Meeting Special Dietary Needs in Child Nutrition Programs

Life-Threatening Food Allergies
and Child Nutrition Programs
To identify requirements,
resources, and ideas for meeting
the needs of children with lifethreatening food allergies.
Laws and Regulations
Rehabilitation Act of 1973
Individuals with Disabilities Education Act
Americans with Disabilities Act (ADA)
U.S. Department of Agriculture's (USDA)
nondiscrimination regulation (7 CFR 15b)
FNS Instruction 783-2, Revision 2, Meal
Substitutions for Medical or Other Special
Dietary Reasons
What is the definition of Disability?
A condition that substantially limits one
or more major life activities; or
 A record of such a condition; or
 Being regarded as having such a condition.
EATING is a major life activity that can be
substantially limited by celiac disease.
BREATHING can be impacted by food
intolerances and food allergies.
 Special education
 IEP completed
 Accommodations
Section 504
Special education
not needed
504 plan
Laws and Regulations
Rehabilitation Act of 1973
Individuals with Disabilities Education Act
Americans with Disabilities Act (ADA)
U.S. Department of Agriculture's (USDA)
nondiscrimination regulation (7 CFR 15b)
FNS Instruction 783-2, Revision 2, Meal
Substitutions for Medical or Other Special
Dietary Reasons
School Requirements for
Children with Disabilities
Accommodation MUST be made
 A disability determination can only be
made by a licensed physician (or other
recognized medical authority)
 No extra charge
 In the most integrated setting appropriate
Required Statement For Children
With Disabilities
Signed by a licensed physician
Identify the disability
How it restricts diet
Major life activity affected
Foods to be omitted
Foods to be substituted
USDA Regulations and Guidance
Child with medical conditions that are NOT
disabilities are encouraged, but not required,
to be accommodated.
Some needs can be met through OvS.
Statement For Children Who
Are Not Disabled
Substitutions for non-disabled students
must be supported by a statement
signed by a recognized medical
authority such as:
physician assistants,
nurse practitioner,
other professionals specified by the State agency.
Statement For Children Who
Are Not Disabled (continued)
Identify the medical condition or special
dietary need
How it restricts diet
Foods to be omitted
Foods to be substituted
Nonacademic Services
7 CFR 15b.26
 Students
with disabilities MUST have an equal
opportunity to participate in nonacademic and
extracurricular services.
 Examples: physical education and athletics, food
services, transportation, health services,
recreational activities, special interest groups or
clubs sponsored by the recipient. Classroom
activities such as parties would fall under this
Food Allergy Awareness Protocol
Common Food Allergies
tree nuts (such as almonds, pecans, walnuts)
fish (such as bass, cod, flounder)
crustacean shellfish (such as crab, lobster,
Food Allergies
 Symptoms
 Anaphylaxis
Symptoms of Anaphylaxis
 Reaction time
 Most dangerous symptoms
Treatment for Allergies
 Epinephrine
 Prevention and Strict Avoidance
Food Intolerance
Definition: Food intolerance is an adverse
reaction to food that does not involve the
immune system.
◦ Lactose Intolerance
with Approval of
Food Service Dir.
◦ Allergies with the
potential of
◦ Allergies with no
◦ Celiac disease
◦ Food intolerances
Food Allergy Awareness Protocol
◦ Establish a building-based general Medical
Emergency Plan.
◦ Develop and implement an Individual Health
Care Plan for students with diagnosed lifethreatening allergies.
◦ Implement annual life-threatening allergy and
epi-pen training for appropriate staff.
◦ Restrict and/or control the use of food during
the school day.
Parent/Guardian Responsibility
Notify the school nurse or principal prior
to the opening of school each year.
 Have doctor complete the necessary
forms for foodservice prior to each year.
 Deliver/provide approved medications to
school nurse and replace when expired.
 Meet with school nurse and other school
staff to develop an IHCP and mode for
School Administrator Responsibility
Establish a basic Medical Emergency Plan
for the building for use in any medical
 Ensure that an IHCP for each child with a
life-threatening allergy is created and
 Establish a procedure for how and when
school staff should communicate.
School Nurse Responsibility
Develop an IHCP, corresponding Allergy
Action Plan and Medication
Administration Plan with
parents/guardians and school team.
 Arrange for periodic review of IHCP at
least annually.
 Provide education and training to all
need-to-know school staff.
Food Services Responsibilities
Attend training if required by IHCP.
