By Gina Mennett Lee, M.Ed.

The number of children with food allergies in the United States is now estimated to be 1 in 13.  This means there are approximately 2 children in every classroom with food allergies.   That number is especially alarming given that children with food allergies can be at risk for having a life-threatening reaction called anaphylaxis.  As a classroom teacher, you spend the greatest amount of time with your students, aside from their families.   You are also most likely to be the person who will first need to respond should a reaction occur.   As a matter of fact, in a study of MA epinephrine use in schools, 45% of symptoms developed in the classroom.  See graph below:

Hopefully your school has implemented a plan for the management of children with food allergies that is consistent with the newly released CDC guidelines.  Whether this has occurred or not, there are still many things you can do as a classroom teacher to ensure that children with food allergies can fully and safely participate in your classroom.   (Please note that older students should be active participants in the management of their food allergies.)

Below are some simple, common sense measures you can implement to ensure that children with food allergies are safe and included in your classroom.

1.    Create a positive climate by fostering an understanding about food allergies.   All eyes are on you and people will follow your lead.  This includes children, parents, and other school employees.

• Students: It is important to note approximately 50% of children with food allergies report being bullied (31.5% of children with food allergies are bullied specifically due to their allergies).  Consider doing a lesson about food allergies with your students.  There are books and videos available for this use.

• Other Parents: Speak in a positive manner when discussing food allergy management in your classroom.  I overheard a teacher making a negative comment about a new classroom food allergy policy at a parent night.  As a result, other parents began to discuss food allergies in a negative manner.  This fostered an atmosphere of resentment rather than support. Be aware of how powerful your words and actions are to those around you.

2.   Reduce the risk of accidental exposure

• Recycled food containers: Are there any food containers being used in your classroom?  If so, get rid of them.  Trace amounts of allergens can be found in these containers.  Even if there were a way to be absolutely sure there were no allergens in the container, it is unsettling for a child to have to use a container of a food he/she has been told not to touch.

• Soaps and Lotions: Do you have soaps or lotions for use in your classroom?  Check the labels for allergens.  Parents of children with food allergies are a good resource and are often happy to help with this.

• Art & Craft Supplies: Check the labels for each item to ensure they do not contain allergens.  This may require a phone call to the manufacturer as craft labels are often more difficult to read.   FALCPA (food allergy labeling law) does not apply to these products.  Enlist the help of the parent to the food allergic child.  They may have already checked these products or may be willing to help.

• Other Classroom Supplies: Go through additional classroom supplies including items such as science experiments and games to ensure they are free of allergens.

• Food storage:  Where are lunches and/or snacks kept?  Can they be kept in an area that is separate from the learning environment?  Children with food allergies may need a special spot to keep their food that is away from the other foods in order to avoid cross-contact (separate cubby or locker).

• Hand washing:  It is recommended that children wash hands before and after eating.  Both soap and water, and commercial wipes are effective at removing allergens.  (Please note that hand sanitizers do not remove allergens.)

• Birthdays, Rewards & Classroom Celebrations: It is recommended that you avoid using food as a rewards or for celebrations.  This will significantly reduce the risk of accidental exposure.  There are additional benefits to this as well.  Children will not associate all fun with food.

• Food in the classroom:  The safest and easiest option is keep classrooms free of food.  This will automatically reduce the risk of accidental exposure and it has no impact on other children.  It also allows you, as the classroom teacher, the ability to focus on learning rather than food allergy management.   Realizing that this may not always be a possibility, I have created a chart of accommodations needed if food is present in the classroom.

ACCOMMODATIONS NEEDED

 If you or your students eat breakfast, snacks, or lunch in the classroom, there will need to be a system in place to monitor the food being eaten to ensure that they do not contain allergens.  The CDC guidelines recommend that no allergens be present in the classroom.   (If the foods the children are eating are being sent in from home and NOT shared, you may be able to provide a list of “safe snacks” for the other parents in the classroom.  It is important to note, however, that labels and manufacturing practices can change at any time.)   The CDC guidelines also recommend that children wash their hands before and after eating and that all eating surfaces be cleaned.

Do not serve food to any child without the parent’s knowledge and consent.  Gone are the days when you could surprise the class with some homemade cookies.  There are too many risks associated with this, and many other food-related health issues affect children beyond food allergies.  Make it a rule not to serve food without parent knowledge and consent.  Even if you “know” the food is safe, please get permission before serving.  For example, a child with a milk allergy can safely eat watermelon.   However, if the sponge the person used to clean the cutting board for the watermelon was also used to wash a cup that contained milk, there now could be milk proteins present in the watermelon due to cross-contact.

