Friday night I attended a 40-minute session on Children and Food Allergies in school. The session was focused on what educators need to know.
The speaker was Christine Szychlinski, who manages the Food Allergy Program at Children's Memorial Hospital in Chicago. She defined allergy as different from sensitivities or intolerances in that an allergy can kill someone, not just make them sick.
She also explained that there is no predictive testing available to tell someone what they will become allergic to. Skin testing has a 50 percent false positive rating. Blood-based testing can provide a 95 percent confident diagnosis but it's only available with milk, eggs, peanut and walnut allergies.
The biggest issues in schools are when there is a change in the routine of a normal school schedule. Field trips are often when children with allergies have issues. For some reason they think they can be less careful. She mentioned one study that a telephone survey of 132 children indicated that 58 percent of kids had a food allergy reaction in the last two years, 18 percent of those were in the school setting (Sicherer S JACI 2003). The largest issues in the classroom are due to cross-contamination and mislabeled or unlabeled foods (like when outside vendors offer foods to a class on a field trip).
As a teacher, I worry about food allergies a lot. I was worried that I didn't know enough on how to prevent cross contamination, because in a pre-school setting we provide snack, but also some of our exploration is or can be done with food. Szychlinski said she believes that no school really can ever be peanut-free. Not only does she think it's not a reasonable expectation, but it's also not what children will find out in the real world. If a parent demands a peanut-free school, ask them if they take their child to the shopping mall or to Target -- because no one sweeps in those places for peanuts, ever. What she did believe in was that no school should have food used in any part of their curriculum and that all food should be relegated to the cafeteria ONLY. That means, exploration with kids and cooking is out the window unless it's done in a school cafeteria or kitchen. But this is nearly impossible in most early education classrooms as most centers don't have a cafeteria. It's also difficult on some schools who have cafeterias that double as gyms (because the contaminates are always there and then gym class is indeed a dangerous place).
The big issue about curriculum is that classrooms should be safe environments where children learn freely. By keeping food entirely in the cafeteria, it allows the classroom to be a safe environment. It can also lessen the possibility of children with allergies feeling isolated or stigmatized by their allergies. In a larger setting, like the cafeteria, everyone is eating everything differently. No one notices if little Mackenzie never has a peanut butter sandwich. It can also lessen the possibility of bullying by classmates.
You may not think that's a big issue, but it is. In fact, children with food allergies are reportedly at a much higher risk of eating and anxiety disorders, and they often have a much higher rate of depression. She also supported the idea that the child has a "safety person" to go to in a school environment, if she is feeling anxious, is being bullied or is worried about an exposure, so that the child knows that this person will be able to set aside time to help her in privacy rather than in front of everyone else in the classroom.
Food allergies cannot be controlled by things like Benedryl. An epi pen must be used and after using it you must call 911. And when a child has been exposed to what they're allergic to, you want to do that as quickly as possible. Don't put it off. If a child has allergies and asthma and his or her breath starts to slow and become labored after eating, don't reach for the inhaler first, reach for the epipen. The inhaler won't save her life. The epipen will. Get over the fear of calling 9-1-1. It's better to call them and not need them than to not call and really need them.
In terms of preventing cross contamination, I learned that schools should never replace regular hand washing with using anti-bacterial hand sanitizer. It won't remove things like peanut butter from a child's hand. So if you have a child in class with an allergy, and a friend comes to school and only uses sanitizer and then touches something in the classroom that the child with allergy picks up -- you have cross contamination. Or maybe they do something as sweet as hug each other good morning or hold hands on the way to the playground...
However, using infant wipes, liquid or bar soap will all get rid of allergens on hands. Similarly when you wipe tables and chairs, cleaning sprays are perfect for getting rid of germs, but for some reason dish detergent does leave some allergens behind.
