1. Working Together to Accommodate Special Dietary Needs Linda Krueger, SNS, Nutrition Program Consultant November 4, 2008

2. Learning about the nature and severity of the child’s special dietary needs and working together to provide what’s best for the child should be the major focus.

3. Children with a Disability Schools must make substitutions of foods in the reimbursable meal for students who have a disability that restricts their diet.

4. Under no circumstances are school food service staff to revise or change a diet prescription or medical order.

5. Keep lines of communication open!

6. Special Diet Management Team DOCTOR PARENTS SCHOOL/AGENCY ADMINISTRATION SCHOOL NURSE TEACHER SCHOOL FOODSERVICE STAFF

7. Making Everyone More Comfortable From the Start Invite the student and parents to tour the school kitchen and cafeteria before school starts and meet with staff to inquire about policies currently in place regarding food allergies. Discuss with parents how to best handle the identification of their child, to ensure they receive appropriate meals. Reinforce to the parents how important it is for the child to know his or her potential food allergy triggers and identifying them to school staff. Find out if the child has a medical bracelet or necklace that identifies the specific allergy. Provide parents an open invitation to join their child for breakfast/lunch during the school year.

8. Causes of Accidental Exposures Not reading ingredient label to be sure food is allergen-free Food trading Inaccurate labeling Contamination from other foods from improperly cleaned utensils and table surfaces

9. Managing Food Allergies in the Cafeteria (Food Allergy & Anaphylaxis Network) Know what to avoid and what to substitute Read labels Prepare the kitchen Identify the student Develop cleaning procedures http://foodallergy.org/school/cafeteria.html

10. Food Safety and Sanitation Concerns in Dealing with Special Diets Prevention of cross-contamination by a known food allergen with other food items that will be served to a child with a documented food allergy. Cleaning of any special equipment used for modifying food. Transporting of food items. Holding time of food items (both hot and cold). Handling of any previously cooked food items (i.e., reheating). Prolonged feeding/service time. Special feeding devices (cleaning, sanitizing and storage).

11. SCHOOL FOOD SERVICE RESPONSIBILITIES: The School Food Allergy Program The Food Allergy & Anaphylaxis Network 1)Understand the basics of food allergies 2)Meet with parents and learn about the special diet 3)Get signed medical statement from doctor 4)Learn how to read labels 5)Establish an allergy-free zone in the kitchen 6)Develop strategies for accommodating a food-allergic student 7)Consider how to identify students with special diet needs 8)Know the Emergency Plan of Action 9)Understand the differences between food textures 10) Meet with the School Nurse and if necessary the teachers to insure everyone’s understanding of the diet 11) Assist in training staff as to how to accommodate special diet needs 12) Ensure that there is no cross contamination between foods, equipment, food trays, etc. 13) Ensure proper sanitation procedures for preparation and service of special diet meals

12. DAILY MANAGEMENT: Kitchen: Use Parents expertise in managing child’s food allergies Read ingredient labels for all foods Learn to recognize the synonyms for foods that commonly cause allergic reactions Designate one or two people to be responsible for special diets… BUT TRAIN EVERYONE Create a separate storage space for allergy-free foods Create a separate preparation area for preparing allergenic foods Avoid cross – contamination Communicate with the serving line staff. Communicate with the school nurse and classroom staff Encourage thorough hand washing Understand the emergency plan and be prepared to act on it!

13. Daily Management (continued) Cafeteria: Make sure cafeteria tables are cleaned and sanitized Avoid cross – contamination Communicate with the school nurse, classroom staff and kitchen staff Learn to recognize the synonyms for foods that commonly cause allergic reactions Discourage food trading Encourage thorough hand washing Identify students with special diets in a way that does not compromise their privacy. Learn to recognize symptoms of an allergic reaction. Be prepared to intervene in case of harassment. Understand the emergency plan and be prepared to act on it.

14. Always Be Prepared The school needs to make sure that a plan is in place should the child have an adverse reaction at any point during the school day (i.e., allergic reaction, choking, diabetic reaction, etc.) Until there’s a cure…education is the key. Food Allergy Network, 2005.

