A Little Bit Can Hurt (17 page)

Q: Individuals with multiple food allergies (e.g., milk and soy) and children with food allergy who also happen to be picky eaters face significant challenges in maintaining well-balanced nutrition. What advice can you offer? Is there a resource to which food-allergic families and individuals can refer for nutritional requirements and food substitutions?

A:
The Academy of Nutrition and Dietetics is my main source of research-based nutrition information.

The Food Allergy and Anaphylaxis Network (FAAN) is another terrific resource. They are in the process of merging with the Food Allergy Initiative (FAI) to form a new group, FARE - Food Allergy Research & Education. The mission is to ensure the safety and inclusion of individuals with food allergies and relentlessly search for a cure. The website,
www.foodallergy.org
, offers families up-to-date information in the management of food allergies. They also connect families with local support groups.

CSA Gluten-Free Resource Directory (
www.csaceliacs.info
) is an excellent resource for living gluten free.

There's a neat book out by Ellyn Satter that I encourage people to read,
Child of Mine: Feeding with Love and Good Sense.
It's such a good resource for families who have any sort of food battles with their kids. Her discussion around parental responsibility versus a child's responsibility around food and fueling is interesting and thought provoking. She's a dietitian but also has a master's degree in counseling.

Q: For what symptoms should a parent or food-allergic individual remain alert regarding nutritional deficiency?

A:
I think the biggest issue with most food-allergic kids is making sure that they are plugged into their pediatrician yearly so that they're really on the
growth chart. Pediatricians pick up those early signs. As long as your child is developmentally okay and is growing just fine, nutritional deficiency is probably not an issue.

Q: How do you assist patients on an elimination diet?

A:
An elimination diet is a method of identifying foods that an individual cannot consume without adverse effects. Adverse effects may be due to food allergy, food intolerance, other physiological mechanisms or a combination of these. These diets typically involve entirely removing a suspected food from the diet for a period of time, perhaps weeks or months. The approach relies on trial and error, and I encourage individuals to do it under the guidance of their physician or healthcare provider.

Q: It can be difficult to think positively about food allergies given the inherent danger associated with them. What encouragement can you offer to food-allergic individuals concerned with their nutrition and health?

A:
If there's a silver lining to the whole challenge that families face with food allergies, it's that by virtue of the allergy, you're forced to get smart about what you're doing with regard to food and fueling. I applaud the families that come in to see me. This is actually a gift to the whole family. Some of the pitfalls that are really driving health in the wrong direction can be avoided by families who say, "Wait a minute. Let's step back here and take a look at what we're doing. For whatever reason, we've been handed these cards. How can we make the best of it?" By focusing on improving nutrient density, by and large your children are going to be eating better than most other children. Having the entire family focused on healthier eating and exercise is the goal I have for all families I counsel.

Section 7

EDUCATORS

P
rincipals, educational directors, childcare providers and teachers are experiencing a growing number of children entering their schools and programs with food allergies. Communicating with parents of food-allergic students and obtaining all necessary medications and medical forms is of paramount importance. Creating a balance between protecting and isolating a child with food allergies can be challenging. In addition, the job of educators and caregivers to provide a safe learning environment for all children, recognizing the rights of both food-allergic and non-food-allergic students, is becoming increasingly difficult. Many schools and programs find it benefits all students to incorporate food allergy in the educational curriculum.

Section Seven interviews three educators who share their collective wisdom on the following topics:

• The management of food allergies in a school and childcare setting;
  
• Food allergy policies and training;
  
• Classroom and cafeteria safety procedures;
  
• Treatment of allergic reactions at school and childcare;
  
• Field trip protocols;
  
• Communication with parents;
  
• Student education and awareness;
  
• The establishment of a food allergy action plan for each food-allergic child; and
  
• Learning experiences and industry resources.
  

Chapter 19

CECELIA PFEFFER

Title: Director, The Learning Tree Child Development Center

Question: What procedures and protocols do you have in place to protect food-allergic children in your care?

Answer:
We do not serve peanut butter in the center; we offer soy butter instead. Classrooms with nut-allergic children are nut free. Children who are allergic to milk are given an alternative milk product, such as soy milk, which is provided by their parents. If children have any other food allergies, parents will tell us which snacks, if any, their child may not have. In this case the parents bring in a substitute food. In the younger classrooms where a child might grab another child's food, children may be placed in a highchair or a table separate from the other children. Children and staff in all classrooms wash their hands before and after lunch. All food, bottles and sippy cups coming into the center from home must be labeled with the child's name. The teachers are aware of the children in their classrooms with food allergies and keep this in mind when having lessons with food items, during special parties and when other parents are bringing in special treats for the class.

Every classroom, the office and the kitchen have Allergy Alert Posters posted in them. This poster identifies the child's name, the classroom, the specific food allergy, parents' emergency numbers, whether there is an epinephrine auto-
injector, its location, and a reminder to call 911 first and then the parent if the epinephrine auto-injector is administered. Whenever a child with a food allergy enters a new classroom, we review the plans with the classroom staff. This may be in the beginning of the school year and/or anytime during the year.

Q: What resources are available to assist childcare providers in developing food allergy protocols?

