One of the scariest days of my life was the day that my child with life-threatening food allergies started kindergarten. At the time, my child was so allergic to peanuts and tree nuts, that she could (and did) go into anaphylaxis from merely touching nut residue or breathing nut dust.
Until she started kindergarten, we felt that she was safe. We maintained a nut-free home. Friends and family knew about her allergy and understood that it was serious. They went out of their way to serve nut-free foods, and to remove any nut products from the room when we came to visit. We avoided restaurants that served foods containing nuts, to prevent the possibility of cross-contamination. Her preschool served nut-free meals and snacks, and her camps prohibited nut products.
Until she started kindergarten, we had control. We controlled her environment – the places we went and the people with whom she came into contact. We studied food labels and did not give her any foods that contained nuts, might contain nuts, were manufactured on equipment that processed nuts, or were made in a facility that handled nuts. We made sure that she always had access to epinephrine. If we accidentally left it at home, we turned around and went back to get it.
Despite these precautions and our best efforts, there were times that she came into contact with her allergens, and she went into anaphylaxis. Fortunately, that was a rare occurrence. For the most part, what we were doing was working. Although we could not eliminate the risk of exposure completely, we had learned to live with her allergy, and we felt like we had it under control.
That all changed when she started kindergarten.
For the first time, we could not control her environment. She was going to attend school with people that we did not know, who did not understand the severity of her food allergy. Other students were going to bring lunches and snacks from home, and we could not prevent them from bringing nuts. Some children might come to school with nut residue on their hands, or nut dust on their clothing and backpacks.
My child was at risk, and she was too young to protect herself. When she started kindergarten, she could not yet read ingredient labels, and she was not old enough to carry epinephrine or administer it to herself. This meant that we had to depend upon others (teachers, staff, students, and their parents) to keep her safe. We had to hope that other people – complete strangers – would not expose her to her allergens. If she were exposed, we had to trust that they would recognize and identify the signs that she was having an anaphylactic reaction, and that they would administer life-saving epinephrine quickly enough to keep her alive. I could not control any of it. And I was terrified.
I hope that the people reading this article never experience that kind of fear and helplessness – knowing that your child is at risk, hoping that complete strangers will do what is required to keep her safe, and praying that everything will be okay. Over and over. Every day.
But for the parents of children with severe food allergies, for whom this fear is a reality, the suggestions below might help ease the transition from preschool to elementary school. Some of these suggestions might not work for everyone. Every child is different, every school is different, and every situation is unique. Parents and schools must work together to develop a plan that works for them and their situation. But if you aren’t sure where to start the discussion or what to ask for, the list below can be used as a starting point.
How to handle your child’s nut allergy while they’re in school
1) Get a doctor’s note.
In our experience, it is critically important to get a doctor’s note. A doctor, especially an allergist, will know his or her patient’s medical needs, which is the first step in managing a child’s food allergies at school. For example, our child’s elementary school did not allow nuts in the classroom, but it did allow nuts at the lunch table in the cafeteria. Because our child could have an anaphylactic reaction from merely touching nut residue or breathing nut dust, her doctor wrote a note stating that it was medically necessary for her to be in a completely nut-free environment, both in the classroom and in the cafeteria.
2) Complete the school health forms.
Before the first day of school, investigate whether the school requires medical forms to be completed pertaining to the child’s allergy. For example, in addition to the School Entrance Heath Form, Virginia has additional forms relating to allergies and asthma – the Anaphylaxis Emergency Action Plan and the Virginia Asthma Action Plan. These forms, and any others that the county, city, or school might require, outline what is to be done and who is to be contacted if the child has a medical emergency. Because many of these forms require a physician’s signature, it is important to complete the forms early, well in advance of the first day of school.
3) Schedule a meeting.
Before the first day of school, schedule a meeting on campus to discuss the child’s allergy and develop an allergy plan with the teacher, school nurse, resource officer, and any other individual who should be involved. Holding the meeting before school starts is critically important because it provides an opportunity to set expectations, strategize solutions, and have an action plan in place when the child enters the building on the first day.
4) Develop a transportation plan.
Children with severe food allergies must always carry or have access to epinephrine because they can be exposed to their allergen anywhere. If the child is going to take the bus to and from school,
parents and schools should ensure that epinephrine is available.
