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For a child with a severe, life threatening food allergy preparing for school isn’t just about new shoes and backpacks. Planning for a safe school environment requires a strong, cooperative team---the child, parents, school personnel and physician all working together. Each team member must be responsible, respectful, flexible and willing to communicate. Various schools have a variety of approaches. There isn’t just ONE way to accomplish the goal of keeping these students safe. The focus for all must be the health and safety of the student. The following information will provide at least some basic ideas to get the planning process started. Certainly the lists are not all inclusive--parents and school nurses and teachers will add more details to customize the plans for a student with severe allergy.
The Vermont Dept. of Education’s manual, Managing Life-Threatening Allergies in Schools has been developed under Vermont law Act 158 to assist schools with managing students with life-threatening food allergies. Guide booklets on 504 Development and Risk–reduction and management are also available from VTFAO by request.
START EARLY
Several weeks before school opens, make an appointment to meet with the school nurse. By mid August, most school nurses are spending time in their offices preparing for the return of students. Take your child with you and bring along any medications that will be kept in the school. Please do not wait until the first day of school (or even the day before the first day) as by then the nurse will probably be overwhelmed with the details of the school opening. A relaxed time for planning care for your child is much more likely to occur several weeks before school begins.
If your child is a returning student, medically stable and known to the school nurse , this meeting might be brief. However, new teachers, new schedules and a year of growth may require some changes in the student 504 Plan or Individual Health Plan. (There is a difference between a 504 Plan and an IHP) The plan should be reviewed and revised at this meeting.
Certainly when students are new to the school (or if the nurse is new) a longer meeting time to develop a Care Plan will be required.
ITEMS FOR DISCUSSION
It’s suggested that the following be addressed at the meeting with the parent, child and nurse before school begins:
· Introduce the student to the school nurse · Describe the allergy, usual exposure symptoms, treatment, most recent event · Does the student recognize symptoms which may indicate exposure? · Is the student able to verbalize to an adult that symptoms are present? What words does the student use? · Is the child aware of the need to avoid certain foods? Will he ask if a food is safe? · What is the plan for food at school? Only food from home? What about special events? Will parent provide a supply of “special safe treats” for teacher to use in such situation? · What about after school activities? Most school nurses are not available after school hours. · What about field trips? · Bring EPIPEN and any other prescribed medications that might be needed in case of an exposure. If possible, bring a current (within one year) Emergency Plan signed by the physician. · Will the student be carrying and self-administering their medications?
See “An Act Permitting Students to Possess and Self-Administer Emergency Medications”
The school nurse should be ready to discuss the following points with the student and parent so that a proper and inclusive plan can be developed.
· Will the classroom be allergen free? · Will the classroom teacher and nurse send a letter to all parents of students to explain classroom practices? · How will classmates be educated? · Will the nurse educate other personnel about the allergy, possible exposure symptoms and the Emergency Plan? This includes classroom teachers, special area teachers (music, art, PE), bus drivers, cafeteria personnel, playground aides. · How will cafeteria personnel get to know this student? Introduction? Picture? Cash/computer flag? · Who will be taught about how to administer the EPIPEN? · Where will EPIPEN(s) be stored? With student in fanny pack? In unlocked cupboard in Health Office? In classroom?
As a result of this meeting well before the opening of school, the nurse can develop an IHP. The IHP will include at least the following information and be available to all school personnel who come in contact with the student. (Severe allergy is one piece of health information that we DO want shared with others!)
· Specific ID of student, the allergy and brief history of symptoms · Detailed plan of action in case of exposure/ingestion--Emergency Plan · Signed physician order for any medication to be given in case of emergency · Listing of all emergency phone numbers for parents and physicians · School accommodations to keep child safe
When the Individual Health Plan is completed by the School Nurse, parents should review the plan. If a 504 Plan is developed, the plan should be reviewed by the parents and if accepted, than the school nurse, 504 Team and the parents should sign the plan. Parents and School Nurses should know that if an EPIPEN is administered, the child must be taken to the Emergency Room in an ambulance.
Avoidance of the allergen is the main goal. However, school nurses should be alert for ANY signs of anaphylaxis. Some of the symptoms of anaphylaxis are common complaints in a school health office--nausea, hoarseness, cough, hives. However, these symptoms in a student with known severe allergy demand prompt attention and may require initiation of the Emergency Plan for that child.
Lastly, school personnel should welcome a parent’s phone call or visits during the school year. Parents should feel free to contact the cafeteria manager to check on the safety of menu items or just to say that their child is buying the school lunch on a certain day and request that an adult visually check the child‘s tray. If parents have concerns about a field trip, call the school nurse to learn about what arrangements have been made. Such communications are reassuring to parents and serve to gently remind school personnel of the need for constant vigilance.
It is also helpful if parents mark their home calendar with EPIPEN expiration dates and supply the school with new EPIPENS as needed. If the student visits his allergist during the school year, please let the School Nurse know of any changes or updates in the medical plan.
The goal is health and safety of the student. Team work and planning is necessary. With good communication and cooperation, the young student will feel safe in school and can take full advantage of all the educational opportunities available.
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