School Lunch: Nut Allergies
The brown-bag favorite — peanut butter and jelly — can be a death sentence for some kids. Here’s how schools in the nation’s heartland are keeping students with nut allergies included in activities and out of harm’s way.
When first-grader Gavin Meyers walks into the lunchroom at Valley Christian Academy in Aurora, Ohio, everyone — teachers, cafeteria workers, students — knows the drill. Gavin is seated at one end of an eight-foot-long table, along with friends who have nut-free lunches. Any classmates who have brought peanut butter and jelly sandwiches or other nut products from home are moved to the far end. A separate pail and rag is used to wipe down Gavin’s table, before and after he eats, and all children must thoroughly wash their hands before leaving the lunchroom.
For Gavin, who is severely allergic to peanuts and tree nuts, these are life-and-death precautions. If he is even exposed to peanut residue and doesn’t immediately take an antihistamine such as Benadryl, his lips will swell up and his throat will begin to close. And if the Benadryl doesn’t work, Gavin must be treated with epinephrine — administered through an auto injector, EpiPen — or he’ll go into anaphylactic shock, a reaction that affects multiple systems of the body. It can be fatal.
“As soon as Gavin tells me, ‘Mommy, my throat feels funny,’ I know I’ve got 10 seconds before he goes into shock,” says Gavin’s mother, Kathy Meyers. Her son’s allergies are manageable when he’s home, because she doesn’t have anything in the house that might trigger an allergic reaction. But keeping a child like Gavin safe becomes a major concern when he goes to school.
The number of children with food allergies is on the rise, according to the Food Allergy & Anaphylaxis Network (FAAN). FAAN estimates up to three million Americans suffer from peanut or tree nut allergies, most of which are severe. And, The Journal of Allergy and Clinical Immunology reports that allergic reactions account for more than 30,000 emergency room visits annually. Peanut and tree nut allergies are the cause of most of the 150 to 200 allergy-related fatalities each year.
The increase in allergies is often blamed on overly processed foods and diet changes, according to Anne Munoz-Furlong, CEO and founder of FAAN. “But no one is really certain,” she says. FAAN is currently doing a study to determine what is causing the number of severely allergic people to rise. But whatever the cause, parents must work closely with schools to protect their allergic children from exposure.
An Ethical Decision
Lucy Villa’s son, Mark, was severely allergic to peanuts. As a student at St. Barnabas Catholic School in Northfield, Ohio, Mark ate lunch at a designated “no-nut” table. The school also made an effort to limit Mark’s contact with peanuts in his classroom, asking parents to refrain from sending lunches or snacks that contained peanuts. Even with these precautions in place, when Mark was in third grade he had an anaphylactic reaction to something on the playground that sent him into cardiac arrest. His mother says they still don’t know what caused that reaction. Four years later, in June 1998, after taking a small bite of what he thought was a sugar cookie served at his school’s piano recital, Mark died. The cookie contained peanut butter.
After Mark’s death, St. Barnabas went totally nut free, according to Beverly Tabacco, who took over as principal at that time. She says she made the “no nut” decision because “ethically, it was the only right one.”
“People sort of feel that an allergy is just an allergy — that it’s no big deal. But we at this school know it is a big deal,” Tabacco says. A total of 786 children, in kindergarten through eighth grade, attend St. Barnabas. Eleven students currently suffer from nut allergies, including three who have just entered kindergarten.
The school’s cafeteria serves nothing containing nuts, and all parents are asked to read labels and avoid packing anything containing even trace amounts of nut oils in their children’s lunches. At the beginning of the school year, a letter is sent home to parents whose children have a classmate with a peanut and/or tree nut allergy. Included is a list of commercial name brand nut-free snacks parents can choose from and the option to order snacks, like Popsicles, directly from the school’s cafeteria. The school nurse goes over all the specifics again at the school’s annual open house.
All staff is retrained yearly in the use of the EpiPen, as well as the signs and symptoms of an allergic reaction. And in the cafeteria, a table set off to the side is designated “nut-free” in case an item containing nuts is accidentally brought in. “The kids are pretty good at alerting someone right away when something is brought in by mistake,” Tabacco says.
“Every year, we get one or two complaints from new parents about how restrictive our no-nut guidelines are. They usually tell me their child won’t eat anything but peanut and jelly sandwiches for lunch. But when we explain the gravity of these nut allergies — that it’s a life-and-death issue for these children — these parents seem to understand why we have to do it,” says Tabacco.
Since the school became nut free, no allergy-related 911 calls have been necessary. Lucy Villa appreciates what St. Barnabas has done since her son died and says she bears no ill will towards the school for what happened, insisting that she and the school were doing the best they could. “There was no negligence involved. I was standing right next to him when he ate that cookie, and I couldn’t save him,” she says.
