By Meagan Gillmore
For most students, a water fountain can give refreshment. But for those with life-threatening food allergies, it could be a site of cross-contamination.
“Everything is a danger zone,” says Karen Rhebergen, a mother in Whitecourt, AB, whose daughter has a peanut allergy. Schools present unique challenges. Children aren’t always clean; traces of an allergen can travel easily. Peanut butter residue is particularly difficult to remove.
So is yogurt, causing some to say dairy allergies are more difficult to manage than peanut allergies. Both peanut and dairy products are common in school lunches, and these are only two of the top 10 food allergens identified by Health Canada. The others are egg, mustard, seafood, sesame, soy, sulphites, tree nuts, and wheat.
Anaphylactic allergies are life-threatening. Reactions take different forms, including hives, swelling, nausea, dizziness, headaches, and difficulty breathing. Survival depends on quick responses. People experiencing an allergic reaction need epinephrine—fast.
Everyone has a role to play in keeping children safe. Parents need to provide accurate medical information to school staff—it’s a legal requirement in some jurisdictions. Principals need to have individualized plans for each student who has allergies, again a legal requirement in some areas.
In Canada, every province and territory has some guidelines, whether laws or policies, for keeping kids safe at school. It’s impossible to keep every food that could cause an allergic reaction out of school, says Lilly Byrtus, the coordinator for the prairies region of the Allergy/Asthma Information Association. Both of her daughters have several life-threatening food allergies.
“Common sense indicates what is important and what is not important,” says Byrtus, who is also an educational assistant, noting how some discussions about bans can make one allergy seem more important than others. A middle-ground approach is usually more effective.
Teachers are very important because classrooms present numerous opportunities for allergic reactions, says Jan Hanson, author of Food Allergies: A Recipe of Success at School and founder of Educating for Food Allergies, a consulting company in Massachusetts that trains educators about this topic.
Prevention means more than telling a child not to eat or drink something they’re allergic to, says Hanson. Most reactions happen when someone eats something they think is safe or are exposed to an allergen unknowingly. “These allergic reactions happen accidentally,” she explains.
Students need to know how to explain what they’re allergic to, and treatment for allergic reactions. Some may wear MedicAlert bracelets. Students also need to be able to access their EpiPens® immediately. Their risk of dying increases the longer they wait before receiving an epinephrine injection. It’s strongly recommended they carry their EpiPens®.
If the student isn’t carrying it, they should have quick access to one at all times. The EpiPens® should not be kept in locked cupboards. Students should also not be left alone when they’re experiencing an anaphylactic reaction.
“Give them opportunities for age-appropriate control,” says Hanson. This could mean knowing to ask if they have questions about any food that’s used in school. But children can’t be expected to know about every potential danger. Parents may be the experts about how things work at home, but they don’t know how everything works in the class.
Prevention requires a plan. Surfaces need to be washed routinely; children should wash their hands when entering the classroom. Soap and water is the best. Baby wipes are also effective, says Hanson, but hand sanitizers do not remove allergens.
Other protective measures aren’t so obvious. Teachers “have to think a little differently,” says Marni Halter, a mother in Toronto who has two children with life-threatening food allergies. Teachers need to be careful when using food to teach lessons—even if they’re not using food, or if students aren’t eating anything.
Kids often use containers, like egg cartons or milk cartons, for crafts. These could be dangerous for children with egg or dairy allergies. Science experiments may use personal hygiene products, like shaving cream. These may contain dairy products or traces of nuts.
There’s been “very few instances where we haven’t been able to find a safe way to do whatever the teacher wants to do,” Halter says. Her children’s classes have used rice pasta for crafts—it’s safer for children who have wheat or egg allergies. She provided her son’s teacher with an allergy-safe recipe and separate dishes when his class made pancakes.
Field trips require extra care. Classroom handwashing routines can’t be followed; meals are harder to monitor. Teachers have a lot to watch out for on field trips, says Halter, so it may be easier for them to forget about allergy concerns.
Milking cows at a farm may be dangerous for a child with a food allergy, for example. Students who milk the cows will need to make sure to wash their hands when they’re finished. Often, parents will attend field trips with their children. But this means they’ll need notice to book time off of work.
Allergies affect more than a student’s ability to participate in learning activities. Food is a big part of a school’s social environment. Teachers need to “address the whole child [and] have procedures in place to protect the child’s physical and emotional safety and well-being,” says Hanson, citing studies that indicate children with food allergies are more likely to be bullied. Even if classmates aren’t making fun of them outright, children can feel excluded when they can’t fully participate in activities like birthday parties.
“It is very difficult to sit in a classroom that is a community, and yet for that community-building event, you’re not a part of it,” says Hanson.
Byrtus would make separate cupcakes that were kept for her daughters in the school freezer so they had something to eat at celebrations. “Little measures like that can make a world of difference in inclusion,” she says.
Often, parents whose children have allergies are willing to provide safe food for all students to enjoy. Food made specifically for the child with an allergy should be offered in a low-key way so they don’t feel like they’re being put on the spot.
Food can be eliminated from celebrations—some schools have policies against having outside food in the classroom. Even if it’s allowed, it’s not needed, says Heather Gardner, a fitness expert and former teacher with Ontario’s Hamilton-Wentworth District School Board. Classmates can write encouragement notes to students on their birthday. This goes “beyond just that instant moment” of eating a cupcake, Gardner says.
Teachers don’t need to use food as rewards, either. Fun classroom supplies like pencils, or activities like special games in the gym, eliminate risks for children with allergies—and can promote healthy living and build community.
All students should be involved in prevention. This means creating “a culture of kindness,” says Rhebergen. When teachers talk with students at the beginning of the year about how they’re going to treat each other, that’s a perfect time to address how they’re going to keep kids who have allergies safe, along with respecting everyone else. Students who want to be good friends will become advocates, says Byrtus, recalling how her daughters’ friends would ask their parents to make sure food at birthday parties was safe.
Living with a life-threatening food allergy can be stressful. Students respond to that anxiety differently. “I do believe each child has a sense of worry that they carry with them that they might be exposed, so that is a major emotional component of having a food allergy,” says Hanson.
Students’ responses change over time. Younger students may need close monitoring. Older students may engage in risky behaviour because they want to fit in, or think the food will be safe this one time. Teachers and parents can’t anticipate every challenge. But they can give students the tools to face them.
Meagan Gillmore is a freelance writer in Toronto, ON.