15. Classroom Issues Eating and/or sharing food in the classroom Food used in class projects, celebrations & activities Designated “allergen free” areas Who cleans desks, chairs, tables, etc. and how Peer education about food allergies Confidentiality of student’s identity Encouragement of other parent/student support Field trips

16. School Bus Policies concerning food on the bus Assigned seating Bus driver’s procedure for contacting 911 Bus monitors and are they trained

17. How a child might describe an allergic reaction Sometimes young children will put their hands in their mouths, or pull or scratch at their tongue. Also their voice might change or they may slur their words. “This food is too spicy “ “My tongue is hot (or burning)“ “My tongue (or mouth) itches” “It feels like something’s poking my tongue” “My mouth feels funny” “It (my tongue) feels like there is hair on it” “There’s a frog in my throat” “My lips feel tight” “There’s something stuck in my throat”“My tongue feels full (or heavy)” “It feels like there are bugs in there (itchy ears)”“My throat feels thick” “It feels like a bump is on the back of my tongue (throat)” Food Allergy News, Vol.13, No.2. © 2003 The Food Allergy & Anaphylaxis Network. All rights reserved If you suspect a child is having an allergic reaction, follow your emergency plan immediately.

18. Medications & Storage Where is student’s epi-pen stored Easily accessible in an emergency Checking expiration dates Staff trained in recognition & response Availability of school nurse and/or health aides Emergency protocol

19. To Ban or Not to Ban Concerns to be addressed if banning a product: 1.It creates a false sense of security. 2.A ban can pit parent against parent. 3.In order for a ban to work, one would have to have everyone in the school constantly reading ingredient labels and calling manufacturers to determine if products contain any of the offending food. 4.How do you decide which allergen to ban (i.e., peanuts, tree nuts, milk, eggs, wheat, soy, fish, shell fish)? 5.Creating a ban that stigmatizes those with the allergy may be offensive and discriminatory. Information from the Food Allergy and Anaphylaxis Network

20. Table Sign

21. In Dealing With Special Dietary Requests Don’t Lose Sight of the Customer Remember to take a step back and put yourself in the shoes of the child and the parent to gain understanding!

22. School Guidelines for Managing Students with Food Allergies This two-page handout lists responsibilities for: Family School Student The following organizations participated in its development: American School Food Service Association (currently SNA) National Association of Elementary School Principals National Association of School Nurses National School Boards Association The Food Allergy & Anaphylaxis Network http://foodallergy.org/school/SchoolGuidelines.pdf

23. FAAN’s School Food Allergy Program The Food Allergy and Anaphylaxis Network (FAAN) has a food-allergy information program for elementary, intermediate, and high schools. If you haven't already done so, you may want to purchase FAAN's School Food Allergy Program (SFAP). The comprehensive, multimedia program includes a video, an EpiPen® trainer, Twinject® trainer, a poster, and a binder filled with more than 100 pages of information and standardized forms. Thousands of schools across the country have used it to safely and successfully manage their students with food allergies. Website for ordering the School Food Allergy Program http://foodallergy.org/school.html#

24. Resources USDA’s Accommodating Children with Special Dietary Needs in the School Nutrition Programs, Fall 2001 http://www.fns.usda.gov/cnd/guidance/special_dietary_needs.pdf http://www.fns.usda.gov/cnd/guidance/special_dietary_needs.pdf NFSMI’s Handbook for Children with Special Food and Nutrition Needs http://nfsmi-web01.nfsmi.olemiss.edu/documentLibraryFiles/PDF/20080213015556.pdf Special Needs Fact Sheets http://www.nfsmi.org/ResourceOverview.aspx?ID=107 http://www.nfsmi.org/ResourceOverview.aspx?ID=107

25. Resources USDA Healthy Meals Resource System http://healthymeals.nal.usda.gov/nal_display/index.php?info_center=14&t ax_level=1&tax_subject=232 This sight spotlights links for: Resources at the National Agricultural Library Diabetes Management in School and Child Care Food Allergies Variations in Meal Requirements Other Special Needs

26. Resources 2007 Guidelines for Use of Health Care Professionals and Health Care Procedures in a School Setting http://health.state.tn.us/Downloads/HealthySchoolsGuidelines.pdf The Food Allergy & Anaphylaxis Network http://www.foodallergy.org

27. Resources Celiac Disease Foundation http://celiac.org/ Celiac Sprue Association http://csaceliacs.org/ Gluten Intolerance Group http://gluten.net/diet.htm American Diabetes Association http://www.diabetes.org/home.jsp

28. All children will benefit by the cooperative efforts to meet their nutritional needs throughout the school day!