Planning for School with Food Allergies
A food allergy diagnosis can be emotional for parents of school-age children. They are understandably worried about their child’s safety at school. And with good reason: a variety of foods and even some school supplies could potentially trigger a serious allergic reaction.
What can you and the school do to plan for food allergies at school? Education, advance planning, and clear communication with school staff and other parents about food allergies are the best ways to ensure your child is safe.
How do I prepare for the school year when my child has food allergies?
First, let the school know right away if your child is diagnosed with a food allergy. This allows the nurse, teachers, cafeteria staff, and other school personnel to take the necessary precautions – including avoiding that food – to help keep your child safe.
Work together with school staff to create a safe, supportive environment for children with food allergies.
- Make a plan to update the school with any new information about your child’s condition. Inform staff if your child had a severe allergic reaction outside of school.
- Make arrangements to see your child’s pediatrician or allergist during the summer (before school starts). Ask for a refill on medication and updates to their medication forms and Allergy and Anaphylaxis Emergency Plan, if needed.
- Check the expiration date on epinephrine products that your child is taking to school. Mark this date on your calendar and be ready to obtain updated medication when needed.
- Ask your child’s doctor for a letter or note identifying your child’s food allergy. Give it to the school nurse, teachers and the food service department. Include and any potential food substitutions or alternative food products. (For example, if your child has a milk allergy, you may want the school to substitute juice or water.)
- Make an appointment to meet with school staff, preferably before the beginning of the school year. Discuss your child’s allergy with the school nurse, teachers, coaches (if your child is involved in athletics) and other school staff. Discuss any accommodations that your child may need – in the classroom or cafeteria, as well as while on field trips.
- Drop off forms, medication, and your child’s Allergy and Anaphylaxis Emergency Plan with school health officials. Consider providing the school with written permission to call your child’s pediatrician with any food allergy questions.
- Review with your child what to do if severe symptoms occur. Demonstrate how to correctly take emergency medication, if age-appropriate. Be sure your child knows when to get help and who to go to in an emergency.
How to prepare a child with food allergies for kindergarten?
Starting kindergarten is an exciting milestone, but it can also feel overwhelming when your child has food allergies. This video from food allergy mom Amanda Eisen walks you through simple steps to prepare – from meeting with school staff to creating an action plan – so your child can start school safely and confidently.
Treatment for a food-allergic reaction at school
Food-allergic reactions can be mild or severe. A mild reaction involves one body organ and may involve skin hives on the mouth or an upset stomach. Parents should talk with their child’s doctor about treatment. The doctor may recommend you provide the school with antihistamines.
But remember – even if your child usually develops only mild symptoms, the school should still monitor the child for a severe reaction. Mild symptoms can progress to severe at any time and require emergency treatment.
Epinephrine is the first-line treatment for severe allergic reactions, or anaphylaxis. Use epinephrine first, epinephrine fast. Any delay in treatment could increase the risk of worsened symptoms and a fatality. Epinephrine products include a nasal spray, a pre-filled auto-injector, a strip of film that is placed under the tongue, or a vial that can be used to fill a syringe.
Many schools have emergency supplies of stock epinephrine on site. Speak with the school health official about where stock epinephrine is kept. Is it easily obtained in an emergency? Quick and easy access is important in a life-threatening emergency.
You may prefer that your child self-carry epinephrine. This is permissible under federal and state laws. Talk with your child’s doctor and school staff about whether your child is mature enough to self-carry and self-administer. Make sure your child carries two doses of epinephrine in case symptoms come back or worsen.
Federal and state laws on epinephrine
The School Access to Emergency Epinephrine Act permits trained school staff to give epinephrine to anyone having a life-threatening allergic reaction. The law also allows schools to stock emergency supplies of epinephrine in an easily accessible and secure location.
All 50 states allow students to self-carry and administer epinephrine in school. If your age-appropriate child needs to self-carry epinephrine, make sure to coordinate with the school nurse and/or teachers.
How schools can obtain epinephrine
EpiPen® is available through the EpiPen4Schools program. This program provides free epinephrine auto-injectors for schools.
The epinephrine nasal spray neffy® has a school program to provide eligible public and private K-12 schools in the United States with free stock neffy devices. Participating schools receive two cartons (four single-use doses), with replacement doses available as needed.
Managing food allergies at school
Most schools are familiar with supporting students who have food allergies, but every child’s needs are different. After you have shared key food allergy information with the school and met with staff, talk with your child about ways to prevent food-allergic reactions and other issues at school.
- Create safe routines. Help your child understand how to avoid allergens – from not sharing food to reading labels when possible. Work with the school to ensure safe snacks and precautions are in place for class activities, field trips and celebrations.