A:
The Office of Child Care has a Food Allergy Action Plan that physicians and parents are required to complete. It is the form that FAAN created.

Q: What food allergy training do you provide for your staff?

A:
We have discussions with the teachers in each classroom that has food-allergic children. The discussions include the specific food allergens to be avoided, the symptoms the child may exhibit if the allergen is ingested and what to do if this occurs. We also review each Food Allergy Action Plan with the staff. Eleven staff members have Medication Administration training and are trained in the use of epinephrine auto-injectors.

Q: Are there particular challenges to managing food allergies in a childcare setting? If so, please elaborate.

A:
The only challenge that we have had is occasionally we have parents who do not think it is fair that their child cannot bring peanut butter and jelly sandwiches for lunch. We have to explain to them the seriousness of the situation if the food-allergic child is exposed to the allergenic food. So far cleaning or dealing with the kids has not been a challenge. The tables are cleaned with soap and water and then sprayed with a disinfectant. The children are okay with not bringing in PB or nuts, etc. In the preschool classes, ages three and four, we teach them about food allergies.

Q: Do the food-allergic children in your care have special emergency action plans? If so, what do those plans entail?

A:
Yes, we provide the Food Allergy Action Plan from the FAAN website to parents with the enrollment forms when they enroll their child. We ask them when they enroll their child if they have any food allergies. We discuss our protocols with the parents at this time to make sure they are comfortable with them.

The detailed plans are completed by the child's doctor and signed by both the doctor and the parent. We keep the action plans with the Benadryl
^®
and/or epinephrine auto-injectors in the cabinet in the classrooms. The cabinet is unlocked but out of reach and accessible only to staff. I also have a copy of the plan in the child's file in the office.

We do post an allergy alert in each classroom. I want all staff to be familiar with which classrooms have the children with food allergies.

Q: What do you believe are the responsibilities of the food-allergic child's family in managing his/her food allergies?

A:
The parents need to get the Food Allergy Action Plan completed and provide alternate foods when something is being served that their child cannot have. All parents need to label their children's food. They also need to keep several safe snacks for emergencies. I give them packages of the food we serve so that they can read the labels. They then let me know what they want their child to have and which foods we should replace with an alternate food. Parents of two-, three-, and four-year-old children are asked to encourage their children not to share or trade food. The parents also need to provide us with a list of foods the child must avoid.

Q: Is there a particular experience or individual that helped raise awareness about food allergies in your professional setting? If so, please explain.

A:
Yes, a particular child's mother was the person responsible for making me aware of food allergies and the seriousness of them. She also provided me with many resources including the contacts for setting up our initial training.

Q: What recommendations do you have for parents who are searching for a childcare facility to meet the needs of their food-allergic child?

A:
If you do not feel comfortable with the food allergy policy of a childcare facility then keep looking until you find a childcare facility with which you are comfortable.

Chapter 20

SUSAN ROSENDAHL, Ed.D.

Title: Pre-School Division Head, The Key School

Question: Please detail the policies and protocols you have in place to manage the safety of your students who have food allergies.

Answer:
As part of the enrollment process, parents complete a Food Allergy Action Plan: Emergency Care Plan for any child with life-threatening food allergies. This form is signed by the child's physician. Before the school year, parents often meet with the school nurse to discuss the plan. The school nurse meets with preschool faculty during the faculty meeting days prior to the first day of school. At this meeting faculty learn about the unique medical needs of "at risk" students, and they are trained in the administration of an epinephrine auto-injector.

The preschool is a nut-free environment. No food is provided for children without a parent's consent. Preschool students bring their morning snack and lunch. Tables are disinfected throughout the school day.

Preschool students learn about food allergies through hands-on, developmentally appropriate "Life Skills" lessons taught by the school nurse. Lessons taught incorporate literature, puppets and role-play so that young children can concretely experience the concept. Practice with classmates through play in the
Dramatic Play center of the classroom allows children to develop deeper understandings.

Q: What do you need from the parent of the food-allergic child?

A:
We encourage open communication throughout the school year. The preschool faculty is committed to a close, collaborative partnership with each student's parents. The safety and well-being of each student is a priority. Parents are required to provide the school nurse with all prescribed medications including epinephrine auto-injectors.

Q: How are snack time and class celebrations of birthdays and holidays handled?

A:
Pre-K and Kindergarten students bring their snack from home. A nutritious snack is recommended, and parents often receive snack ideas from the Health Office. Candy and chocolate are not allowed.

Holiday celebrations such as Halloween, Celebrations of Learning, Valentine's Day and End of Year Picnics may include food. Teaching teams decide about the items needed for a party and make a list that includes enough items for each child to contribute one of the items. If there is a child with a food allergy in the classroom, that parent is consulted before the list is posted for the entire grade level.

Birthdays are celebrated at snack time, but the children have their regular snack from home. The birthday child wears a special crown, is sung to and receives a birthday book made by his or her classmates. At the preschool's monthly community meeting, teachers and students with birthdays during the month are asked to stand so that the community can sing a birthday song to them. Each child with a birthday during the month receives a rainbow "Happy Birthday" bracelet.

Q: Do you stock epinephrine in the event a child suffers a severe allergic reaction in school but does not have an epinephrine auto-injector?