(a) Students with Special Health Care Needs Food Allergy Management Overview and Rationale

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1 (a) Students with Special Health Care Needs Food Allergy Management Overview and Rationale Food allergies are presenting increasing challenges for schools. The life-threatening nature of these allergens and their increasing prevalence, have created the need for school districts to be ready for the entry of students with food allergies. Accidental ingestion of the offending allergen occurs most often at school. Studies from the archives of Pediatric and Adolescent Medicine states that one in five children with food allergies will have a reaction in school. Moreover, the student with an undiagnosed food allergy may experience their first food allergy reaction at a school. Food allergy is an exaggerated response by the immune system to a food that the body mistakenly identifies as being harmful. Scientists estimate that approximately 11 million Americans suffer from potentially life-threatening food allergies. Of these 2 million are schoolaged children. At present there is no cure for food allergy and avoidance is the only way to prevent an allergic reaction. Delays in recognizing symptoms and not responding promptly or effectively have produced fatal results. Plans that focus on food allergy education, awareness, avoidance and immediate treatment of allergic reactions are critical to saving lives. Although an individual can have a life-threatening allergic reaction to any food, including fruits, vegetables and meat, over 90 percent of allergic reactions are caused by the following eight foods. These eight foods are peanuts, tree nuts (walnuts, cashews, pecans, hazelnuts, almonds, etc.) milk, egg, fish, shellfish, soy and wheat. Every food allergy reaction has the possibility of developing into a life-threatening and potentially fatal anaphylactic reaction. This can occur within minutes of exposure to the allergen. Allergic reactions to foods vary among students and can range from mild to severe anaphylactic reactions. Anaphylactic allergic reaction can involve one or all of the following body systems: skin, respiratory, gastrointestinal and cardiovascular. Ingestion of the food allergens is the principal route of exposure which leads to the allergic reaction. While it is also possible for a child to have an allergic reaction to tactile (touch) exposure or inhalation exposure, research has shown that they are extremely unlikely to result in severe or life threatening reactions. However, if the child touched the allergen and then put their fingers to their eyes, nose or mouth, the exposure becomes an ingestion and may cause anaphylaxis. There is no way to predict how serious any reaction will be. Therefore, all reactions must be taken seriously. Studies show that fatal and near-fatal anaphylactic reactions are sometimes associated with not using an epinephrine auto-injector or delaying the use of epinephrine treatment. When in doubt, it is better to give the epinephrine auto-injector, call 911 for an ambulance and transfer the child to the nearest hospital emergency department even if the symptoms appear to be resolved. Fatalities are more likely to occur when epinephrine administration is withheld. The key to preventing serious consequences is to react quickly to control the allergic reaction. In order to properly implement the Board policy pertaining to the management of food allergens, the following administrative regulations are hereby established:

2 (b) SCHOOL RESPONSIBILITIES 1. Each school shall establish a method of ensuring that relevant information is transmitted to all supervising persons of an identified student with food allergies, especially those which may be life threatening, such as peanut or other food allergies. 2. The primary concern of the school is the prevention, education, awareness and appropriate treatment of potentially severe allergic reaction. 3. The District and its school personnel shall not be responsible for determining food allergens and/or those foods or ingredients in foods that are safe to consume for a student with an identified food allergy. 4. The District will establish at least one allergy free table in each school cafeteria. This table will be washed with separate cleansing material and disposable paper towels known to effectively remove food proteins after each lunch period. Parents who do not wish their child to sit at this table must request this in writing to the Director of Food Services. 5. A no-food and no utensils trading/sharing policy within the school will be encouraged. A sign is to be posted in all cafeterias informing students that they are expected to neither trade nor share food or utensils. 6. The District will not knowingly make use of peanuts, peanut products, tree nuts and tree nut products for instructional purposes. 7. The District will provide training for designated staff in basic first aid, resuscitative techniques and in the use of epinephrine auto injections. These trained personnel will know the location of emergency medical equipment and 911 policies. 8. An emergency qualified staff member will be available in each school during the school day. 9. The District along with the bus transportation company will enforce a No Eating Policy on school buses with exceptions made only to accommodate special needs students under federal or similar laws, or by school district policy. In addition, the bus company will maintain communication devices in case of emergencies. 10. The administrator of the building informs the nurse of the monthly calendar events, especially all after school activities and intramural programs.

