Life-Threatening Food Allergies and Child Nutrition Programs

Objective

To identify requirements, resources, and ideas for meeting the needs of children with life-threatening food allergies.

Laws and RegulationsRehabilitation Act of 1973

Individuals with Disabilities Education Act (IDEA)

Americans with Disabilities Act (ADA)

U.S. Department of Agriculture's (USDA) nondiscrimination regulation (7 CFR 15b)

FNS Instruction 783-2, Revision 2, Meal Substitutions for Medical or Other Special Dietary Reasons

What is the definition of Disability?A condition that substantially limits one

or more major life activities; orA record of such a condition; orBeing regarded as having such a

condition.

EATING is a major life activity that can be substantially limited by celiac disease.

BREATHING can be impacted by food intolerances and food allergies.

Disability Special education

neededIEP completedAccommodations

made

DisabilitySpecial education

not needed504 plan

completedAccommodations

made

5

Section 504IDEA

Laws and RegulationsRehabilitation Act of 1973

Individuals with Disabilities Education Act (IDEA)

Americans with Disabilities Act (ADA)

U.S. Department of Agriculture's (USDA) nondiscrimination regulation (7 CFR 15b)

FNS Instruction 783-2, Revision 2, Meal Substitutions for Medical or Other Special Dietary Reasons

School Requirements for Children with DisabilitiesAccommodation MUST be madeA disability determination can

only be made by a licensed physician (or other recognized medical authority)

No extra chargeIn the most integrated setting

appropriate

Required Statement For Children With DisabilitiesSigned by a licensed physician

Identify the disability

How it restricts diet

Major life activity affected

Foods to be omitted

Foods to be substituted

9

USDA Regulations and Guidance

Child with medical conditions that are NOT disabilities are encouraged, but not required, to be accommodated.

Some needs can be met through OvS.

Statement For Children Who

Are Not DisabledSubstitutions for non-disabled students must be supported by a statement signed by a recognized medical authority such as: physicians, physician assistants, nurse practitioner, other professionals specified by the State

agency.

Statement For Children Who Are Not Disabled (continued)

Identify the medical condition or special dietary need

How it restricts diet

Foods to be omitted

Foods to be substituted

Nonacademic Services 7 CFR 15b.26Students with disabilities MUST have an

equal opportunity to participate in nonacademic and extracurricular services.

Examples: physical education and athletics, food services, transportation, health services, recreational activities, special interest groups or clubs sponsored by the recipient. Classroom activities such as parties would fall under this regulation.

THESE THINGS DO NOT NECESSARILY INVOLVE THE FOOD SERVICE STAFF, BUT SOMEONE AT

THE SCHOOL NEEDS TO ADDRESS THESE

Food Allergy Awareness Protocol

15

Common Food Allergies• peanuts• tree nuts (such as almonds, pecans, walnuts)• milk• eggs• soy• wheat• fish (such as bass, cod, flounder)• crustacean shellfish (such as crab, lobster,

shrimp)

Food AllergiesDefinitionSymptomsAnaphylaxis

Symptoms of AnaphylaxisAnaphylaxisReaction timeMost dangerous symptoms

Treatment for AllergiesAntihistamines/BronchodilatorsEpinephrinePrevention and Strict Avoidance

Food IntoleranceDefinition: Food intolerance is an

adverse reaction to food that does not involve the immune system.

Example◦Lactose Intolerance

RegulationsAccommodations

Required

◦ Allergies with the potential of anaphylaxis

◦ Celiac disease

Accommodations with Approval of Food Service Dir.

◦ Allergies with no anaphylaxis

◦ Food intolerances

Food Allergy Awareness ProtocolPurpose

◦Establish a building-based general Medical Emergency Plan.

◦Develop and implement an Individual Health Care Plan for students with diagnosed life-threatening allergies.

◦Implement annual life-threatening allergy and epi-pen training for appropriate staff.

◦Restrict and/or control the use of food during the school day.

Parent/Guardian ResponsibilityNotify the school nurse or

principal prior to the opening of school each year.

Have doctor complete the necessary forms for foodservice prior to each year.

Deliver/provide approved medications to school nurse and replace when expired.

Meet with school nurse and other school staff to develop an IHCP and mode for communication.

School Administrator ResponsibilityEstablish a basic Medical

Emergency Plan for the building for use in any medical emergency.

Ensure that an IHCP for each child with a life-threatening allergy is created and implemented.

Establish a procedure for how and when school staff should communicate.

School Nurse ResponsibilityDevelop an IHCP, corresponding

Allergy Action Plan and Medication Administration Plan with parents/guardians and school team.

