Back to School with Food Allergies

If your child has an IgE-mediated food allergy — such as to cow's milk, nuts or eggs that triggers an abnormal immune system response — the end of summer is a great time to reconnect with your child’s school to prepare for a safe school year.

Rushani Saltzman, MD, an attending physician with the Allergy Program at Children’s Hospital of Philadelphia (CHOP), advises parents of children with these types of allergies to take three important steps as the new school year approaches.

1. Review your child’s medical action plan

Review your child’s medical action plan, or plan of care, with your child's allergist to make sure it is up to date. Some medications and treatments are based on your child’s weight, so it should be reviewed and updated every year.

Once you’ve got a current medical action plan from your child’s allergist, share it with key people at your child’s school: the school nurse and the principal or administrator responsible for ensuring that the plan is followed by teachers and staff.

2. Provide the school nurse or other responsible staff with up-to-date medications

Connect with the nurse at your child’s school, or the staff member responsible for administering students’ medication, to make sure they are aware of your child’s health needs and know what to do in case of an accidental exposure to a food allergen. Provide the nurse with an unexpired twin-pack of epinephrine autoinjectors. Make sure the school has completed copies of any forms it requires for administering medication.

3. Build a partnership of care with key people at your child’s school

Meet with the school nurse, the principal and other administrators, and your child’s teachers to review your child’s health needs and discuss how the school will meet those needs. You want to build a partnership with these people to ensure your child’s safety while encouraging full engagement in the classroom and with peers.

Work with key people at the school to protect your child from exposure. Different schools address the needs of children with food allergies in different ways, and you want to be comfortable with the approach your child's school is taking.

• Where children eat is one element of the school’s plan for ensuring your child’s safety. Some schools have food allergen-free rooms for meals and snacks, for example, or reserved tables for children with food allergies. This is a helpful safety measure for younger children. As your child grows older and learns to eat safely at the same table as people without food restrictions, it may be better to have meals and snacks without this separation, for social reasons.
• Policies around food as part of classroom celebrations are another important consideration. Food-centered birthday and holiday celebrations can present risks for children with food allergies, so find out how the school handles these events. Some schools are working to shift the focus away from food as the highlight of these celebrations. Others coordinate with parents ahead of time so they can provide alternative foods free of allergens.
• Some classroom learning activities can present risks for children with allergies and should be avoided. Counting activities with peanuts or tree nuts are clearly off-limits to children with allergies to these foods. But other classroom materials can present a less obvious hazard. Some children’s modeling dough is made with wheat, for example. By developing a good relationship with your child’s teacher, you can raise awareness of these risks and help to find alternatives for the classroom or for your child.

The key to a healthy school experience for your child is the three-way relationship between you, the school and your child’s allergist. Your role is to help the school staff understand the medical advice from your child’s doctor and to help the school implement a plan that protects your child’s health without unnecessary isolation.

If you need help in conveying the allergist’s recommendations to your child's school, consider asking the allergist to step in with further assistance. If you are concerned about the school’s adherence to your child’s care plan, you can work with the school to develop an individualized health plan. Another helpful resource is a publication from the Centers for Disease Control and Prevention (CDC): “Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs.” You might want to share this link with school administrators.