3 (c) PARENTS/GUARDIANS RESPONSIBILITIES 1. Parents will be encouraged to inform the school nurse of their child s allergies prior to the opening of school or as soon as a diagnosis is made by a physician. 2. Parents of children with life threatening food allergies are expected to provide written medical documentation and instructions from the student s health care provider. 3. Parents are expected to provide the school nurse with the proper authorization for administration of medications form and emergency response protocol. This document shall be signed by the physician and parent. 4. Parents are expected to participate in developing an Individualized Health Care Plan (IHCP) and Emergency Care Plan (ECP) with the school nurse and school team. The Plans will be reviewed annually and revised as needed. 5. Parents are expected to provide the school nurse with at least two up-to-date epinephrine auto-injectors. 6. Parents will be requested to provide a recent photograph of the student to help food service/cafeteria staff and substitute school personnel easier recognition of the student. 7. Parents are expected to be responsible for determining food allergens and/or those foods or ingredients in foods that are safe to consume for a student with an identified food allergy. 8. Parents are expected to provide the school nurse with a list of foods and ingredients to avoid. 9. Upon request, parents may review menus and ingredients used in school lunches in order to select safe foods for their child. 10. Parents are expected to review the list of student responsibilities with their child and be sure he/she understands their role. 11. Parents will be asked to go on their child s field trips when possible. 12. Parents will be encouraged to provide a medical alert bracelet for their child. 13. Parents are expected to provide non-allergy snacks for classroom events, i.e., birthday parties. 14. Parents are expected to provide the school nurse with updates on their child s allergy status annually and as needed.

4 (d) STUDENT RESPONSIBILITIES The role that students with life-threatening food allergies play in staying safe at school will increase as they become older. Younger children cannot be expected to assume the same responsibility for their safety as older children can. 1. Students will be taught to recognize symptoms of an allergic reaction. 2. Students will be expected to promptly inform an adult as soon as accidental exposure occurs or symptoms appear. Ask a friend for assistance if an adult is not available. 3. Students will be expected to follow safety measures established by their parent(s) /guardian(s) and school team at all times. 4. Students will be expected not trade or share foods or utensils with anyone. 5. Students will be expected not to eat any food item that has not come from home or been approved by their parent or guardian. 6. Students will be expected to wash hands with soap and water before and after eating to prevent cross contamination. Hand wipes may be used when soap and water are not available. Hand sanitizers are not effective for removing food allergens. 7. Students will be encouraged to develop a rapport with the school nurse and/or another trusted adult in the school to assist them in the successful management of the allergy in school. 8. If approved by their parent and the school nurse, students will carry their epinephrine auto-injector at all times. 9. Students will be expected to report any instances of teasing or bullying to an adult immediately. SCHOOL NURSE RESPONSIBILITIES (HEALTH OFFICE) 1. Prior to the start of the school year, each clinic will have an adequate supply of epinephrine for unidentified as well as identified allergic reactions. The school medical advisor authorizes yearly standing orders for epinephrine administration, BOE policy (a). 2. Prior to entry into school, or as soon as possible after a diagnosis of a life-threatening allergic condition, the school nurse will meet with the student s parent/guardian to develop an Individualized Health Care Plan (IHCP) and Emergency Care Plan (ECP).

