By Jan Hanson, M.A.
Way back when, food was eaten at lunch in a lunchroom. Now it’s everywhere in schools. Snacks, holiday parties, birthdays and celebrations—no day is complete unless it’s punctuated with scheduled or random acts of eating. For the food-allergic child, food is a big enough challenge when it’s just there to be eaten, a potential health threat and another opportunity to feel excluded from the mainstream of school activity. But more and more, school curricula seem to have become Food Channeled, and this presents food-allergic students with another set of challenges.
Consider these situations, presented by some of my clients:
Elementary school: a first-grader, with multiple, life-threatening food allergies, including to egg, participated in a classroom project to make gingerbread houses. Despite the fact that the parents reviewed their child’s allergies and what foods needed to be avoided with the teacher, she chose to use Marshmallow Fluff, which contains egg, for the snow. When the youngster was finished, he asked the teacher for permission to wash his hands. Her response was to say, “No”, and instead, suggested that he lick his fingers since he was working with food that many children like to eat. And so he did. Result: hives on his face within five minutes, which went unnoticed by his teacher, and anaphylaxis within fifteen minutes of his ingestion that required a hospital emergency room visit and treatment with epinephrine. A traumatic experience, both physically and emotionally, for this young student. A difficult situation for his classmates to witness, as well. Let’s hope, at very least, that it was a teaching moment for the teacher.
Middle School: an eighth grade boy, with peanut and tree nut allergies, was surprised when his French teacher announced there would be a cooking lesson that day. His written healthcare plan had procedures for him to be notified in advance of any project involving food. The student asked to read the ingredient labels of the foods being used, and was told that they had all been thrown out before the teacher had read them. When he expressed concern about his safety, her solution was for him to go to the library while the foods were prepared, and suggested he do the same the following day when the meals would be eaten. He reluctantly complied. Result: the potential for an allergic reaction was avoided by removing the student from the class, but this strategy didn’t allow the student his opportunity to benefit from this creative lesson, as it was for his peers. Not only was his reassignment to the library disappointing and embarrassing for him, but this type of segregation is, in fact, discriminatory.
High School: a sophomore with peanut allergy was informed during Chemistry class that the lesson that day would involve an experiment in which peanuts would be heated in order to investigate their properties. The teenager expressed concern for her safety in the event that peanut protein became aerosolized. The teacher, who had known that his student was peanut-allergic, hadn’t realized that the experiment might jeopardize her health. He decided to conduct a different lesson plan that day, and scheduled the experiment at a later date with a safe alternative. Result: The peanut-allergic student avoided the risk of having an allergic reaction, and with the exception of a delay, participated in an interesting and informative lesson along with her classmates.
These events highlight why there is debate and discussion about whether food should be used in a school curriculum. An article by Michael C. Young, MD, Anne Munoz-Furlong, and Scott H. Sicherer, MD, presented in a 2009 Journal of Allergy and Clinical Immunology, cited that of the children registered in the US Peanut and Tree Nut Registry, 79% of the allergic reactions occurred in the classroom, and usually from skin contact during craft projects. Although skin reactions are usually mild, there is always the possibility of transfer of the allergen from skin-to-mouth, which could result in a much more serious reaction, as was the case in the first scenario presented.
Food can undoubtedly serve to enrich a teacher’s curriculum and can be used in a variety of ways for lessons in art, science, math, history and culture. Food used for cooking can provide an engaging medium as well as cultivate valuable skills for managing one’s own life in classes like what used to be called home economics. If cooking teaches us anything, it’s that we can be flexible in approaches to problem solving. Any lesson that can be taught with food is larger than any single set of ingredients. Moreover, one of the hallmarks of any kind of cooking is that safety comes first. This should extend beyond the fact that fire can burn you to the safety of the ingredients themselves. My experience has been that students also tend to enjoy changes from a more staid lesson plan and find them to be refreshing and more interesting. But can food in the curriculum be managed safely for students with food allergy?
