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

It was a lazy afternoon in the residence common room – students were studying for classes, watching TV or simply hanging out with friends. Christine Creese was hungry and grabbed the phone to call a familiar number. Months earlier, the 22-year-old had discovered a local Chinese restaurant that would deliver to her dorm at the University of Toronto. Despite serious allergies to peanuts and nuts, as well shellfish, kiwi and onion – Creese was able to eat the restaurant’s delicious pineapple orange chicken.

On the phone, she went through her usual explanation of her allergies, and got an assurance that her favourite was safe from cross-contamination in that kitchen. “When it arrived, I put a whole piece of chicken in my mouth and suddenly realized that it tasted different,” recalls Creese. She spit it out, and called the restaurant back. The restaurant had accidentally sent the General Tso peanut chicken dish.

A tingling began in her mouth. Soon, Creese’s tongue was itchy and she became hot and flushed. Friends in the common room sprang into action: one called 911 while another had Creese’s EpiPen at the ready. Creese, a third-year student, used her asthma inhaler while others ran out to flag down the ambulance.

She was about to administer her EpiPen, when the paramedics arrived. Creese would end up needing two doses of epinephrine to bring her reaction under control, and spent the rest of the day in hospital.

Creese, now 24, is generally mindful of her medical condition. Before starting her undergraduate degree, she took precautions including asking for, and being given, a single room since it is difficult to enforce a peanut-free shared room, and she feels that “infringes on the autonomy of the other person.”

Food allergic students entering university this fall face a similar need to develop their own safety strategies while adapting to a new, big and autonomous school environment. Of course, any freshman has a lot to adjust to: moving away from home, living in residence, going to class in lecture halls and finding one’s way around campus.

But for those with life-threatening allergies, there is an additional layer of change – there are no parents around to explain to the professors about allergies as they did with the teachers in elementary school, and perhaps high school.

Even the most cautious student with allergies will find an environment of shared accommodations and cafeteria and residence meals an adjustment. And not every allergic student will be careful all the time – science has proven that the late teens and early 20s are a time of the most impulsive decision-making.

Throw into the mix the introduction of campus pub life, new friends and potential romantic interests, and university remains a time of learning inside the class and out. But for the allergic, it is also a time of managing a new level of risk and of learning to speak up for oneself.

With the number of teens entering university with allergies on the rise, many institutions are examining what sort of protective measures they can offer students.

The range of policies among universities and colleges is vast, but there are some encouraging advances. Carleton University in Ottawa has eliminated nuts from the residence dining hall menu and this spring became the third campus in Canada to allow its Student Emergency Response Team – a 24-hour service of volunteers trained in advance lifesaving techniques – to carry EpiPens. The practice began at McMaster University in Hamilton, Ont.

British Columbia’s University of Victoria takes one of the most proactive approaches. Three years ago, a group of students met the UVic administration to ask for improved options for those with allergies and food sensitivities. The university agreed that change was needed.

Of a population of 2,400 students who live in residence, 1,600 eat daily at campus cafeterias and restaurants. The number in residence who informed the university administration of allergies and other dietary restrictions grew to about 24 this year from three in the fall of 2005.

Traditionally, first year students at UVic live in residence, and would only move into cluster housing – a self-contained environment on campus – in second year. “We see it as the next level,” says Gavin Quiney, Director of UVic’s Housing, Food and Conference Services.

“But as we found more and more people presenting allergies, we thought this is too risky to involve them in the large institutional food program.” As a result, first-year students with severe allergies are being allowed to move into cluster housing.

So Eric Champagne, a 17-year-old Calgarian with tree nut, peanut and seafood allergies, is now living in such an apartment with two other young men with severe allergies. “Kudos to them for a great solution that goes a very long way in allaying our fears,” says Eric’s father, Gilles.