Nurses Offer Advice for Life-Threatening Food Allergies and School Safety
The National School Boards Association (NSBA) has issued a guide for school districts to create policies that will help to keep children with life-threatening conditions, such as asthma, diabetes, and food allergies, safe. Anne L. Bryant, Executive Director of the NSBA, strongly recommends that school administrators proactively develop policies and practices for the success and well-being of all children.
The NSBA notes that “Safe and School and Ready to Learn: A Comprehensive Policy Guide for Protecting Students with Life-Threatening Food Allergies” does focus on only one aspect of children’s health, but that the recommendations are applicable to other chronic health conditions.
Brenda Z. Greene, Director of the School Boards Association, and Amanda K. Martinez, Project Associate for Coordinated School Health, note in the Preface that there is an increase in the prevalence of food allergies among school children, and extra education and training for school personnel is necessary to keep children safe. The “Safe and School and Ready to Learn” policy guide addresses elements within the Food Safety and Modernization Act of 2010 that will benefit districts and school administrators in creating a comprehensive plan and a coordinated approach within their schools.
Estimates suggest that one in 25 school-aged children suffers from a food allergy and that complications result in an average of 317,000 ambulatory-care visits per year in children under the age of 18. Children with allergies are at greatest risk for life-threatening anaphylaxis. The eight types of foods that are responsible for the majority of allergic reactions (more than 90%) are milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat.
A comprehensive policy for the management of life-threatening food allergies in school and school-settings must address the following essential elements:
• Identification of students with food allergies and provision of school health services
• Individual written management plans
• Medication protocols: storage, access, and administration
• Healthy school environments: comprehensive and coordinated approach
• Communication and confidentiality
• Emergency response
• Professional development and training for school personnel
• Awareness education for students
• Awareness education and resources for parents/caregivers
• Monitoring and evaluation
The 58-page guide goes into detail for components of a plan for each of these essential elements. Some examples of procedures schools should have in place include:
• Systematically collecting information about the health of all students, including information about allergies. Periodically review health files throughout the year to ensure they are up-to-date.
• Have a team available that includes the school nurse, the principal, the student’s teacher, the parents and the student (if age-appropriate) to map out an individualized plan for what needs to be done should an allergic reaction occur. Maintain open and on-going communication between all members of the team.
• Ensure that all students with prescriptions have these available during the school day. Monitor medications for expiration dates. Consider obtaining a standing, non-patient specific order for epinephrine from a physician to be administered in an anaphylactic emergency (if allowed by law).
• Within the classroom, limit or reduce the presence of identified allergens. This includes school-provided snacks and parent-provided treats (such as cupcakes for another child’s birthday party.) Implement appropriate hand-washing procedures, as the use of hand sanitizers is not effective in removing the residue of known allergens.
• In the school cafeteria, enforce the responsibility of food service staff to review menu items and make appropriate accommodations. Be vigilant of “food bullying” and intervene where necessary.
• Remember that exposure to allergens can also occur on the playground, on school buses, during field trips, and during after-school activities.
• When training school personnel, remember to include signs and symptoms of food allergies, as children who may not be aware they have them may describe the sensation differently than adults. Kids may describe their tongues as being “hot” or “itchy”, their lips as being “tight”, or that they have “bugs in their ears”. Also note voice changes, as children may begin to sound hoarse or squeaky during a reaction or may slur their words.
National School Boards Association - “Safe and School and Ready to Learn: A Comprehensive Policy Guide for Protecting Students with Life-Threatening Food Allergies”
The Food Allergy and Anaphylaxis Network - “How a Child Might Describe a Reaction”