Arrange for periodic review of IHCP at least annually.

Provide education and training to all need-to-know school staff.

Food Services ResponsibilitiesAttend training if required by

IHCP.Follow safe food handling

practices to avoid cross contamination.

Follow cleaning and sanitation protocol to avoid cross contamination.

With parent approval, set up procedures for cafeteria.

After receiving the approved statement, make reasonable meal accommodations.

Food Service Assistants

30

• Read food labels.• Know what to avoid and how to

substitute.• Designate allergy-free zones in the

kitchen.• Follow safe food handling practices.

Preventing exposure to allergens starts in the kitchen.

www.foodallergy.org

Food Service AssistantsUnderstand the allergy plan.Identify the students with

documented food allergies.Learn to recognize signs of

anaphylaxis, and know how to activate the school’s emergency plan.

Cafeteria Host/Custodial ResponsibilitiesAttend training according to the

student’s IHCP.Following safe food handling practices

and cleaning and sanitation protocol to avoid cross-contamination.

Provide a clearly labeled allergen free table for students if required by an IHCP.

Respond appropriately to all complaints/concerns.

Peanut Free vs. Peanut Aware?

Students’ ResponsibilityDo not trade food with others.Wash hands before and after eating.Do not eat anything with unknown

ingredients or known allergen.Be proactive in the care and

management of their food allergies and reactions.

Notify an adult immediately if they eat something they believe to contain the allergen, and/or if they are having symptoms.

Transportation Staff ResponsibilityProvide a representative for school team

meetings to discuss IHCP as appropriate.Provide annual training for all school bus

drivers on managing life-threatening allergies.

Provide functioning emergency communication device.

Know how to activate EMS.Maintain policy of not permitting food to

be eaten on school buses.

Meeting the Needs of All

Other Examples of Diet-Related DisabilitiesDiabetesSevere Food Allergies (anaphylaxis)Celiac DiseasePhenylketonuria (PKU), other

metabolicEpilepsyEmotional illnessHeart diseaseAutism

39

Accommodations

Use food already purchased when possible

May require special trainingMay require professional help of a

dietitianState agencies may be of

assistance

Diet Restrictions can be hard…

Recipe Ideas…

Specialty Foods

Accommodating Children with Special Dietary Needs in the School Nutrition Programs:Incurring Additional Expenses; Potential Funding SourcesSchool District’s General FundIndividuals with Disabilities Education

Act (IDEA)MedicaidSupplemental Security Income (SSI)

Food Service Assistants

44

• Maintain communication among parents, teacher, school nurse, food service, and consultant if needed

• Understand the dietary restrictions prescribed in the plan kept on file with the school nurse

• Obtain and serve special formula or foods• Follow prescribed portion sizes• Report mistakes immediately• Keep information confidential

Practical Applications

Baked chicken and baked potato or steamed veggie with chicken and rice for someone who has celiac

disease. The meal does not have to be exactly the same as what is

provided to others.

Allergy Scenarios:

Janet is making cookies for school lunch. Since there are a few students with life threatening peanut allergies, she is making peanut butter cookies and sugar cookies. When the cookies are finished baking, she uses a spatula to place the peanut butter cookies on one serving tray and the same spatula to place the sugar cookies on a separate tray. During serving, Janet puts on a pair of gloves and serves the students their choice of cookie as they pass through the line. She identifies the students with peanut allergies and serves them only sugar cookies.

Alice is making ham and cheese sandwiches for school lunch. She first slices the cheese on the slicer and then slices the ham. She first makes the ham and cheese sandwiches, and then because there is a student with milk allergies, she changes her gloves and makes ham-only sandwiches.

Tom is making peanut butter and jelly sandwiches for lunch. When he finishes preparing the peanut butter and jelly sandwiches, he wipes off his knife and then takes the knife, the jelly, and the bread over to the kitchen’s allergy-free zone and makes the jelly sandwiches for the students with peanut allergies.

The cafeteria received a new shipment of hotdogs for school lunch. Shirley has served hotdogs several times to the students with milk allergies, so she does not read the label when she takes the hotdogs out of the packaging. Shirley then throws away the packaging. She prepares the hotdogs and puts them on the serving line.

Peter is taking out the milk to put it on the line for lunch. He realizes that the cafeteria is out of soy milk, which is usually served to the two students who have milk allergies. The list of appropriate substitutions for these students states to use soy milk or rice milk in place of cow’s milk. Peter decides that these students will probably be fine with lactose free milk as well, so he puts that on the line for them to take.

Obstacles are opportunities to expand our resourcefulness.

More Resources…

More Resources…

THANK YOU!!!