It is important for teachers and social workers to teach children of any age that if they think they've come in contact with something they're allergic to to stretch out their hands away from their body. A lot of children get upset when they figure out they've eaten something that could make them sick and tend to cry and rub their eyes or put their hands on their faces, which can make it worse. It's also helpful that if they're too scared to talk (like while you're waiting for the ambulance and a parent) to try and get them to sing. Some children find this easier and comforting. It's also important that during this time HELP COMES TO THE CHILD, the child does not go for help.
As an educator, the highest risk for cross contamination at school usually revolves around things like the drinking fountain. It's impossible to clean it enough.
Another helpful part of the session came regarding reading labels. I love how most things now have words like, "Contains: milk, egg and soy" on the nutrition label to make it easier to find dangerous ingredients. This is not required by law. There is no standard. However, I always wondered, when my own son's school went peanut-free three years ago what the possibility of contamination was with things labeled, "May contain eggs" or "Processed in a facility with wheat." Turns out that testing showed that on average, 10 percent of the foods labeled "May contain" or "Processed in a facility" had those other allergens on them. And seven percent of the foods had enough allergens that it would cause an adverse reaction in a child.
In addition, you have to understand what you're reading on the ingredient label. Whey is a milk... If a child has an allergy to tree nuts you need to understand what that means and have a list available to teachers. Restaurants are NOT covered in the labeling law. You can call and ask if items are gluten free and a manager might tell you they are, but he's not required by law to do so.
Mistakes happen all the time. The speaker brought up a story about how a mother who sent her child to school every day with a salami sandwich, but this particular day she accidentally grabbed the lowfat version of her brand and didn't notice. Turns out it had milk in it (why salami had dairy in it is a whole different stupid food issue) and her child had a reaction to the sandwich he ate every day. The cafeteria supervisor was able to call the nurse who brought the epi pen and dialed 911. They treated the symptoms as they saw them and the boy was fine.
As a teacher/school employee, it's important to double check the expiration on all of your students' epi pens and make sure that parents keep them current. It's also important that teachers and administrators know where those pens are (especially when substitutes come in). It's important to have an epi pen drill the same way you have fire drills, where someone in the school walks up to a teacher and says, "Bobby is allergic to peanuts his face is swelling." The timer starts and the teacher has 5 to 7 minutes to get the epipen, use it (or assist/watch the student use it if he/she is old enough to self administor) and dial 9-1-1. If you can't do that in 5-7 minutes, you need to train and retrain. School staff should retrain on how to use epis when they do their CPR/First Aid certification every two years.
I have a lot of children in my life with severe food allergies. I love them dearly and I'm more prone to excluding food from the classroom and making sure that all of my students are eating snacks that the child with allergies can eat (in order to avoid the idea of isolation, special treatment or difference). But I have to admit, I look forward to using food in the classroom as a way to let my students explore. I do know that whatever activity I might use it must be safe for everyone in the classroom. But I do appreciate the reason and concept between the no food in the curriculum rule. I also know that even though my child's pre-school is peanut-free... that most parents don't follow that rule. This year, X-man has often had chocolate candies and such in his eggs at egg hunts or given as Valentine's. In years past, the teachers would check the candy before we brought it in and always check the food labels.
And I do support the idea that no unlabeled food should ever enter the classroom -- that is, no home baked snacks. I'm going to go with the DCFS rules on this one. But I do wish that was the rule at big kid schools, too. I know people like to bake, and as a teacher, I love to eat what you bake, but really, I so don't want to administer an epi pen because a parent forgot she used eggs in a recipe and Jayne ate some and is now on the way to the emergency room scared to death while her parents race across town to meet her ambulance there. That's not a happy birthday for any one.
The surprising statistic of the day--10 years ago, children who were lucky to outgrow their food allergies did so by the time they were five. Now, a majority of children who somehow outgrow their allergies do it by the time they're 18. Know one knows why the instances of food allergies are increasing or how. There are no cures for food allergies.
The only way to prevent negative events is through AVOIDANCE.
And I'm all about avoidance when it comes to something that can kill.