A Multi-Faceted Approach
“The Meyers family would’ve liked us to become a no-nut school, but we didn’t go that route because we felt we couldn’t guarantee it,” says Connie Eide, principal of Valley Christian Academy, which has 307 students from kindergarten through sixth grade. Like St. Barnabas, Valley Christian is a private school and is not required by law to do anything to accommodate a child’s food allergies. Even still, Eide says it was important for the school to do as much as it could, without creating “an undo burden on the rest of the school,” or making Gavin feel isolated — something that was also very important to his mother.
In the beginning of the year, a letter went out to all parents asking for their cooperation. Food service staff scoured food labels, switching brands if a nut-free alternative product was offered. Safe foods for Gavin include pizza, all-beef hot dogs, fruit snacks, Rice Krispies Treats, and fresh fruits and vegetables. Eide says she has not received any complaints about the new guidelines, only a lot of questions about whether certain food items were safe.
The cafeteria continues to offer peanut butter and jelly sandwiches but makes those after the jelly-only sandwiches are prepared for Gavin’s entire class, using disposable parchment paper and disposable gloves, as well as the “Gavin-specific” knife.
“If Gavin orders lunch, we prepare his tray ahead of time and put it aside to avoid cross-contamination,” says kitchen coordinator Linda Barrows. After use, his tray is kept separate from the others. Barrows says whenever Gavin orders lunch from the cafeteria, she rereads the label of whatever he’s ordered “just to double check, to make sure it’s nut free.” This practice has proved valuable. After Gavin ordered pancakes for the first time, Barrows reread the pancake mix’s label. “The small, small print at the very bottom of the pancake label stated, ‘This mix was processed on the same machine that processes tree nuts,’” she says. Gavin’s order was switched from pancakes to pizza.
An EpiPen is kept in a fanny pack that follows Gavin around — to the lunch room, music room, art class, gymnasium, and playground — on the waist of the teacher or adult monitoring his class. The school nurse trains all staff members in EpiPen use.
The only close call Gavin had in kindergarten, Eide says, was on a class field trip to an apple orchard. Kids were told to collect nuts from underneath a walnut tree. “Before he touched a single walnut, Gavin’s teacher got him out of there so fast and ran him to the bathroom to wash his hands,” Eide says. “And then she took the rest of the class into the bathroom to wash their hands too.” No one was allowed to bring any walnuts home as souvenirs.
“We’re just feeling our way through all this,” Eide comments. “So far, so good.”
A Few Safe Changes
For public schools, the United States Department of Agriculture (USDA) Food and Nutrition Service offers guidelines for accommodating allergic children. If a child’s allergy is non-life threatening, the school food service is under no obligation to make food substitutions. But if a child’s allergies are considered life threatening, “the child’s condition would meet the definition of disability and the substitutions…must be made,” the USDA guidelines state.
In a suburb southeast of Cleveland, Ohio, Aurora City School District nurse Sandra Petti says there are 20 severely allergic children out of 2,500 students in the Aurora schools. The district has been able to keep these children safe by changing relatively few things. The cafeterias switched to self-contained peanut butter packs and started serving celery sticks with ranch dressing instead of peanut butter. Certain crafts, like the pine cone bird feeder filled with peanut butter and bird seed, are no longer made in school.
“We haven’t had a parent ask for a peanut-free cafeteria or ask to have their child placed at a peanut-free table, but that’s certainly a possibility,” Petti says. “The government requires us to provide a free and appropriate public education for all kids. We’re doing all we can to help these families so that it doesn’t come to the point where parents feel their only recourse is to file a complaint under the American Disabilities Act.”
Each year, teachers, aides, cafeteria staff, and bus drivers are trained in the use of EpiPens and briefed on the emergency medical records of all severely allergic students. Petti says Aurora hasn’t had any allergy-related emergencies.
“Aurora schools have been able to keep our severely allergic students safe without going totally peanut free,” says Petti. She feels success is achieved by working in partnership with the students who have food allergies and their parents.
FAAN’s Munoz-Furlong says a school can never really be totally nut-free. “Claiming you are totally nut free gives a false sense of security to parents,” she says. “A better way to handle it is to keep it top of mind and remain absolutely diligent.”
For St. Barnabas parent Marge Venczel, the school’s attempts at protecting her two boys, who are severely allergic to peanuts, is “a Godsend.” But starting all over again in high school scares her. To that end, both Munoz-Furlong and Petti feel strongly that the most important thing parents can do is teach their allergic children the art of avoidance.
“Once these kids go out into the world, there’s only so much a parent or school can do to protect them,” says Petti. “Their best defense is to learn to avoid foods with ingredients they don’t know and to avoid places that might serve food with ingredients that are dangerous to them.”