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Beth Foland, MS, RD 4/2014 Managing Food Allergies in Schools 1.

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Presentation on theme: "Beth Foland, MS, RD 4/2014 Managing Food Allergies in Schools 1."— Presentation transcript:

1 Beth Foland, MS, RD 4/2014 Managing Food Allergies in Schools 1

2 Key Topics Overview of food allergies Requirements for accommodation- disability vs non-disability School response-working effectively with team to create comprehensive food allergy management plan Action steps for foodservice employees Resources 2

3 A Variety of Students Have Special Needs Diabetes Celiac disease Food Allergies Texture Modification Metabolic-PKU

4 Assess Your Knowledge 1. T or F: Foodservice must make accommodations for students that have a food intolerance or a food allergy. 2. T or F: The primary school staff that need training on managing food allergies include classrooom teachers, foodservice and the school nurse. 3. T or F: When parents come to a school meeting for their (food allergy) child, it is imperative that both nursing and foodservice be represented. 4. T or F: Hives is usually the first sign of a severe reaction to a food allergy 4

5 Assess Your Knowledge, cont 5. T or F: Only a licensed physical can sign diet orders for both disability and non-disability students. 6. T or F: Bullying is very unlikely to be an issue for students with food allergies. 7. T or F: The National Food Service Management Institute (NFSMI) and Food Allergy Research & Education (FARE) have free food allergy training materials. 8. T or F: Sanitizer may be used to effectively remove food allergen proteins from table surfaces. 5

6 Food Allergy Background Affects 1 in every 13 children (under 18 years of age) in the U.S. or ~ 2 in every classroom Food allergies among children increased approximately 50% between 1997 and 2011 (CDC, 2013) Every 3 minutes, a food allergy reaction sends someone to the emergency department – that is more than 200,000 emergency department visits per year. Sc: 6

7 Food Allergy Background cont. 7 Teenagers and young adults with food allergies are at the highest risk of fatal food-induced anaphylaxis Children with food allergy are 2-4 times more likely to have other related conditions such as asthma and other allergies, compared with children who do not have food allergies. Sc:

8 What Is a Food Allergy? An immune response to ingesting a particular food or food ingredient/additive edded&v=AKVjKC3u9hk 8

9 Swelling Hives are common but not always present in anaphylaxis Anaphylaxis A serious allergic reaction that is rapid in onset and may cause death

10 Symptoms of a Food Allergy mouth feels funny; tongue is itchy 10 Skin Reactions Swelling of lips, tongue, face Itchy eyes Hives Rash Respiratory Tract Reactions Itching, tightness in throat Shortness of breath Dry or raspy cough Runny nose Wheezing, asthma Digestive Tract Reactions Abdominal pain Nausea Vomiting Diarrhea

11 Reactions Oral ingestion Skin contact (skin to mouth) Inhalation When food proteins are inhaled through the air o Steam from cooking (sizzling fish) o Powder released into air (blowing powdered milk) o Small amounts get into air when crushed/ground (tree nuts) o Peanuts/peanut butter at room temperature have no significant vapor phase containing peanut protein

12 IMPACT Stand Up Exercise 12 Policies & procedures Communication

13 Food is Everywhere 13 Reactions primarily caused by food used in class projects and celebrations – 79% Classroom – 12% Lunchroom 25% reactions in those who had no known allergy

14 8 Major Food Allergens 1. Peanuts 2. Tree Nuts 3. Milk 4. Egg 5. Wheat 6. Soy 7. Fish 8. Shellfish 14

15 15 A life-threatening food allergy can be considered a disability under federal laws Rehabilitation Act of 1973, Section 504 The Individuals with Disabilities Education Act (IDEA) The Americans with Disabilities Act (ADA), along with the ADA Amendments of 2008 (ADAA)  Indiana Law Ind. Health Care Plan (IHP)  Assure compliance for privacy and confidentiality -Family Educational Rights and Privacy Act (FERPA) and -Health Insurance Portability and Accountability Act of 1996 (HIPAA) Governing Laws Policies/Procedures

