Q. My daughter is allergic to several tree nuts, and is just starting kindergarten. Her school restricts peanuts, but not tree nuts. Can you give me any advice on how to keep her safe at school?
Dr. Pistiner: Passing the responsibility of caring for children with food allergies to others can be tricky and anxiety-provoking. Increasingly, schools have been establishing and implementing well-thought-out policies that take the safety and emotional well-being of the child with food allergies into account.
To be effective, each food allergy policy needs to consider the school’s characteristics (range of ages and developmental levels) and resources, which will guide school-wide policy. In your case, your school has decided that universally restricting peanuts, but not tree nuts is what makes the most sense at this time.
Having a working relationship with your school will be key. Alert your school to your daughter’s specific allergies, past reactions, and emotional and developmental needs. The easiest way for her to avoid tree nuts would be to not allow food containing tree nuts in the classroom. Young children frequently put their hands in their mouths and can be messy eaters.
If, after discussion with your daughter’s teacher and principal, this is not possible, then it will be necessary to implement strategies to avoid cross-contact with allergens in classroom. The specifics of where food is allowed to be eaten and where activities are conducted will need to be taken into account. Your daughter should always wash her hands prior to eating, and ideally, the other children’s hands should be washed after eating, especially those eating meals with tree nuts.
Provide the school with an up-to-date food-allergy & anaphylaxis action plan  that has been signed by your health-care provider along with an up-to-date epinephrine auto-injector. Also be sure to teach your child age-appropriate self-management skills, such as how to properly wash her hands, and how to tell others if she’s experiencing symptoms.
Dr. Michael Pistiner is an allergist in Massachusetts and clinical instructor at Children’s Hospital Boston, Harvard Medical School. His 7-year old son is allergic to tree nuts.