 Follow safe food handling practices to
avoid cross contamination.
 Follow cleaning and sanitation protocol to
avoid cross contamination.
 With parent approval, set up procedures
for cafeteria.
 After receiving the approved statement,
make reasonable meal accommodations.
Food Service Assistants
Preventing exposure to allergens starts
in the kitchen.
• Read food labels.
• Know what to avoid and how to
• Designate allergy-free zones in the
• Follow safe food handling practices.
Food Service Assistants
Understand the allergy plan.
 Identify the students with documented
food allergies.
 Learn to recognize signs of anaphylaxis,
and know how to activate the school’s
emergency plan.
Cafeteria Host/Custodial
Attend training according to the student’s
 Following safe food handling practices and
cleaning and sanitation protocol to avoid
 Provide a clearly labeled allergen free
table for students if required by an IHCP.
 Respond appropriately to all
Peanut Free vs. Peanut Aware?
Students’ Responsibility
Do not trade food with others.
 Wash hands before and after eating.
 Do not eat anything with unknown
ingredients or known allergen.
 Be proactive in the care and management
of their food allergies and reactions.
 Notify an adult immediately if they eat
something they believe to contain the
allergen, and/or if they are having
Transportation Staff Responsibility
Provide a representative for school team
meetings to discuss IHCP as appropriate.
 Provide annual training for all school bus
drivers on managing life-threatening
 Provide functioning emergency
communication device.
 Know how to activate EMS.
 Maintain policy of not permitting food to
be eaten on school buses.
Meeting the Needs of All
Other Examples of DietRelated Disabilities
 Severe Food Allergies (anaphylaxis)
 Celiac Disease
 Phenylketonuria (PKU), other metabolic
 Epilepsy
 Emotional illness
 Heart disease
 Autism
 Use
food already purchased when
 May require special training
 May require professional help of a
 State agencies may be of assistance
Diet Restrictions can be hard…
Recipe Ideas…
Specialty Foods
Accommodating Children with Special Dietary Needs
in the School Nutrition Programs:
Incurring Additional Expenses; Potential Funding
School District’s General Fund
 Individuals with Disabilities Education Act
 Medicaid
 Supplemental Security Income (SSI)
Food Service Assistants
• Maintain communication among parents,
teacher, school nurse, food service, and
consultant if needed
• Understand the dietary restrictions
prescribed in the plan kept on file with the
school nurse
• Obtain and serve special formula or foods
• Follow prescribed portion sizes
• Report mistakes immediately
• Keep information confidential
Practical Applications
Baked chicken and baked potato or
steamed veggie with chicken and rice for
someone who has celiac disease. The
meal does not have to be exactly the
same as what is provided to others.
Allergy Scenarios:
Janet is making cookies for school lunch. Since
there are a few students with life threatening
peanut allergies, she is making peanut butter
cookies and sugar cookies. When the cookies are
finished baking, she uses a spatula to place the
peanut butter cookies on one serving tray and the
same spatula to place the sugar cookies on a
separate tray. During serving, Janet puts on a pair
of gloves and serves the students their choice of
cookie as they pass through the line. She
identifies the students with peanut allergies and
serves them only sugar cookies.
Alice is making ham and cheese
sandwiches for school lunch. She first
slices the cheese on the slicer and
then slices the ham. She first makes
the ham and cheese sandwiches, and
then because there is a student with
milk allergies, she changes her gloves
and makes ham-only sandwiches.
Tom is making peanut butter and jelly
sandwiches for lunch. When he finishes
preparing the peanut butter and jelly
sandwiches, he wipes off his knife and
then takes the knife, the jelly, and the
bread over to the kitchen’s allergy-free
zone and makes the jelly sandwiches
for the students with peanut allergies.
The cafeteria received a new shipment
of hotdogs for school lunch. Shirley
has served hotdogs several times to
the students with milk allergies, so she
does not read the label when she takes
the hotdogs out of the packaging.
Shirley then throws away the
packaging. She prepares the hotdogs
and puts them on the serving line.
Peter is taking out the milk to put it on the
line for lunch. He realizes that the cafeteria
is out of soy milk, which is usually served to
the two students who have milk allergies.
The list of appropriate substitutions for
these students states to use soy milk or
rice milk in place of cow’s milk. Peter
decides that these students will probably be
fine with lactose free milk as well, so he
puts that on the line for them to take.
Obstacles are opportunities to
expand our resourcefulness.
More Resources…
More Resources…