16 ADA Amendments Act of 2008 Amends federal definition of disability to include additional individuals Broadens definition of “major life activity” and includes “major bodily functions” May increase number of individuals diagnosed and requesting accommodations Disability: Condition limiting one or more major life activities OR a record of such condition OR being regarded as having such condition FNS Guidance Related to the ADA Amendments Act, SP 36‐2013

17 Accommodating Children with Special Dietary Needs in the School Nutrition Programs (Guidance Document, 2001) Under revision 17

18 Disability VS Non-Disability Diet Order components o Specify disability o How restricts diet o Major life activity affected o Foods to omit o Foods to substitute Menu substitutions required 18 Diet Order components o How restricts diet o Foods to omit o Foods to substitute Signed by licensed MD Signed by recognized medical authority Option to provide menu substitutions

19 19 Physician Allied Health Professional School Adm. RN Food Service Teachers Others Family Parents Child Communicate / Educate Partnership For Child’s Safety Sc: Deb Scherrer, FAAN

20 Team Approach 20 Leaders  Administrators  School RN  Foodservice Director  Teachers Others need to be informed: Classroom Aides, Janitors, Bus Drivers, Coaches, Foodservice personnel, After-School Staff, Substitute Teachers, anyone working in the building CURE Family MD

21 Student’s Food Allergy Action Plan Completed by student’s MD or MD designee Use by nursing AND school personnel Outlines care in emergency situation For the student’s safety Do you have a formal plan written for your school? 21 Pass handout Life Threatening Allergy Epi

22 Key Steps for Developing a School Food Allergy Action Plan (FAAP) Identify Students at Risk Establish Communication Channels Identify Allergens in Products Develop Plans for When a Reaction Happens

23 Step 1 Identify Students at Risk Establish procedures (e.g. forms for parents to complete at registration, or letters sent out to parents) Establish file system and maintain/update Post identifying information (w/ parental permission)** in a secure but accessible location Reminder in student meal account information at POS

24 Secure, Accessible Location

25 Real Life Example

26 Step 2 Establish Communication Channels Team Meeting Standard Forms ProceduresTraining

27 Team Meeting Nurse Classroom Teacher Parent(s)  Expectation from school: outside school hours Foodservice  Consent signed  Accommodations: seating cafeteria, birthday parties 27

28 Standard Forms (Building/district) Elementary vs MS/ HS Standard parent letter Standard signage in classroom Standard diet order/physician statement Party Policy Signage in café-No food sharing 28

29 Signage 29

30 Take Caution When Making Statements! “Peanut-free” may create a false sense of security FOCUS: STRATEGIES TO REDUCE ACCIDENTAL EXPOSURE Allergen-safe tables/classrooms are options to school- wide bans. Banerjee, D. K., Kagan, R.S., Turnburr, E., et al. Peanut-free guidelines reduce school lunch peanut contents. Arch Dis Child. 2007 Allergy ALERT We appreciate your cooperation DO NOT Bring peanut/tree nut products Into this classroom

31 31 Procedures

32 Disability VS Non-Disability Diet Order components o Specify disability o How restricts diet o Major life activity affected o Foods to omit o Foods to substitute Menu substitutions required 32 Diet Order components o How restricts diet o Foods to omit o Foods to substitute Signed by licensed MD Signed by recognized medical authority Option to provide menu substitutions

33 Procedures: Plan the Process 33 (Nursing) before enrollment, make parent/guardian packets*; FAAP & consent In-service to school staff; bus drivers, child care  Computer usage: designated computer; plastic covered keyboard  Field trips: removal of trash from bus prior to trip; cleaning of designated seat; meet driver  Playground: eating policy; monitoring of students * school policy/required completed forms/RX

34 Procedures: Plan the Process cont. 34 Enter health info into student database (foodservice-POS) Introduce food allergy student to office/special area staff Training  FS Director—Manager—Cashier –Front Line  Recognize symptoms reaction  Enforce no trading  Monitor pop-up screen  Nursing- Monitor; evaluate plan; practice; debrief

35 Step 3 Identify Allergens in Products Read Labels Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA) Contact Manufacturers