 3.    Communicate: 

• School Nurse:  If you are fortunate enough to have school nurse available, speak with him/her about food allergies in general and about the specific needs of the children in your class as soon as possible.  The sooner you are able to do this, the more time you will have to prepare your classroom.

• Past teachers: Talk to the teacher the child had the previous year to discuss strategies that worked well.

• Parents/Guardians of Child with Food Allergies: Meet the parents/guardians before school starts to discuss their child’s needs.   Make communication a priority when dealing with the parents/guardians of a child with a food allergy. They will be extremely appreciative.  As an added benefit, they can help you.  Caring for a child with food allergies is a big responsibility and one that they fully understand.

• Other parents/guardians of children in your classroom: It is considered best practice to not have the child’s allergens in the classroom.  Typically, the school nurse, principal or classroom teacher will send a letter home to classroom parents asking that food containing specific allergens not be eaten in the classroom.  If snacks are consumed in the classroom, it can be helpful to create a list of safe snacks to send home to parents as well.  However, please keep in mind that labels and manufacturing practices can change at any time. Some schools have opted to have only fruits and vegetables for snack time.   The parents of children with food allergies may be willing to offer suggestions for a safe snack list.

• Be sure to respect the child’s privacy.  It is the law. It’s important not to use the child’s name or give details of the child’s medical history without permission from the parent.

• Substitute teachers : How will you communicate the needs of the child with food allergies to substitutes?  Will it be in your sub folder?  How will you ensure that the sub reads it?  Will there be a specific sub assigned to your classroom that has been trained and is aware of the needs of the children in your class?

• Special guests: Whenever someone comes into your room, there is a risk that they may bring something unexpected.  For example, a parent volunteer may walk in with a coffee that contains milk, or a guest speaker may bring in a craft supply that contains an allergen.  Do as much planning as you can in advance.  Discuss guests with the parents of the food allergic child, when possible.  They may be able to anticipate potential risks.   (If the child is old enough, you may discuss it with the child directly.)  Be prepared to respond if someone does bring an allergen into the classroom.  Some teachers post signs outside the classroom as a reminder that the classroom is allergen-free.

• Field trips:  Again, communicate with the child’s parents/guardians in advance of the trip.  Some things you can prepare for and others you cannot.  The child with food allergies should always be with a chaperone who is trained and has immediate access to the child’s medication.  It’s also good idea to travel with wipes and keep them with you at all times.  It can be helpful for unexpected clean-ups and hand washing.  Always offer to allow the child’s parent to attend field trips.

4.    Be prepared to respond should a reaction occur

• Training: Have you been trained to recognize the symptoms of an allergic reaction?  Do you know how to respond?   Do you understand the child’s Food Allergy Action Plan/Emergency Care Plan?  Do you know who is repsonsible for administering the epinephrine?  If you are responsible, have you been trained and are you comfortable using the epinephrine auto-injector? Do you know who is responsible for calling  911 and what to say?  (If not, discuss creating a 911 script with your school nurse and/or principal and post it near the phone and keep it with emergency communication devices when away from the classroom.)

• Emergency Communication: Do you have a way to directly contact emergency services at all times during the school day?  (This includes recess and other times you are not in your classroom.)

• Medication:  Where will medication be kept?  Is the child old enough to self-carry?  If not, will the medication be kept in your classroom?  (One suggestion is to hang a zippered pouch from a hook that is too high for children to reach but easily accessible to adults.)

• Don’t be afraid to use the epinephrine auto-injector.  It will save the child. It will not hurt them.  If state law/regulations and local policy allow you to administer epinephrine, ask your school nurse if there is an opportunity to try administering an expired epinephrine injector it into a grapefruit.  This will allow you to experience how a real auto-injector feels.  Depending on the type of auto-injector the child is prescribed, it can feel quite different from the trainer.

5.  Be confident.  Once you have implemented these strategies, you should feel confident that you can provide a safe and welcoming environment that will allow all of your students to grow as learners and as people.

I have created a FREE checklist for managing food allergies in the classroom.  

* * Data taken from The Management of Life Threatening Allergies in School: Lessons Learned from Massashusetts  By Michael Pistiner MD, MMSc and Anne H. Sheetz RN, MPH, NEA-BC.  

Thank you to Julia Verillo, B.A. Elementary Education (3rd grade teacher in CT), and Tina Stewart, M.Ed. (3rd grade teacher in MA) for reviewing this article.

Resources:

Food Allergen Exposure in the School Setting

The Management of Life Threatening Allergies in School: Lessons Learned from Massachusetts, Epinephrine Administration in Schools Brief Summary

Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs