The emergency protocols stay the same, but the specific accommodations a food-allergic student will need at school evolve as they mature and move from one level to the next. Following is a thorough list of issues and approaches at the elementary, middle school and high school levels. [Editor’s note: This advice is framed for U.S. public schools. However, some accommodations may pertain to private schools that use public spaces.]
Elementary School: Things to Consider
Whether your child is entering school for the first time or you’re registering your child into a new school, this can be a time of mixed emotions. Yet with preparation and the knowledge that you’re not alone, gathering the information necessary to advocate for your child can be empowering.
Review the different accommodations topics below to consider what is necessary for your child’s individual needs. Then discuss your list with your child’s school in order to provide a safe and inclusive school year.
Epinephrine Auto-Injector Location: It is important to have your food-allergic child’s epinephrine close and easily accessible. Consider the following options:
• Self-carry – As a parent, you’re able to decide if your child is mature enough to manage this responsibility. It is important to communicate with your child’s allergist/physician and have the proper paperwork completed for the school.
• Emergency Bag – This option involves the epinephrine being at your child’s side in an “emergency bag,” tote or other bag. The teacher usually keeps a list of students with medical issues and the pertinent medical information. The teacher is responsible for handing off the emergency bag, which eliminates concerns that other students may handle medication. In an emergency (fire drill, lockdown, etc.), the emergency bag will follow your child’s class to the assigned safe location. During the day, the emergency bag follows your child’s class from the classroom, to the gym, cafeteria, art space, the playground and back to class. No food should be kept in the emergency bag. It is a good idea to communicate with your child’s teacher to see if they already have a bag, or if you’re able to donate one.
Cafeteria: Seating arrangements will depend on several factors, including age, medical history and more. While the seating solution is based on the needs of the student, here are a few points to consider.
• Sitting with the rest of the class (so not to be excluded), but with a buffer of students between those eating the allergens and those with allergy-friendly lunches.
• Sitting toward the end of the table to reduce the chance of exposure to food allergens. Because there is no true “allergy-free” environment, discuss with the school how they will accommodate seating for your child and the needs of students with different or opposing food allergies, who may be seated with your child during the same lunch period.
• Monitors: Find out who they will be and what training they receive.
School Bus: It’s important that your child has their epinephrine readily available while riding the bus to and from school, whether it’s self-carried or toted by an aide. Several considerations need to be addressed with the school. Ask when your child’s bus driver will be informed about your child’s health plans and trained on the recognition and treatment of an allergic reaction, as well as emergency protocols following epinephrine injection.
Also discuss whether a trained substitute driver could be requested, if the regular driver should become unavailable. It’s best to work with the school to have bus issues spelled out in a child’s 504 plan, the federal disability document that provides what’s known as FAPE – a free appropriate public education.
Morning Drop-Off: Ask about where your student will wait after drop off and prior to the first bell. In most elementary schools, students wait in the multi-purpose room (gym). If this is the case, this area is also used for celebrations, after-school activities, as well as a venue for third parties. Discussions should include how often the space gets cleaned, and what to expect in terms of cleaning following after-school or weekend events. Plus, what is the back-up plan if the janitor calls in sick?
Celebrations: Holidays, Valentine’s Day, 100 Days of School, awareness campaigns and other festivities: Are they done in class? If so, are they food-free? Discuss the plans for school rallies held in common areas such as the gym or cafeteria.
School Breakfast Program: The School Breakfast Program (SBP) operates in schools to provide nutritionally balanced food. The SBP includes federally funded programs that are offered to all students, such as Breakfast in the Classroom (BIC) and Grab & Go. Funded through grants, some school districts in several states have already implemented these programs. The SBP was designed to support students who may not ordinarily receive breakfast, eat a complete breakfast or may have missed their federally funded breakfast at school as a result of arriving late. Parents of students with food allergies and other special dietary needs should be aware that these programs could exclude and potentially expose a child to allergens, increasing the risk for a reaction at school.
Open a dialogue with your child’s school about BIC or Grab & Go in the school, and accommodations to keep your child safe and included.
Middle and High School: Things to Consider
Middle and high school students have more independence, so you will want to have conversations about the different school environments your tween or teenager will encounter. Review the key points associated with your student’s grade level and keep an open dialogue with the school throughout the year.
It’s encouraged that a maturing student plays a part in planning meetings, such as those for an Individual Health Care Plan (IHCP) and/or a Section 504 Plan. If, for any reason, it is not appropriate for your child to attend, at least gain his or her input in advance.
Epinephrine Auto-Injector: By middle and high school, allergic students are encouraged to self-carry epinephrine. Also consider that with before and after school activities, the school clinic office is usually closed. Quick access to epinephrine is important. When your child self-carries, it provides some freedoms, as long as the school staff in charge is trained on how to recognize and treat a reaction, and the emergency protocols to follow.
Discuss with your child’s school whether backpacks are allowed to be carried from class to class. This may alleviate concern a child may have about appearing different. Some food-allergic students carry their epinephrine auto-injectors and asthma inhalers in drawstring bags (approved by school), purses, and even epinephrine carriers. Whatever your child chooses to carry their medication in, it is important to check in with them throughout the year to be sure they are not stowing it in their phys ed or main locker. It needs to be immediately available.