When my child was in elementary school, she rode the bus to school in the morning. After school, a daycare van picked her up and drove her to daycare. To ensure that she had continuous access to epinephrine, we placed her epinephrine into a sturdy box that was labeled with her name, school, grade, and teacher, and our phone number, and we placed a copy of her Anaphylaxis Emergency Action Plan into the box. We handed the box to the bus driver in the morning, who then gave it to the staff member on duty in the bus lane, who then gave it to the school nurse for safe keeping (Our child also had epinephrine in the classroom, which remained at the school).
In the afternoons, the school nurse gave the box to the daycare driver, and then we collected the box when we picked up our child from daycare. We found that pencil boxes manufactured by Vaultz were affordable, readily available, and held up the best, but any sturdy box would work. Note: do not lock the box containing the epinephrine. If the child starts to have an anaphylactic reaction, the bus driver or staff member must be able to access and administer the epinephrine quickly.
5) Send a photo.
In our school, the teachers return to campus the week before students arrive. During that week, they attend trainings and prepare for the upcoming year. The principal asked us to provide a photograph of our child so that she could show it to the teachers during one of the training courses, and put them on notice of our child’s allergy. When our child started school on the first day, she felt like a celebrity because the teachers and staff knew who she was and greeted her by name – even teachers who taught higher grade levels. Medical information is protected, and so the principal got our permission before discussing our child’s allergy publicly. We always gave permission because we wanted teachers and staff at the school to know about her allergy, so that they could help to keep her safe.
6) Develop a lunch plan.
The most dangerous part of the school day for a child with food allergies, is lunchtime. And so, parents and schools should give special consideration to how lunchtime will be handled, to minimize the child’s risk of exposure to their allergen.
Our child’s lunch plan evolved every year, as she got older. When she started kindergarten, before she could read food labels and fully advocate for herself, the school gave her an assigned seat in the cafeteria, close to the doorway, within view of the nurse’s office. Cafeteria workers and volunteers were told that the child who sat in that seat was allergic to peanuts and tree nuts. They made sure that the other students at the table – especially the students who sat next to her – did not have nuts, and the cafeteria workers took extra care when cleaning the table before and after our child’s lunch block.
As my child got older, and especially after she learned to read food labels, the lunch plan relaxed. For example, when she was in kindergarten, none of the children in her class were allowed to bring nuts for lunch, and both lunch tables for her class were designated as “nut-free.” In later years, when she was less vulnerable, only one of the two tables was designated as “nut-free.” As she got older, her classmates were allowed to bring nuts for lunch if they sat at the other table, and our child could sit wherever she wanted at the “nut-free” table.
7) Allergy table
Some schools have a special table in the cafeteria called an “allergy table” where children with food allergies, and perhaps some of their friends, can sit and eat lunch apart from the rest of the class. Although having an “allergy table” is a solution that has worked for many students and schools, that was not a good option for our child. First, not all children at her school were allergic to nuts.
The United States currently recognizes nine major allergens. The Top 9 major allergens are:
- Fish
- Soy
- Wheat
- Tree nuts
- Peanuts
- Sesame
- Egg
- Shellfish
- Milk
Although our child was allergic to nuts, other students at her school were severely allergic to milk. At our school, it was not possible for all the children with food allergies to sit at the same table because they were allergic to different foods.
We were also concerned about isolation and the unfairness of forcing a child with food allergies to sit apart from the other students in their class every day. And so, rather than sit by herself at a separate table, our child sat with her classmates at a “nut-free” table. When she was in kindergarten and both tables were supposed to be “nut-free,” classmates who brought nuts to school were relocated to a different class’s table during that lunch period. They were also required to wash their hands before reentering the classroom.
8) Send a note home.
If other parents do not know that there is a severe allergy in the classroom, they might send foods containing the allergen to school. At the beginning of each schoolyear, our principal sent a letter home to all parents, highlighting the seriousness of food allergies and asking them to follow the guidelines for each classroom, if they were asked to do so.
Then, the teachers who had students with food allergies in their classroom sent letters to their students’ parents, advising them of the guidelines that the class needed to follow that year. The teachers reiterated the message during Back-to-School Night, and followed up with reminders throughout the year, if needed.
9) Classroom parties and celebrations
Elementary schools love parties. Many schools have holiday celebrations that include food. Some teachers allow parents to bring treats from home to celebrate their child’s birthday at school. It is important to discuss how the teacher will manage classroom parties and celebrations that involve food. Does the teacher allow “outside food” into the classroom, or does the teacher require all treats to be non-edible?
If the teacher allows food, does the teacher allow the food to be homemade (which carries the risk of cross-contamination), or does the teacher require all food to be purchased from a store, so that it has an ingredient label? Will the teacher inform parents before the day of the celebration if food is going to be served, so that the child with food allergies can bring their own treat to school that day? Having these conversations early, before school starts, will help keep children safe and increase inclusion in the classroom.
10) Field trips
In our experience, most parents remembered not to pack nuts into their child’s lunch during the school year. However, we did encounter some issues on field trips, perhaps because the parents of children who ordinarily purchased lunch at school, and who were not used to packing lunches, did not remember that there was a food allergy in the classroom. In such cases, when providing information and instructions about the field trip, it might be helpful for the teacher to remind parents about any food guidelines.
11) Rewards
Some teachers reward students with food, like candy. Before the child starts school, find out whether the teacher uses food as a reward. If the teacher does, ask if the teacher would consider using food that is safe for every child in the class, or if the teacher is willing to provide non-edible treats instead of food.
12) Classroom activities
Occasionally, classroom activities and projects might put a child with food allergies into contact with their allergen. For example, when my child was in elementary school, one of her teachers wanted the students to make ornaments using peanut butter and bird seed, that they would then hang on trees to feed the birds.
This project was problematic in our child’s class not just because of the peanut butter, but also because most brands of bird seed (including the brand that the teacher proposed to use) contain peanuts. Thankfully, the teacher knew about our child’s allergy and consulted with us in advance. As a result, we substituted alternate supplies that all the children could safely use, that did not contain nuts. Other classroom activities that might put a child with nut allergies at risk include petting zoos, especially zoos that house birds, because many birds eat peanuts and tree nuts.
13) Read a book.
During our initial meeting before the first day of school, the teacher asked us to recommend books about food allergies that she could read to the class, to help them understand food allergies.
There are several good books on the market, including the Bugabees series. We purchased a book for the classroom, and the teacher read it to the class during the first week. In our experience, starting in kindergarten, our child’s classmates understood the severity of food allergies and were thoughtful about keeping children with food allergies safe.
14) Meet the cafeteria workers.
During our initial meeting, the principal took us to the lunchroom and introduced us (parents and child) to the cafeteria workers. Although our school did not serve or prepare food containing nuts, meeting the cafeteria workers and talking to them before school started put all of us – my child included – at ease.
15) Get a 504 plan if needed.
A 504 plan is a legally-binding document between the parent and the child’s school, that addresses how the school will accommodate the child’s food allergies. This type of plan is called a “504 plan” after Section 504 of the Rehabilitation Act of 1973, which prohibits discrimination against students who have disabilities. According to Section 504 and the Americans with Disabilities Act (ADA), a food allergy is a disability if it is severe and impacts a major bodily function or other major life activity.
A 504 plan identifies actions that the school will take to make sure that the student is safe, has the same access to education as other children, and is treated fairly. It is a tool that can be used to make sure that students, parents, teachers, and staff understand their responsibilities. One of the benefits of a 504 plan is that it is legally enforceable. Not every child needs a 504 plan, but if it makes sense for a child to have one in place, organizations like FARE and the Asthma and Allergy Foundation of America offer helpful information on their websites.
16) Practice administering epinephrine.
Virginia requires schools to have epinephrine on site, and to have someone at the school who is trained to administer it in the event of an emergency. Even still, parents should teach their children how to administer epinephrine to themselves at the earliest opportunity.
Boxes of epinephrine include “practice” auto-injectors, that do not contain sharp needles or medication. We taught our child how to administer epinephrine to herself before she started school. In addition, and at the school nurse’s request, we provided our surplus “practice” auto-injectors to the school so that teachers and staff could practice administering epinephrine before school started.
Starting school is exciting, and it should be a happy time. Although nothing can erase the anxiety of sending a child with food allergies to school for the first time, having an action plan in place before the first day of school goes a long way toward easing the transition.
Most importantly, having an action plan will help keep the child safe so that they, their parents, and the school, can focus on what makes school fun – making new friends and learning new things.