Yes, I believe it can. Following are recommendations that will help to insure these students can have a safe experience at school when it is determined that food may be beneficial to the educational program.
Be proactive and plan ahead. This can’t be stressed enough. It is critical that the appropriate amount of time is allocated to address food allergy management strategies well in advance of the first day of school.
All students with food allergies should have a written, individual healthcare plan that identifies procedures meant to reduce exposure to the student’s food allergens. This plan can take the form of an Individual Healthcare Plan (IHP) or a Section 504 Plan. When developed, it should be the product of a combined effort between the school nurse, the parents, and the child when appropriate. When completed, it should be reviewed in a staff meeting with all school personnel who have assigned responsibilities within the plan. All students with food allergies must also have a written treatment plan, should they experience an allergic reaction at school. Teachers and auxiliary staff responsible for their care should be trained to recognize the signs and symptoms of an allergic reaction and anaphylaxis, and be competent in emergency response, including the administration of epinephrine by auto-injector. This medicine should always be stored where it will be readily accessible.
A student’s food allergens should never be used in the curriculum, regardless of whether the child is in elementary, middle or high school. This requirement should be clearly stated in the student’s healthcare plan. It is reasonable for the parents of a child with physician-documented life-threatening food allergies, as well as for the students themselves, to expect modifications will be made to the curriculum to allow for their safe participation. If a teacher plans an activity believed to have sound educational value, then all students in that class are entitled to benefit from that program. Excluding a student from an activity for the sole reason that food will be used is never an option. This would be discriminatory, pure and simple, and the provisions found in Section 504 of The Rehabilitation Act of 1973 make this clear. Common sense should also make clear the fact that this approach shows little compassion for the student.
Projects where food might be involved must be given careful attention. If food is not essential to the curriculum, then it shouldn’t be used. An example of this would be when foods such as beans, pasta or nuts are used as a counting tool during a math lesson. If a non-food substitution will be just as effective to the lesson, then that should be the clear choice. When it is determined that food could enhance the curriculum, then the parents, and the student, when appropriate, are usually excellent resources. They should be actively consulted by the teacher to help find a safe food that would also allow for the integrity of the lesson plan to remain intact. This safe food choice should be used by all students in the class, not just the child with food allergies.
Parents are strongly urged to share with teachers the lesson most of them have already learned: never assume an item for consumption or handling is safe. School personnel are not always aware that food allergens may be “hidden” as part of the ingredients of items commonly used in lesson plans. For example, modeling dough may contain wheat, crayons may contain soy, pet foods often contain nuts, seeds, milk, wheat, and shellfish and rubber cement contains natural latex. Manufacturers may need to be contacted to confirm ingredients are safe. Ingredient labels should always be kept and read by the appropriate person(s), and all procedures followed should be consistent with the requirements written in the student’s healthcare plan/504 Plan.
Good Communication is essential between all individuals who will have direct contact with the care of the food-allergic student. That means between the parent-school nurse-teachers-auxiliary staff-the student, for example. The healthcare plan must be carefully reviewed by all involved, and school personnel must understand their role and responsibility in the implementation of the procedures outlined in the plan.
Education about the health condition of food allergy and its management in the school setting should be conducted by the school nurse or school-affiliated physician to all staff, and optimally to the entire school community. Information should be shared that exposure to a student’s food allergens can happen not only through ingestion, but also through skin contact, inhalation and cross-contamination. This knowledge will go a long way in helping to facilitate an understanding of why a student’s healthcare plan needs to be taken seriously, followed as written and never forgotten or ignored.
Without a doubt, the best results are accomplished when a strong partnership exists between the parents and school staff. Students who have food allergies are entitled to a safe school experience. With the appropriate education, a thoughtful, reasoned approach, and a coordinated and concerted effort, this can be achieved even when food is used in the curriculum.
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