Morning Drop-Off or Bus-In: Ask about where your child will be waiting if you drop off your child or he/she arrives by bus before the first bell. In some schools, students wait in a common area. This area may be the cafeteria where they may be serving breakfast.
School Breakfast Program: Middle and high schools may implement the same breakfast programs as mentioned in the elementary school section. However, older students tend to use the Grab & Go breakfast selection. Therefore, it is important to discuss these different programs with your child’s school as well as accommodations that will keep your child safe and included.
Multiple Teachers and Classes: Meeting with all the teachers before the start of the school year provides you with the ability to inform and to answer specific questions pertaining to your child. This is an ideal opportunity for your child to transition into attending meetings and get to speak up about how food allergies impacts his/her education.
Before and After-School Activities and Programs: If an instructor is someone other than a teacher who is well-versed on your child’s food allergy plan, discuss options to have someone available who is trained in food allergy management.
Electives: It is important to discuss class placement and electives early before the new school year. Some schools require a semester of “family and consumer science,” previously known as home economics, which involves cooking. While students may not be cooking every day in this class, you will need to be notified of activities where food is involved. For example, the curriculum may include modules and projects where food may be used. Start by reviewing the teacher’s syllabus to see when certain activities take place. If your child has a 504 Plan, the school must accommodate your child in order to receive an education equal to other peers.
If for any reason your child is unable to participate, and your child agrees, discuss the option of an alternative class. Do confirm that the alternative class provides the equivalent required credits. In addition, discuss whether your child’s classes have the same students for the electives as they do for their academic classes, as this may mean the same group of students may go from algebra, for example, to family and consumer science. For some students, this could put them in a position of feeling or appearing “different”. Inquiries should be made with your child’s school prior to the new school year.
Celebrations: Some examples may include seasonal dances, pep rallies, and prom, all which can be held in common areas such as the gym or cafeteria. Discuss with the school food accommodations, how often the space is cleaned, and what to expect in terms of cleaning following after-school or weekend events. Plus, what is the back-up plan if the janitor in charge calls in sick?
Fundraisers and Vending Machines: In some middle and high schools, vending machines may be available to students throughout the school day or during certain times of the day. The Smart Snacks in School rule, as it has come to be known, was developed to promote healthy habits and alternatives. This rule applies to all foods sold to students during the school day, including those sold in vending machine and through fundraisers. However, some foods may also contain allergens. Find out the vending situation, and research your state’s regulations on the sale of any food during the school day.
Lunch Detentions: Typically held in classrooms, and it may not be one of your student’s regular classrooms. Discuss accommodations to provide a safe environment, in the event your child has to attend detention.
Standardized Testing: The testing location may be not be one of your child’s usual classrooms, but rather a centralized location, such as computer/testing room. Discuss this environment as well as the moderator having access to your child’s health plans. If your child has a 504 Plan, consider accommodations that will be necessary to address during tests. For example, self-carrying the epinephrine auto-injector and/or any other medications, detailing instructions on retaking the test in case of symptoms of a reaction, or a food-free testing room.
College Board Exams: One rite of passage for a high school student is taking district wide assessments like the SAT, PSAT, AP exams, etc. If your student has a recognized health disability through aSection 504 Plan, he or she may receive some accommodations during test taking. The College Board is the organization that prepares and administers these standardized tests used in college placement. The board requests that parents to work with their child’s school to discuss necessary and appropriate accommodations. It can take up to seven weeks for the approval process with the College Board to review and approve accommodations for students with disabilities.
Cafeteria: By the time your child enters either middle or high school, there may no longer be assigned seats, and cafeteria monitors are a thing of the past. It is more likely that administrators and/or staff who are assigned and rotate during the week to oversee the cafeteria. Students may be able to eat in the common area in some high school, which means your student will have to be aware and likely carry wipes.
Foreign Language Classes and Clubs: If your child will take part in a foreign language class or club, ask about the curriculum to be sure your student is safe and included in all activities. It is not uncommon for food to be used as a teaching tool to introduce different cultures.
However, there are food-free methods. Examples are inviting professionals and creating curriculum around them: an artist can demonstrate how to draw while the teacher speaks in the target language; or playing games like Bingo or Jeopardy using answers relating to the country the students are studying.
Sports: If your student has a Section 504 Plan, under federal rules the school must ensure that he or she participates with peers in non-academic and extracurricular activities and services, to the maximum extent appropriate to his/her needs. This includes athletic programs. Work with your child’s school and discuss accommodations to assist your child access the sport he/she chooses.
Locker: Prior to the school year, discuss your child’s locker accommodations. For example, inquire how your child obtains his/her locker combination in advance of the first day of school. Middle and high school are fast-paced, and getting locker access in advance allows your child practice the combination and lower anxiety if he/she accidently locks medication in the locker. Additionally, you will have a chance to store emergency safe foods in case of a lockdown or if your child’s lunch becomes compromised.
Discuss the locker location with the school. For example, it may be necessary for your child to receive a locker that’s not in an area of the busiest hall, where students may be eating their Grab & Go breakfast. Depending on your child’s specific needs, the locker could be close to a bathroom, a hallway accessible to the nurse’s clinic, or guidance office.
In closing, we hope these tips help you with discussions with the school at different stages. It is always important to discuss your child’s individual needs to be sure they are appropriately addressed.
Thanita Glancey is the support group leader of the Loudoun Allergy Network and has a teenager with multiple food allergies.
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