For parents of children with food allergies, school can sometimes seem like a minefield, with danger lurking everywhere.
It’s not just the peanut butter and jelly sandwiches that pop out of lunchboxes in the cafeteria. It’s the constant stream of food in the classroom, for snacks, parties, rewards, and even crafts like paper maché planets or peanut butter bird feeders.
Colorado Springs parent Katie Prichard knows the feeling. Her kindergarten daughter is allergic to peanuts, eggs, soy, sesame, green peas and apples, and while Pritchard is very pleased with the precautions in place at her charter school, Rocky Mountain Classical Academy, she said there are always worries. Sometimes about safety and sometimes about her daughter’s inevitable sense of being different.
“At school you should get to be like your friends…to have equal access to your classroom,” she said. “It’s kind of a barrage for a young kid in kindergarten.”
Pritchard, who leads Colorado Springs Mosaic, a group for parents of children with severe food allergies, said despite the challenges, she believes schools are moving in the right direction when it comes to accommodating food allergies.
“I’ve heard so many struggles other parents had before I came along,” she said “I definitely feel like things have improved.”
Kathleen Patrick, assistant director of student health services at the Colorado Department of Education, agreed, saying state laws and policies have enabled several key measures, such as allowing students to self-carry epinephrine auto-injectors, ensuring school districts have allergy policies and educating school staff about allergies.
Today, about 8 percent of children have food allergies, an average of two per classroom.
Patrick said when she was a school nurse years ago, she sometimes heard stories about school staff not taking a student’s food allergy seriously.
Today, she said, “We’re on the right road in terms of the education and getting the information out there…I think food allergy awareness is very high.”
Nicole Smith, co- founder of the AllergicChild website and mother of a teenage son with food allergies, said the landscape for Colorado students with food allergies can vary depending on their school and district.
“Even within a school district you can have different levels of awareness,” she noted.
Patrick said sometimes the successful dissemination of food allergy information can hinge on how school nurses are deployed in a district. Compared to schools with a full-time nurse, there may be less overall awareness about allergy precautions, not to mention fewer trained staff members to administer epinephrine injections in an emergency, in schools where nurses work part time because they cover multiple buildings.
Another factor in how schools and districts measure up, she said, can be the presence of a parent, nurse or other staff member who serves as a champion for food allergy awareness and preparation.
Despite the differences between schools and districts, state policies and resources have created some uniformities in the last several years. Under a state law Smith helped pass in 2009, school districts are required to have policies to accommodate students with food allergies.
In Academy School District 20, which has a Food Allergy Task Force and is widely considered a leader on food allergy issues, the district’s five-page policy weighs in on food allergy issues large and small, from training staff to choosing field trip chaperones. (It’s recommended that parents of students with food allergies get preference.)
“Academy School District 20 is amazing, just plain and simple,” said Smith, whose son attends high school there. “They have long looked at the safety of every child.”
Often, food allergy measures depend on the number of students with food allergies at a school, the severity of their reactions, what precautions are requested by parents and what is deemed feasible by administrators.
For example, at some schools cafeteria tables are set aside for students with food allergies and there are strict rules about sanitation procedures as well as hand-washing guidelines for students. This is the case at Ralston Elementary in Golden, where peanut and tree nut products are banned in all classrooms, but are permitted at designated cafeteria tables.
Even when schools have comprehensive plans in place and staff are attentive, allergens sometimes slip through the cracks. Patrick started tracking the number of students who experienced anaphylaxis and needed epinephrine at Colorado schools in the 2011-12 school year.
There were about 30 cases reported that year, and so far this school year, there have been 24. The causes include students sharing food, which is prohibited at most schools, but can be hard to enforce. In one case, a parent brought in cupcakes containing peanut products after signing up to bring something else. In another, a student with a latex allergy touched a balloon while she was helping decorate a friend’s locker.
“You can be as careful as possible and something may still happen,” Patrick said.
House Bill 13-1171
In case something does happen, many in the food allergy community are hoping that a bill currently under consideration in the legislature will lead to additional potential safeguards for children with allergies. Bill 1171, also called the stock epinephrine bill, would allow schools to keep epinephrine auto-injectors on hand for trained staff to use on students experiencing anaphylaxis even if they don’t have their own prescription.
The idea is to allow teachers or other school staff to immediately curb a life-threatening reaction during the crucial minutes before paramedics arrive. In part, the measure would protect students who have undiagnosed allergies that are triggered at school.
“Twenty-five percent of first-time [allergic] reactions occur in the school setting,” said Jennifer Jobrack, director of major gifts and regional advocacy for Food Allergy Research and Education, a national advocacy group.
Christianna Fogler, principal at Rocky Mountain Classical Academy, knows firsthand how that scenario plays out. Last fall, a first-grader at the school’s elementary campus came in from the playground and began experiencing anaphylaxis. The girl had no known allergies but her throat was closing and her breathing was labored, said Fogler, who will testify before the state Senate in favor of Bill 1171 this week.
After school staff called 911, paramedics arrived in just a couple minutes because they happened to be at a building down the street. They treated the girl, who may have reacted to a bug bite, and she recovered.
Fogler, who worries about what would have happened if the paramedics had taken 10 or 15 minutes to arrive, said the bill would empower school staff to do the right thing without worrying about liability or other legal issues. The school already trains all teachers, substitute teachers and lunchroom monitors how to recognize anaphylaxis and administer and EpiPen.
Currently, 17 states have laws covering stock epinephrine in schools, though the language and requirements range widely. Only Nebraska, Virginia and Maryland require schools to stock epinephrine auto-injectors. In most states, as would be the case in Colorado, the practice is voluntary.
Among the objections to the law are the expense of the auto-injectors, which typically cost $180 for a two-pack, and the extensive training needed to ensure school staff besides the nurse know what anaphylaxis looks like and how to use the auto-injectors.
Jobrack noted that Mylan Speciality, the distributor of EpiPens, has a program providing free and discounted EpiPens to schools, and that her organization has training resources available.
Trends toward protection and prevention
As a result of the Americans With Disabilities Act Amendments Act of 2008, students with severe food allergies are also increasingly getting 504 plans, which provide children with disabilities accommodations to fully participate in school.
Holly Camp, administrator for food service operations for JeffCo Public Schools and a registered dietician, said she helped execute the first food allergy-related 504 plan in 2009. Today, about 50 students in the 85,000-student district have such plans, usually because of allergies or intolerances to gluten, dyes or casein, a protein found in milk.
As part of the plans, the students’ parents, physician and often the school nurse make a list of accommodations, which may range from using extra sanitizer at the student’s lunch spot to allowing them to be first through the cafeteria line to ensure their food is prepared and wrapped first.
Patrick believes the increasing use of 504 plans for food allergies is a good development. In addition to helping individual students who have the plans, it can raise awareness overall, she said.
“What they are doing for one, they will very often understand that it’s important for another student with a recognized food allergy,” she said.
Smith, of AllergicChild, said another encouraging trend she’s noticed is that school wellness initiatives aimed at reducing obesity are being coupled with efforts to reduce allergy risks. Thus, many schools are getting away from using food as rewards or as the focal point of class parties.
For example, a few elementary schools in the Thompson School District in Loveland adopted regulations this year eliminating edible treats for student birthdays and sometimes communal snacks where every child gets a portion from a large box of crackers or cookies. Wellness coordinator Kathy Schlepp said the changes came because school staff were trying to respond to food allergy concerns and also “the extra calorie piece.”
The district’s wellness plan, which is currently being revised, will also include some version of these restrictions next year.
“It will definitely be trying to cut down on unhealthy classroom snacks or treats,” she said.