stock epinephrine premeasured auto-injection devices for general emergency use. Staff will respond to allegations of harassment or bullying on the basis of an allergy in accordance with the district s policy on bullying. All staff will be instructed in approved cleaning methods, including the use of soap and hot water, and required to use approved methods in any location in which food is served. Response to an Allergic Reaction Any staff member who becomes aware that a student is having an allergic reaction must: 1) Stay with the student 2) 3) Contact the parents If a staff member determines that the allergic reaction is potentially life-threatening the staff member Action Plan (EAP) if the staff member is familiar with the plan. member will immediately take or direct another person to take the following actions. 1) 2) (designee). 3) Administer epinephrine, if available, at the direction of the school nurse or designee. If the school nurse is not present, the staff member may administer epinephrine, if available, if the staff member determines it is necessary to safeguard the health of the student. 4) 5) Provide first responders with information about the student s allergy and reaction and any actions already taken. 6) A staff member will remain with the student until a parent/guardian or emergency contact arrives or until the student is transported from the district by first responders. or IHP/EAP would be appropriate for the student. Instructional Areas permission from the building administrator. Courses that include food preparation or consumption as a regular part of the curriculum are exempt from this provision, but instructors in these courses have an increased responsibility to monitor student adherence to prevention procedures. Dining Areas Plan or IHP that concerns diet, along with a photograph of the student. In lieu of providing a copy of the actual plan, the nurse or designee may provide a document with all the pertinent information.
STUDENT ALLERGY PREVENTION AND RESPONSE PROCEDURES from a licensed physician that: 1) Describes the disability or condition. 2) Explains how the student is restricted as a result of the disability or condition. 3) Identifies the major life activities affected by the disability or condition. 4) personnel will not act on individual requests for dietary accommodations. If a student or parent/guardian director requests an accommodation, he or she will be referred to the school nurse for assistance. cross-contamination avoidance, safe food handling and food item labeling requirements. If there is any change in the menu after the menu has been posted, the food service director will Students who use these tables may not have any food or beverage that contains or may contain peanuts or other nuts. If any student has been identified as having life-threatening allergies to a allergen-free areas and specify the prohibited foods and beverages. Staff responsible for cleaning will be required to sit at the designated table. prevent students from trading food, beverages or dining utensils. Transportation and Off-Site Activities Except as otherwise outlined in this procedure, drivers will not allow students to eat or drink on district transportation unless the student has written permission from his or her building principal. Written permission will be provided if the student has a medical need to consume food or beverages during the time the student is transported. A student who has a medical need to consume food or beverages on beverages the student may consume if he or she is transported with any other student who has a life-threatening food allergy. Students being transported to and from activities on district transportation may be allowed to consume food and beverages if the staff member serving as sponsor has verified that none of the students being transported have documented life-threatening food allergies. Staff members must submit a list of students taking part in off-site activities, such as competitions and Plans or IHPs or EAPs and any medications that may be needed in the case of an allergic reaction.
Note: The reader is encouraged to review policies and/or forms for related information in this administrative area. Implemented: Revised: Explanation House Bill 922 (2009) requires school districts to adopt a policy on allergy prevention and response Department of Health and Senior Services (DHSS) also provided input. allergies are to foods, but environmental, fragrance and chemical allergies may also pose a health risk for DESE and MSBA assigned oversight of this procedure to the school nurse because allergies are a health issue, however, the district may use another employee. If the district chooses to use an employee other than the nurse to implement these procedures, the nurse should still play a significant role. In the General section, the district must choose between two (2) versions of the procedure language, depending on whether the district keeps epinephrine premeasured auto-injection devices on hand. allowing meal substitutions by schools that participate in a federally funded nutrition program Plans that address food allergies. A model form is available on the DESE website in the School Food Services section. Training of Staff Staff training need not be lengthy, but should cover the various types of allergic reactions and how to identify and respond to a life-threatening reaction. Staff members who have responsibility for students and assistance are available on the Missouri Department of Health and Senior Services (DHSS) be trained, but presumably training should be frequent enough that all staff members have at least at the beginning of the school year immediately following the adoption of the policy, annually, or on did not get around to providing training. Nut-Free and Allergen-Free Areas should not be restricted so that only students with allergies sit at the tables.