Question: What tips do you have for dealing with the school nurse about your child's allergies? What information should you provide to the school nurse? Many schools have a required medication form, but if your child doesn't need medication administered at school, and you still want the nurse to be aware of your child's food or other allergies, what's the best way to approach this?
Answer provided by Dr. Jeffrey Lehman who is Director of the Huff & Puff Allergy and Asthma program at St. John's Children's Hospital.
Answer: The prevalence of food allergy appears to be increasing. The avoidance strategies in place to keep a food-allergic child safe will often impact the entire classroom of children, particularly in the younger age groups. Many schools have chosen to designate classrooms as food or peanut-free. Others place restrictions on food brought in for birthday parties or implement bans on peanut products brought in by other children.
However, some schools have no restrictions and therefore sending a food allergic child to daycare or school can be terrifying for parents. They must trust that others will be vigilant in helping their child avoid contact with the problematic food, despite the realization that it is difficult to supervise or be aware of moment-to moment activities of any group of children. In addition, the widespread misunderstanding of food allergy among the general population generates both resentment from other parents and fear and confusion on the part of staff members. 
It is essential that the staff responsible for the safety of a food-allergic child are able to do the following:
• Recognize a food-allergic reaction.
• Access to epinephrine rapidly.
• Know how and when to use epinephrine.
Training a variety of staff members to administer epinephrine is recommended because most schools do not employ full-time nurses. Many schools are including epinephrine auto-injectors as part of the general first aid supplies.
Every child who has a food allergy requires a personalized management plan. Most schools will have standardized health forms for documenting food allergies. If not, easy to follow written instructions, recorded by the child's physician and signed by the parents, can also be used.
A personalized action plan should include:
• A recent photo of the child.
• List of foods to which the child is allergic.
• Signs and symptoms the child might experience during an allergic reaction.
• Appropriate treatment instructions from the child's physician.
• Emergency contact information.
Check out a sample Action Plan here.
Strategies for minimizing risks at school:
• No food trading.
• No food in classrooms.
• No home-made food allowed for class celebrations or parties.
• Designating the parent of the allergic student to be responsible for selecting food for class celebrations.
• Celebration of birthdays or other special events with books or music instead of food.
• Designated peanut or milk-free tables in the cafeteria.
• School-wide food allergy education.
• Children should be taught from a young age that teasing other children because of any medical condition is not acceptable.
Depending upon age and maturity level, food-allergic children should be taught the following:
• Not to trade food with other children.
• Avoid eating anything likely to contain the allergen or any food with unknown ingredients.
• Wash hands thoroughly before and after eating.
• Notify an adult immediately if they suspect they may be having a reaction.
• Know how and when to use auto-injectable epinephrine.
• Notify an adult if they are being bullied or harassed because of their food allergy.
Dr. Jeffrey Lehman is Director of the Huff & Puff Allergy and Asthma program at St. John's Children's Hospital.
He is employed by St. John's Hospital and practices Allergy/Immunology at Physician's Group Associates in Springfield. He is also a clinical assistant professor on the volunteer faculty for SIU School of Medicine. He is board certified in Allergy/Immunology, Internal Medicine and Pediatrics. The Allergy & Primary Immunodeficiency Clinic is for children who were born with an immune system that is not working correctly, often resulting in infections that are more severe and longer lasting. To schedule an appointment, call 217-698-9722, ext 231.