5 (e) 3. The parent is responsible for providing the school with the administration of medication form signed by the health care provider and parent. Parents should provide any information sheets or protocols from the physician that will assist in the development of the IHCP. The school district is not responsible for researching, developing, implementing, updating or otherwise drafting a written plan for the student whose parent/physician do not submit on an annual basis a completed Anaphylactic Treatment Plan and Permission for Administration of Emergency Medication By School Personnel form. 4. Once the IHCPs and ECPs are developed, this information should be shared with the student s teachers and each teacher s responsibilities will be clearly defined. Other staff members who have contact with students with life-threatening allergies should be familiar with their IHCPs and ECPs on a need-to-know basis, including the principal, school medical advisor, specialists, food service personnel, paraprofessionals, physical education teacher, art and music teachers, custodian, bus driver, technology personnel and librarian. 5. At the elementary level, the EpiPen, if prescribed or ordered by the student s physician, may follow the allergic student during his/her school day in accordance with the students administration of medication plan. For older students the nurse is responsible for determining whether the child is capable of self-administration per BOE Regulation (c) (f). 6. Stored emergency medications must be easily accessible to the nurse and other designated staff. Each school in the district needs a location for the EpiPen which is safe and accessibly located. Location of the student s EpiPen should be written in the student s ICHP and ECP. 7. If an EpiPen is administered, 911 must be called and the student transported immediately to the closest Emergency Room. School personnel shall call ahead to the facility to alert them that a patient is enroute. If the ambulance has arrived and the parent has not reached the school and plans to meet the ambulance at the hospital, arrangements should be made to have a staff member accompany the student. This person should not be the school nurse, her responsibility remains with the students in school. If the child is over 18 years of age a staff member must still accompany the student if a parent is not present. Ambulances are equipped and able to administer a second dose of epinephrine if necessary. 8. The nurse shall instruct designated staff with EpiPen injection techniques per BOE Policy (a). 9. In the development of the ECP the school nurse needs to consider access to medication during fire drills, lockdowns, field trips, etc. The nurse must be sure communication systems within the school (i.e. walkie-talkie) and during off-site activities (i.e. cell phones or radios on school transportation and field trips) are available.

6 (f) 10. The school nurse is responsible for updating the school wide medical emergency list and substitute school nurse folder. Current IHCPs and ECPs will be stored in this folder. 11. The school nurse shall continue to update her knowledge of applicable federal laws and their implications such as ADA, IDEA, 504, FERPA and HIPPA, etc. 12. The school nurse shall notify the District Food Services Director regarding the names of students with a food allergy, the parent shall provide a photograph of the student for ease of identification and to assist the food services staff in developing an avoidance plan. CLASSROOM TEACHER RESPONSIBILITIES 1. Teachers shall participate in the development of the student s IHCP and ECP as a core team member. 2. Teachers shall be provided with a copy of the IHCP and ECP which will be kept easily accessible in the classroom with the lesson plan. A copy will be kept in the substitute teacher plans. The teacher will inform volunteers, student teachers and paraprofessionals of the student s life threatening food allergies. 3. Teachers shall always act immediately and follow the ECP if a student reports signs of an allergic reaction. 4. Allergenic foods will not be allowed in classrooms for instructional purposes. 5. Teachers shall consider coordinating with a parent and school nurse in developing a lesson plan about food allergies and anaphylaxis in age appropriate terms for the class. Peer education is a critical component of food allergy management. As students with food allergies and peers mature, it is often the children themselves that first recognize a reaction and summon help. 6. Teachers shall educate classmates to avoid endangering, isolating, stigmatizing or harassing students with food allergies. The teacher shall use this opportunity to teach community caring and enforce rules and policies about bullying and threats. 7. Teachers shall be encouraged to use non food related alternatives to celebrate developmental milestones and student accomplishments. 8. Teachers shall inform parents of children with life threatening allergies of any school events when food will be served. 9. Teachers shall collaborate with the school nurse and parents prior to planning a field trip in order to: a. Plan ahead for risk avoidance at the destination as well as during transportation; b. Review plans when selecting field trip destinations; avoid high-risk places;

7 (g) c. Ensure the epinephrine auto injector and instructions are taken on field trips and remain with the student or in the care of the trained adult during the course of the trip; d. Ensure that functioning two-way radio, walkie-talkie, cell phone or other communication device is taken on field trip; e. Consider eating situations on field trips and plan for prevention of exposure to the student s life-threatening food allergy. For example, if a meal is to be consumed on the bus, parent notification must include the specific allergen that must not be part of any student s lunch; f. Consider ways to wash hands before and after eating (e.g. provision of hand wipes, etc.); g. Know where the closest medical facilities are located; h. Invite parents of a student at risk for anaphylaxis to accompany their child on field trips, in addition to the chaperone. However, the student s safety or attendance must not be conditioned on the parent s presence. FOOD SERVICE AND SAFETY RESPONSIBILITIES Generally children with food allergies or intolerances that are not life threatening do not have a disability as defined under either Section 504 of the Rehabilitation Act or IDEA. Therefore, school food service may, but are not required to, make food substitutions. Any substitutions made would require a completed Medical Statement for Children without Disabilities to be on file. However, if a licensed physician determines the food allergy is severe enough to result in a life-threatening (anaphylactic) reaction, the school food service program must make the substitutions prescribed by the physician, even if the child is not considered disabled under Section 504 or IDEA. In this case, the Medical Statement for Children with Disabilities form must be completed and on file. Collaboration with food service staff is essential to assist the student with life threatening food allergies to participate in the school meal program. With documentation from the student s health care provider, meal substitutions must be made to ensure that students are provided with food choices that avoid certain foods. To the extent possible, school food service staff should provide parents with food labels so that they can identify and approve foods their child may select for meals. 1. The School Food Service Director has the responsibility to ensure school food service facilities are operated in compliance with state and local regulations. School food service employees are to be provided annual training on issues and concerns regarding food allergies in the school environment.