- Teach self-advocacy skills. Encourage your child to speak up if they feel unwell or think they’ve been exposed to an allergen. Practice what to say in an emergency and who to tell right away. Young children can learn simple phrases like, “I can’t eat that” or “I don’t feel good.”
- Encourage your child to fully participate in school activities. If your child ever feels excluded or bullied because of their allergy, contact the school for appropriate action.
- Check in with your child at the end of each school day. Find out if your child experienced any problems managing food allergies.
- Keep communication open. Stay in touch with the school nurse, teachers and coaches throughout the school year. Regular communication helps ensure your child feels safe, included, and confident.
Are students with food allergies bullied?
Studies show children with food allergies are at higher risk of being bullied. This can include teasing, exclusion from activities, or even dangerous behavior like waving or threatening them with allergenic foods. Such actions can cause emotional distress and put the child’s health at serious risk.
Raising awareness among students and staff, along with clear anti-bullying policies, can help create a safer and more supportive environment.
What parents can do
- If you suspect bullying, talk to your child. If they are reluctant to talk, ask leading questions to open the conversation.
- Let your child know that if they see bullying or if they experience it, it’s important to talk about it with you, a school staff member or a sibling.
- Talk about how to stand up to children who bully. The best defense is to remain calm, ignore the remarks, tell the bully to stop and simply walk away.
- Don’t try and fight the battle alone. Talk to school professionals about how to protect your child.
What schools can do
Establish and enforce consequences for bullying. Combine sanctions with supportive interventions that encourage positive behaviors.
Put anti-bullying policies in place – make it a school responsibility to resolve conflicts in a positive manner.
Teach specific skills and values in the classroom. Teach children how to problem solve.
How do schools manage food allergies?
Schools play a vital role in keeping students with food allergies safe and included. A clear, well-communicated plan helps create a safe and supportive learning environment.
Food allergy management at school has four major components:
1. Planning and coordination of care
The school needs to identify the students with food allergies and obtain a written statement from the doctor to confirm the allergy. (There can be confusion about whether a child has a food intolerance or true allergy). The school should coordinate with the teachers, cafeteria staff and family to be sure that medication is at school, food substitutions are available, and measures to prevent exposures are in place.
No matter how prepared the school is to prevent allergic reactions, the staff needs to be ready to deliver emergency care if needed.
2. Educating staff, students and families
The school should provide evidence-based information on food allergies to all school staff, students and families, including:
- Signs and symptoms of an allergic reaction
- Prevention strategies to prevent exposures
- How to administer the Allergy and Anaphylaxis Emergency Plan
- Understand federal laws that protect children including FERPA and Section 504
3. Providing a safe environment
Schools should be aware of potential allergens in classrooms, in the cafeteria, on field trips and at special events. They should develop strategies to prevent allergen exposures.
Policies and procedures need to be in place to protect all children at school.
4. Prompt emergency response
Any staff member who supervises a child should know how to identify a serious allergic reaction, get help, and administer the action plan. Staff should know how to reach the school nurse or designated responder, how to access and administer epinephrine to a child, and what to do following an anaphylactic reaction.
What should a school food allergy plan include?
A good plan for managing food allergies at school should involve:
- Clear rules and steps the school will follow to prevent food allergy reactions and treat food allergy emergencies.
- A written allergy plan that includes ways to avoid the allergen, what symptoms to watch for, how and when to give medication, and what to do in an emergency.
- Education for staff (and fellow students, if age appropriate) about preventing exposure to allergens, what an allergic reaction looks like, and what to do if someone is having a serious allergic reaction.
The school should make sure that teachers, cafeteria staff, and other school staff members are aware of your child’s allergy. Work together to make sure:
- Epinephrine is available at school and easy to access.
- Safe food choices are available.
- Steps are taken to prevent exposure to the allergen.
- A treatment plan is in place of a serious allergic reaction.
- Every staff member knows what steps to take in food allergy emergencies.
Does federal law require schools to accommodate children with food allergies?
Yes. Section 504 of the Rehabilitation Act of 1973 is a federal law protecting students with disabilities, including those with food allergies. The law applies to schools because they receive money from the federal government. Section 504 describes accommodations for children with disabilities to attend school and have full access to school programs and activities.
Should schools ban peanuts?
The question of whether schools should ban peanuts and peanut products is often debated among parents, educators and health professionals. For some children with peanut allergies, even a trace exposure can cause a severe and potentially life-threatening reaction. This makes prevention a top priority.
