Food Allergies in Children

1. Food Allergies in Children A School Nutrition Professional’s Perspective SPARC Annual Conference August 2009

2. Question to Ponder A child has a life threatening allergy which causes an anaphylactic reaction to peanuts. The slightest contact with peanuts or peanut derivatives, usually peanut oil, could be fatal. To what lengths must the food service go to accommodate the child? Is it sufficient for the school food service to merely avoid obvious foods, such as peanut butter, or must school food service staff research every ingredient and additive in processed foods or regularly post all of the ingredients used in recipes? Answer will be provided at the end of this presentation. SPARC Annual Conference August 2009

3. Food Allergy Statistics • About 200 deaths result from food allergy reactions in the US each year • Approximately 12 million Americans have food allergies: • 6% - 8% of children under age 3 • 4% of the overall population Source: http://www.faiusa.org/?page=aboutFoodAllergies&gclid=CITl3_buiZwCFclL5QodBD4mXg Source: http://www.ific.org/publications/other/upload/Color_Food_Allergy.pdf SPARC Annual Conference August 2009

4. More Food Allergy Statistics In 2008, the International Food Information Council (IFIC) and the School Nutrition Association (SNA) found that 21% of surveyed schools did not have a plan to address food allergic reactions. An additional 13% said they were unsure what to do in response to an allergic reaction. Source: Today’s Dietitian, August 2009 SPARC Annual Conference August 2009

5. What is a Food Allergy? • Immune system involvement • The body mistakes an ingredient in food -- usually a protein -- as harmful and creates a defense system (antibodies) to fight it. Food allergy symptoms develop when the antibodies are battling the "invading" food. • Reactions can be severe and life threatening • Symptoms usually begin immediately, within 2 hours Source: http://www.nlm.nih.gov/medlineplus/ency/article/000817.htm SPARC Annual Conference August 2009

6. Food Allergy Symptoms • Symptoms specific to food allergies: • Hives or rash, itchy skin • Chest pain • Shortness of breath • Swelling of airways to the lung • Anaphylaxis • Other symptoms may include nausea, vomiting, diarrhea, stomach cramps and abdominal pain, runny nose and nasal congestion, and difficulty swallowing SPARC Annual Conference August 2009

7. Anaphylaxis SPARC Annual Conference August 2009 Source: http://www.nlm.nih.gov/medlineplus/ency/imagepages/19320.htm

8. What is a Food Intolerance? • Digestive system response rather than an immune system response Occurs when something in a food irritates a person's digestive system or when a person is unable to properly digest or breakdown the food • Uncomfortable but not life threatening • May be able to consumer small portions of offending food • Example: Lactose Intolerance SPARC Annual Conference August 2009 Source: http://www.nlm.nih.gov/medlineplus/ency/article/000817.htm

9. Symptoms of a Food Intolerance • Symptoms include: • Nausea • Vomiting • Headache • Diarrhea, gas, bloating • Stomach or abdominal pain • Headache • Irritability or nervousness SPARC Annual Conference August 2009

10. Common Food Allergies in Children • A food allergy frequently starts in childhood, but it can begin at any age. • Common food allergies in children are: • Eggs • Milk • Peanuts • Shellfish (shrimp, crab, lobster, snails, clams) • Soy • Tree nuts • Wheat SPARC Annual Conference August 2009 Source: http://www.nlm.nih.gov/medlineplus/ency/article/000817.htm

11. Most Common Food Allergies in Older Children and Adults • Fish • Peanuts • Shellfish • Tree nuts Corn, cow’s milk and dairy products, wheat and other gluten containing products are usually food intolerances in older children and adults. SPARC Annual Conference August 2009

12. Is a Food Allergy a Disability? • If a licensed physician assesses that food allergies may result in severe, life-threatening (anaphylactic) reactions, the child's condition would meet the definition of "disability,“ and the substitutions prescribed by the licensed physician must be made. • Section 504 of the Rehabilitation Act or Part B of IDEA SPARC Annual Conference August 2009 Source: http://www.michigan.gov/documents/Accommodating_Children_with_Special_Dietary_Needs_99999_7.pdf

13. Other Special Dietary Needs • SFS may, but is not required to, make food substitutions for children who do not have a disability, but who are medically certified as having a special medical or dietary need. • Examples- • Food allergies that do not have life threatening reactions • Food intolerances SPARC Annual Conference August 2009 Source: http://www.michigan.gov/documents/Accommodating_Children_with_Special_Dietary_Needs_99999_7.pdf

14. Current Legislation in Michigan • Senate Bill No. 233 • Introduced by Senator Switalski • Referred to the Committee on Education on Feb.17, 2009. • Require school districts to adopt policies designed to limit the exposure of students with severe food allergies and ensure timely response in the event such exposure occurs. • Also require the state Department of Education to adopt a model food allergy policy. SPARC Annual Conference August 2009 Source: http://www.michiganvotes.org/2009-SB-233

15. A School Nutrition Professional’s Responsibilities • Must make food substitutions or modifications for students with disabilities. • Must be based on a prescription written by a licensed physician. • What is the disability • How it restricts the diet • Major life activity affected • Food(s) to be omitted • Food(s) to be substituted • Not required to provide food substitutions or modifications for children without disabilities with medically certified special dietary needs who are unable to eat regular meals as prepared. SPARC Annual Conference August 2009 Source: http://www.michigan.gov/documents/Accommodating_Children_with_Special_Dietary_Needs_99999_7.pdf

16. A School Nutrition Professional’s Responsibilities • Do not revise or change a diet prescription or medical order. • Utilize FNS Guidance Accommodating Children with Special Dietary Needs in the School Meal Programs – Guidance for School Food Service Staff • Maintain written documentation • Keep copies of special, non-meal pattern diets on file for reviews. • Diet orders do not need to be renewed annually • Ensure that the diet orders reflect the current dietary needs of the child. Source: http://www.michigan.gov/documents/Accommodating_Children_with_Special_Dietary_Needs_99999_7.pdf SPARC Annual Conference August 2009

17. What Should You Do? • Be Prepared • Have a plan, policies and procedures • Educate your staff and yourself • Work with your state agency • Keep written prescription on file • To make substitutions to menu and food purchasing • To remain vigilant in food prep and service • Know where epinephrine is located and how to use it SPARC Annual Conference August 2009

18. What Should You Do? • Be Involved • Participate in planning meetings with school staff- principal, teachers, school nurse, custodians, etc. • Meet with the student and parents • Follow Physician’s Written Prescription! SPARC Annual Conference August 2009 Source: http://www.schoolnutrition.org/uploadedFiles/School_Nutrition/104_CareerEducation/ContinuingEducation/Webinars/Food_Allergy_Webinar_Presentation_Part1.pdf?n=3418

19. What Should You Do? • Read labels!! • The Food Allergen Labeling and Consumer Protection Act (2006) • Manufacturers are not required to list common allergenic ingredients resulting from shared equipment and cross contamination issues • Contact Shirley Putnam RD, for assistance with product information or questions. • Be prepared for the element of surprise. • Worcestershire Sauce contains fish products • Many hot dogs and deli meats may contain milk and soy products SPARC Annual Conference August 2009

20. Implemented Ideas in Other Districts • Nut Free School District • No Nuts in all schools- cafeterias/classrooms • False Sense of security • Nut Free Environment • Peanut Free tables in cafeteria • Nut Free prep area in kitchen • Education • Multi-disciplinary approach- child can be exposed in many areas- classroom, playground, bus, etc. • 15% in cafeteria, 48% in classroom, 10% playground • Allergy Plan in place SPARC Annual Conference August 2009

21. SPARC Annual Conference August 2009 Source: http://www.foodallergy.org/downloads.html

22. SPARC and SYSCO Support You! • Go to www.MichiganSPARC.com and SYSCO’s eNutrition for product nutrition and allergen info • SPARC Consulting Registered Dietitian, Shirley Putnam, MAT RD • Contact via www.MichiganSPARC.com or SPutnamRD@verizon.net • List of Resources • CEU Opportunity from SNA SPARC Annual Conference August 2009

23. Answer to Question from Slide 3 • Exercise caution at all times. • Do not serve foods if you do not know what is in those foods. • SFS must provide safe, non-allergic meal • SFS must ensure all foods meet prescribed guidelines and are free of suspected foods that cause food allergic reactions • Food labels/specifications must be checked and if adequate info is not provided, SFS must check with manufacturer or supplier or State agency. • Check with parents about certain foods and even provide them with advance copies of menus. • Private organizations, such as the Food Allergy and Anaphylaxis Network, may also be consulted for information and advice. SPARC Annual Conference August 2009 Source: http://www.fns.usda.gov/cnd/Guidance/special_dietary_needs.pdf