8 (h) 2. Food service personnel shall be instructed by the Director of Food Services about necessary measures required to prevent cross-contamination during food handling, preparation and serving. 3. Parents/guardians shall be encouraged to review/preview menus. Information regarding the ingredients of the school lunch will be provided, upon request, by the Food Services Director to parents/guardians, student and staff. Copies of menus will be provided in advance to parents as requested. 4. At least one allergy free table shall be made available to students with identified food allergies in each school cafeteria. 5. The allergy free table shall be washed with a disinfectant solution and dried with paper towels prior to the first lunch and after each following lunch period. Ingredients of disinfectant must be checked to assure that it does not contain any peanut oil. 6. The names of those students who have life threatening food allergies shall be posted in the kitchen along with their photos and food allergy. This posting should be placed where it can be viewed by kitchen staff only. 7. Food service staff may participate in the team meetings of students with life threatening food allergies. 8. Food service personnel shall avoid the use of latex gloves. 9. Food service personnel shall use intercom, walkie-talkie or other communication device available to contact the nurse in an emergency. RESPONSIBILITIES OF COACHES AND ON-SITE PERSONNEL (After-school activities) 1. Coaches shall participate in team meetings as necessary to determine how to implement students Individualized Health Care Plan. 2. Coaches shall conduct sports and after school activities in accordance with all school policies and procedures regarding life threatening allergies. 3. Coaches shall have a copy of the Emergency Care Plan and necessary student EpiPens available for all students with life threatening allergies. 4. Coaches shall make certain that emergency communication devise (e.g., walkie-talkie, intercom, cell phone, etc.) is always present. 5. Coaches shall ensure that at least one person trained to administer an epinephrine autoinjector is present during sporting activities. 6. Coaches shall know EMS procedures and how to access the EMS system from the site of the after school activity or event.

9 (i) 7. Coaches shall remind the student to replace his/her medical alert identification (bracelet) immediately after the activity is completed if for safety reasons it needs to be removed during a specific activity. SCHOOL MEDICAL ADVISOR RESPONSIBILITIES 1. Medical advisor shall provide consultation to and collaborate with school nurse(s) on clinical issues and protocols which may include:! Standing orders for emergency medication including epinephrine; and! Policy recommendations for emergency interventions (for known and unknown reactors) in cases of anaphylaxis. 2. Medical advisor shall guide the district in the development of procedures for prevention of anaphylaxis and emergency planning to ensure safety without undue interference with a child s normal development or right of others. 3. Medical advisor shall participate in staff training regarding life-threatening food allergies. 4. Medical advisor will attend IHCP planning meetings when requested by the school administrator. 5. Medical advisor shall assist in the development of educational programs for student to promote wellness. 6. Medical advisor shall facilitate community involvement by encouraging development of and participation in school health advisory committee or health school policy team. 7. Medical advisor shall communicate with other community physicians regarding school district policy, procedures and clinical protocols for managing food allergies. 8. Medical advisor shall act as a liaison, if necessary, with the media should controversies or opportunities for education occur. MONITORING EFFECTIVENESS OF DISTRICT PLAN AND PROCEDURES Ensure periodic assessments of the effectiveness of the District plan and procedure. Assessments should occur:! At least annually with the school district team;! After each emergency event involving the administration of medication to determine the effectiveness of the process, why the incident occurred, what worked and did not work in the District plan and procedures; and! Include new research and practices in the annual review of the plan and procedures. Regulation adopted: August 10, 2006 STONINGTON PUBLIC SCHOOLS Stonington, Connecticut

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