36 Step 3 Identify Allergens in Products Ingredient label may state “product may be processed in a plant or using equipment that may contain an allergen” CONTACT MANUFACTURER Contacting Manufacturers Require manufacturer contact info in bids AND ingredient information Pay special attention to processed foods-if uncertain, do not serve to students with FA Be aware of hidden ingredients like fish Asian foods (egg rolls/soy sauce) Salad dressing (next slide)

37 Identifying Potential Allergens on Food Labels Soybean Hydrolyzed soy protein Soy sauce Textured vegetable protein Tofu Shellfish/Fish Abalone Crab Prawns scallops Wheat Bran Bread crumbs Cracker meal Flour Gluten Semolina Whole wheat berries Whole wheat flour The Food Allergen Labeling & Consumer Protection Act -not required for products labeled before January 2006

38 T. Marzetti's® Nutrition Facts T. Marzetti's® Nutrition Facts Girard's Caesar salad dressing

39 Read Labels 39 Formulations can change frequently--read every label every time Ingredients may differ:  between different sizes of same product (foodservice pack vs supermarket)  among brands/suppliers Don’t rely on “safe lists”

40 Barilla Whole Grain Spaghetti, Thin 40 Made with 51% whole wheat, Ingredients Whole Grain Durum Wheat Flour, Semolina (Wheat), Durum Wheat Flour, Oat Fiber. Warnings Contains wheat ingredients. This product is manufactured on equipment that processes products containing eggs.


42 Hamburger Buns 42 Enriched wheat flour, B vitamins, water, yeast, high fructose corn syrup or sugar, soybean oil contains 2% or less of wheat gluten, salt,calcium sulfate, vinegar, vitamin D, cornstarch,wheat starch, dough conditioners, soy flour, calcium propionate, whey, soy lecithin. What allergens are in the hamburger bun?

43 A very common ingredient used in making salad dressing, coleslaw and potato salad. Do I contain allergens? 43 My ingredients include: Water, soybean oil, vinegar, high fructose corn syrup, modified food starch, sugar, salt, enzyme modified egg yolks, mustard, flour, artificial color, potassium sorbate, paprika, spice, natural flavor, dried garlic, beta carotene.

44 HACCP for Managing Food Allergies Food Allergy management fits into HACCP o Preventing cross-contamination  Shared eqpt; utensils; counters  Salad bars, serving stations  Reused oil-fryers; splatter  Delivery/storage; leakage o Food handling/prep  Separation techniques-PB&J  Washing hands between tasks  Clean lines between production 44

45 Sabrina Shannon : teen had fatal anaphylactic reaction during her first year of high school, 2003. Reaction triggered by dairy protein - likely due to cross- contamination from tongs used for poutine (potatoes topped with curd cheese and a tomato-based sauce) after ordering French fries from school cafeteria "A Nutty Tale“ first-person radio documentary Cross Contact

46 Reinforce Handwashing 46 At appropriate times Using proper techniques Wash hands before glove use Use gloves when handling ready-to eat foods, changing between tasks Change gloves when transitioning USE DETERGENT, rinse, sanitize, air dry Sanitizer is NOT adequate to remove allergens

47 Cafeteria Strategies 47 Offer designated allergen-friendly tables for young students (? optional for students with parental and physician authorization to sit at “regular” table) Clean tables carefully Prevent food trading Encourage students to wash hands Provide supervision to ensure orderly behavior Be prepared for an emergency (know role in FAAP)

48 Prepare for Bullies 48 Teasing or taunting potentially dangerous for student with a food allergy – Policy to prohibit School officials must take appropriate disciplinary measures

49 Key Resources-free online 49 FARE (Food Allergy Research & Education School Nutrition Association FAME CDC National Food Service Management Institute

50 Key Resources, continued 50 International Food Information Council Foundation Mayo Clinic National Institute of Allergy and Infectious Disease 04/01/2014

51 F ood A llergy R esource and E ducation Safe@School Training Program C.A.R.E Free online interactive course for school personnel NSBA Safe at School and Ready to Learn Policy guide to assist K ‐ 12 school boards in developing a comprehensive food allergy plan Food Allergy Book: What School Employees Need to Know National Education Assoc.

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