Proponents of peanut bans say that removing peanuts from the school environment reduces the risk of accidental exposure and provides peace of mind for families. However, some point out that bans can be hard to enforce. Simply stating that a school is “peanut free” does not guarantee that it is. Even with strict measures, some peanut allergen can be present. “Peanut free” designations can decrease vigilance in the school community. This may create a false sense of security.
Schools can strive for a “peanut-safe” environment. Emphasize the importance of comprehensive allergy management. This involves staff training, action plans, and educating all students about food allergy safety. Schools should use proven strategies that include hand/mouth washing, no sharing of food, and awareness of a child’s food restrictions.
Studies have shown peanut residue is easily cleaned from hands with soap and from surfaces with commercial products. Smelling peanut butter does not cause an allergic reaction.
Are schools allowed to have stock epinephrine?
Yes, every U.S. state either mandates or allows schools to stock emergency supplies of epinephrine. This means the school can keep a supply of undesignated epinephrine available in the event it’s needed for an emergency. Most schools keep stock epinephrine in the school nurse office, but it can be stored elsewhere including the classroom – as long as the medication is safe and secure.
It’s important to be familiar with the laws for stock epinephrine in your state. Not all schools agree to stock epinephrine, so parents should check with your child’s school to confirm it is available.
What additional school training resources are available?
All school staff, particularly those responsible for students with severe allergies, should receive allergy education that is evidence-based. Remember, no two reactions are alike – students can experience different reactions. Even individual reactions can vary from one episode to the next.
Practical points:
- Personalized instruction should be provided to staff supervising a student with a known allergy who is at risk for anaphylaxis.
- School staff can be trained on food allergies at a school-wide faculty meeting to teach signs and symptoms and generalized allergy care.
Allergy and Anaphylaxis Emergency Plan
Every student at risk for anaphylaxis should have a completed Allergy and Anaphylaxis Emergency Plan (or its equivalent). The plan should be filled out by the child’s doctor. Then a copy should be provided to the school.
Posters Available for Download
Staff Training Resources
CDC Voluntary Guidelines for the Management of Food Allergies in Schools and Early Care and Education Centers
The U.S. Centers for Disease Control and Prevention (CDC) developed the Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Centers. The guidelines provide practical information and planning steps for parents, school administrators and staff to develop or strengthen plans for food allergy management and prevention.
The guidelines include recommendations for each of the five priority areas for each school’s food allergy management prevention plan:
- Ensure the daily management of food allergies in individual children.
- Prepare for food allergy emergencies.
- Provide professional development on food allergies for staff members.
- Educate children and family members about food allergies.
- Create and maintain a healthy and safe educational environment.
National Association of School Nurses (NASN)
NASN offers allergy and anaphylaxis information for parents and school health professionals, Toolkits, checklists, and epinephrine policies and protocols.
- Complete list of resources for managing and treating allergies and anaphylaxis
- Allergy and Anaphylaxis Toolkit
- Development of School District Policies and Protocols Checklist
- Development of Student Healthcare Plans Checklist
- Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs – A Checklist for School Nurses
AllergyHome.org: Schools
AllergyHome’s School Staff Training Module is a 30-minute module to assist the school nurse. It helps increase food allergy awareness and trains staff to manage life-threatening allergic reactions. The training module is consistent with CDC guidelines and includes:
- School Staff Quiz – A certificate of completion is available to be printed or emailed after passing the exam.
- Label Reading Handout
- Preventing Cross-contact Handout
- Be Prepared to R.E.A.C.T.
- AllergyHome Resource Flyer for School Nurses
Food Allergy Management & Education (FAME) Manual
The FAME manual and toolkit is designed to help school nurses, administrators and staff work with parents and students to create a safer school environment and develop a comprehensive school-based food allergy program. It features a 504 Plan decision chart and a list of accommodations in classrooms, the cafeteria, and on school buses and field trips.
School Nurse Chronic Health Assessment Tool – SN CHAT
Resources from the National Association of School Nurses (NASN)
A tool developed for school nurses by a school nurse, SN CHAT offers tools and resources to help school nurses manage chronic health conditions in the school setting.
School nurses can use SN CHAT®:
- Guide conversations in person or via phone with a student’s parent, guardian, or caregivers
- Learn about the health needs of an individual student
- Decide if you should create a school plan for a student, which may include an Emergency Action Plan (EAP) and/or an Individualized Healthcare Plan (IHP)
Are there other conditions that can look like or complicate allergies?
There are other types of conditions that can mimic allergies, but these are different than an IgE-mediated allergy. The symptoms, diagnosis and treatment can vary depending upon the condition. Here are some of them.
Food-related conditions that can have symptoms similar to food allergies include:
