The Situation:

My family lives in Ottawa, where the Ottawa Carleton District School Board (OCDSB) has been using Grade 5 and 6 students to supervise children during snack and meal breaks for the past few years. This included children at risk of anaphylaxis. The practice was undertaken for efficiency – because teachers didn’t have enough time outside of classroom duties to supervise all the children at lunch. In the OCDSB most students eat lunch with their class in their classroom instead of a common lunchroom.

The system worked like this: in each classroom two student monitors would watch over students in Grades 1 through 6 while they ate. One adult (teacher or staff member) would rotate through four classrooms over the course of a 25 minute meal break.

The duties of the monitors came to light after a couple of situations in which they’d overstepped their bounds. (The OCDSB hadn’t set out the limits of their responsibilities. In one case a girl with allergies was disciplined by putting her out in the hallway to eat alone – without her EpiPen.

This created a stressful situation for parents of children with anaphylaxis like my wife and I as well as fellow members of the Ottawa Anaphylaxis Support Group (OASG). Our younger daughter (Taya) is allergic to peanuts, nuts, sesame, kiwi and soy. While our allergist has stressed that it’s critical to ensure that epinephrine is given promptly in a reaction, it was hard to see how that could be achieved when the student lunch monitors hadn’t been given any emergency training, and certainly hadn’t been taught how to recognize an anaphylactic reaction or what to do in an anaphylactic emergency.

Had the lunch monitors’ parents been aware, they might have wondered about the level of responsibility being put on the shoulders of kids who are mostly 10 and 11 years old – not even old enough to baby-sit.

The Process:

Two years ago, a group of us from the OASG presented our concerns to several of the trustees at a meeting organized to discuss anaphylaxis policy, but nothing was done.  Then last year, we found out that the school board was reviewing the policy for children with life-threatening medical conditions.

A group of us from the support group prepared a 20-page presentation for the school board staff in charge of the review to explain our concerns. After that meeting, we realized there were too many problems to solve all at once so we prioritized the changes we felt were most critical.

We focused on three key areas: ensuring that children with anaphylaxis were supervised by an adult while they were eating; accommodating the allergic children inclusively, so they were not put in a room away from their friends at lunch; and requiring teachers to get parental permission before giving food to anaphylactic children.

The Resolution:

After many meetings and support from several sympathetic school board trustees, the policy for students with life threatening medical conditions was amended to include all three of our key recommendations. See the sidebar for the new section of the policy and a link to the complete policy.

We are extremely pleased with the changes; however we’re aware that the devil is in the implementation details at the schools.  While the new policy has been communicated to the school principals, it is now up to the principals to find a combination of teachers, casual workers and volunteers to ensure that anaphylactic children are properly supervised.

If you have concerns about the lunchtime supervision at your school, speak to other allergic parents and your trustee.  Once they were made aware of the issues, the trustees proved sympathetic to the needs of the children with serious food allergies, and pressed for a workable solution. Never sell short that others without allergies are still people who can imagine what it is to stand in your shoes. It is possible to win changes, but it does take work, and organization.

See Also:

• The Fall 2009 article “Who’s Watching Lunch”
• New OCDSB policy

An anaphylactic reaction includes more than one of the body’s systems, such as the respiratory tract, gastrointestinal tract, the skin and cardiovascular symptom. Symptoms of an allergic reaction include tingling in the mouth, swelling of the tongue and throat, itchy skin or hives, difficulty breathing, abdominal cramping and vomiting. In a severe anaphylactic reaction, a person may experience a drop of blood pressure, loss of consciousness and even cardiac arrest and death.

One of the issues in managing peanut allergy is that symptoms can vary. A person may have had minor symptoms, only to suffer anaphylaxis on a subsequent exposure.

Because peanut allergy reactions can be severe, it is important that a person with this allergy carry an epinephrine auto-injector (EpiPen or Twinject) with them at all times. Peanut allergy is often considered a lifelong allergy, but research has shown up to 20 per cent of children may outgrow it by the time they reach school-age.*

*Source: 2010 FA primer. JACI

Prevalence

In the United States, the rate of peanut allergy in children increased by 3.5 times from 1997 to 2008, to a rate of 1.4 per cent. In Canada, it is estimated that 1.68 per cent of children and 0.71 per cent of adults have peanut allergy.

More on Peanut Allergy Statistics

Next Page: Not a Nut!

As the mother of a dairy-allergic 8-year-old, I am often asked: “How can anyone be allergic to milk?” From an early age, we’re taught that milk is good for you. It’s hard for people to fathom living without it, and then you explain that the allergy is not just to cow’s milk, but to a protein in every dairy product. Whether milk, cheese or whey or casein ingredients in a packaged food – it’s all dangerous and to be avoided.

When we registered our daughter for Junior Kindergarten back in 2001, my husband and I heard all about anaphylaxis plans for peanuts and tree nuts. But school officials seemed to have a hard time grasping that milk could be just as deadly to a child allergic to dairy. The school had a monthly Pizza Day, and the allergist had recommended that  our daughter not go to school on those days, as the risk of a reaction from the melted cheese (which smears so easily) was high.

Since she missed many events, I asked the school to reconsider the importance of Pizza Day. To my great relief, the new principal was most understanding and promptly dropped the “day”. Not all parents have accepted this easily, but that’s OK. My primary job is to protect my child physically and psychologically; I want her formative years in academia to be positive. Four years into our journey with dairy allergy and the school, the awareness-building continues. Along the way, we have learned much that’s worth sharing.

Next Page: Keeping the Child Safe

She was indignant and didn’t know what she’d done wrong. “They can’t treat me this way,” she said.

Her mother wasn’t pleased to hear of a student disciplining another student, but she had a more immediate concern. Her severely peanut-allergic daughter had been alone while eating.

“Where was your EpiPen?” Cameron asked. The reply: “In my backpack.” And where was that? “In the classroom.”

“If she’d had a reaction in the hall, no one would have been there to help her,” says Cameron. The previous fall, Cameron first learned that adults weren’t supervising the lunch breaks at the Ottawa public school. Instead, pairs of Grade 5 or 6 students oversaw the younger children as they ate at their desks. In case of an emergency, these monitors would have to run and seek out an adult.

Thousands of miles west, in Victoria, B.C., Caroline Posynick can relate. She became a convert to allergy advocacy in 2006 over the issue of student lunch-monitoring.

She had been blissfully unaware that, in a school that ran from kindergarten through Grade 7, lunch for younger grade children was supervised by kids from the eldest grade. She also didn’t realize that the teacher had decided to keep her son Griffin safe by isolating the 7-year-old at the crafts table.

On Valentine’s Day in 2006, “my son was sitting at this special table. A kid who was really, really active got up and put some peanut butter on his finger and then put it on Griffin’s arm,” Posynick says. “He wanted to see what would happen. This occurred with kids watching kids, so they couldn’t stop it.”

There was panic in the room, Griffin froze, and the monitors hustled him off to the teachers’ staff room to get his arm washed.

When Posynick and her husband got to the school they found Griffin with a huge hive on his arm. Benadryl was enough to handle the contact reaction. But the boy’s sense of upset did not go away nearly as quickly.

Incidents with lunch supervision are not hard to find among the parents of food-allergic children. They illustrate that, for all of the advances such as Sabrina’s Law in Ontario (an act to protect anaphylactic pupils) or B.C.’s ministerial framework on anaphylaxis, and for all the allergic community’s advocacy on risk reduction and readiness for emergencies, gaps remain in the protection of food-allergic children.

Within Canada’s public elementary schools, there’s a patchwork of student monitors and adult lunch supervisors, but even with the latter, the person in sight line of the child may not be trained on giving an epinephrine auto-injector. Who’s watching the kids depends on a school board’s policy and then, in turn, on how an individual principal handles (and applies budget to) lunch supervision at his or her school.

For instance, in Vancouver, the norm today is paid lunch assistants, but a ferry ride away in Victoria, students not old enough to babysit frequently patrol lunch in the class.

In 2005, Anaphylaxis Canada did a survey of its online registry about allergy policies in Canadian schools. Of the 678 parents who responded about their child’s public elementary school, 28 per cent said the school relied on student lunch monitors, 43 per cent said school staff supervised (sometimes in combination with students) and 33 per cent had paid lunch supervisors. At some schools, there were also a small percentage of parent volunteers assisting.

Most public elementary students (73 per cent) ate lunch in their class as schools often lacked the space for lunchrooms. “You do have to consider what the principals are dealing with,” notes Laurie Harada, executive director of Anaphylaxis Canada. “They’ve had cutbacks, the best that many principals can do is to have someone to wander the halls and poke their head in and monitor the kids.” That said, she adds: “too much of this is ad hoc, and schools need to think through this.”

U.S. ‘All Over the Map’

In the United States, student lunch volunteers are less the issue, but again – despite a growing number of anaphylaxis laws among the states, there are gaps. Lunch is usually eaten in a cafeteria or lunchroom, making it possible for fewer adult eyes to survey a larger group of kids.

Yet anaphylaxis prevention practices and auto-injector training can vary from district to district, and cafeteria to cafeteria.

Lunch supervision “is an all over the map situation in the U.S.,” says Deb Scherrer, vice president of education for the Virginia-based Food Allergy & Anaphylaxis Network. “Sometimes it’s a teacher, sometimes it’s a food service worker, sometimes it’s a parent – it may be paid staff or volunteer.”

*Name changed by request.

UNITED STATES

FAAN’s Back-to-School Tool Kit
FAAN’s Food Allergy Action Plan
Food Allergy Initiative’s Authorization of Emergency Treatment Form
FAAN/FAI e-learning resource, comprehensive tool for teachers. www.allergyready.com
Federal 504 Plan
AAFA on the Americans with Disabilities Act (ADA)
National Assn of School Nurses’ Anaphylaxis Provision of Care documents

CANADA

Comprehensive resource - Allergy Safe Communities site.

• Allergy Safe Communities’ Emergency Plan for EpiPen
• Allergy Safe Communities’ Emergency Plan for Twinject
• Sample letter from principal
• Sample letter from teacher
• Steps for school anaphylaxis plan
  

Also: Canadian School Boards Association publication:
Anaphylaxis: A Handbook for School Boards (New Edition)

Asthma Action Plans

• Alberta’s Asthma Action Plan (Canada)
  
• The Lung Association’s Action Plan (Canada)
• AAFA’s Student Asthma Action Card (USA)
• American Academy of Family Physicians Asthma Action Plan (USA)

Allergic Living‘s School Articles

• Food in the Classroom – click here
• Allergic Living’s award-winning article – Sabrina’s Law
• Hear Sabrina – Her moving CBC radio documentary – A Nutty Tale
• FAAMA: Inside the U.S. Food Allergy Law here
• Laurie Harada: Talking to School Officials here
  
• Laurie Harada: Off to Kindergarten - here
• Laurie Harada: If Your Child is Bullied - here
• Food Allergy and the Risky Teenage Years - here
• Sabrina’s Law: The Girl Who Inspired Change - here
• Who’s Watching Lunch at School? New excerpt here
  
• Off to College with Allergies - here
• Teens Talk: Life with Allergies - here
• Samantha Yaffe: Grade 1 and Letting Go – click here
• Kids, Anxiety and Anaphylaxis - here
• Backlash Against School Accommodations - here
• Air Quality at School - here
• The September Asthma Spike - here
• Sara Shannon’s Journey with Sabrina’s Law - here
• Reader’s Story: Sabrina’s Law Success - here
• Sabrina’s Law in Context – For a Kid, Dairy Allergy is a Life Changer

State and Provincial anaphylaxis laws, policies and guidelines, click here.

The amount of food the average child comes in contact with at the modern school is several times what his 30- or 40-something parent encountered as a pupil. Today’s staples include the pizza-at-school fundraisers, rich and fatty cafeteria food, and school vending machines brimming with oversized beverages and chocolate bars.

Add to the mix the modern child’s obsession with computers, the hours of instant and text messaging time, and results are a shocker: kids across Canada and the United States are more overweight now than at any other time in history.

Between 1978 and 2004, government statistics show that the proportion of overweight Canadian kids aged 6 to 11 doubled to 26 per cent, while the rate of teenagers who were too heavy also doubled – to a whopping 29 per cent. The rate of obese teens tripled to 9 per cent.

Due to weight issues, the federal government stated that, for the first time, this generation of children might not live as long as their parents. In the United States, over the past three decades there has been a doubling of obesity rates for preschoolers and teens, and a tripling for the 6-to-11-year-old group.

“Kids are drinking more sugary drinks, and you have exercise being designed out of their lives,” says Dr. Brian McCrindle, a cardiologist at The Hospital for Sick Children in Toronto, professor of pediatrics and author of Get a Healthy Weight for Your Child. “Because of safety concerns, they don’t play outside, and you see a proliferation of sedentary pursuits, video and computer.”

As children have grown ever heavier, the concurrent trend, of course, is the skyrocketing of food allergy. A study from Mount Sinai’s School of Medicine in New York, published in 2004, confirmed what allergists knew anecdotally; the incidence of food allergy in the U.S. had doubled, and those statistics are mirrored in Canada. Six to 8 per cent of Canadian school children now have food allergies, which can cause dangerous, even life-threatening reactions. Provinces and states are considering and, in a few cases, passing anaphylaxis-readiness laws in the schools.

But as those bring restrictions on what is appropriate for the lunchbox, simultaneously, the weight issue has grabbed the attention of educators and the media. The result: the pendulum is beginning to swing toward better nutrition in some schools. This means a new focus on fruits and vegetables, which happens to dovetail neatly with concerns about allergens in the class, since those foods are not the top allergenic sources, and they won’t lead to accidental exposures.

The Institute of Medicine, a scientific advisory group based in Washington, produced a report in April, 2007 calling for a dramatic new approach to food in the classroom: no food as rewards; no food for celebrations. Then it ranked foods into tiers. Tier 1 is acceptable: fruits, vegetables, real juice, low-fat dairy, and nothing with trans fat.

These are the only snack foods to be allowed for elementary school children and fundraising efforts, while higher-fat and sugary Tier 2 food could be available for after-school activity for teens. No snack, though, should be more than 200 calories.

Next: Banning the cafeteria fryer