SchoolclassBy Linda Marienhoff Coss

In May 1993, I was determined to find a preschool for my son with severe food allergies. Life-threatening food allergies were far from mainstream knowledge, and there were few reliable resources on the subject. I had no idea what it would take to create a“safe” preschool environment for my little sweetie (or more accurately, to get as close to that as possible), but I wanted a school that was willing to work with me to figure it out. And the first three dozen or so schools I approached turned me down.

The number of children with life-threatening food allergies has increased dramatically since then — and thankfully, so has awareness. But creating and maintaining the safest possible environment for these kids at a vulnerable age remains a big challenge. Preparation, planning and cooperation between parents and school staff are critical.

A key point, of course, is that this is a bunch of preschoolers we’re talking about! Kids at this age are very messy (especially when they eat), extremely physical (likely to touch everything in sight) and live completely “in the moment.” They are not yet developmentally capable of managing food allergies reliably, and should not be expected to.

Precedented Success

Countless preschools across the country have proven it’s possible to keep food-allergic kids free from harm without going to extremes. I asked my long-time friend Heidi Kahn, director of University Synagogue Preschool in Irvine, CA, what’s being done in food allergy management at her preschool.

Parents of a severely food-allergic preschooler might well think they’ve hit the jackpot with Heidi. Not only is she an award-winning early childhood educator, she’s the mother of a college student with lifelong severe food allergies, environmental allergies and asthma. Her preschool doesn’t advertise itself as accommodating kids with food allergies specifically, but it does, and can accommodate other medical conditions and special needs as well. This year, 10 of the school’s 80 students have food allergies.

One of the first things an inquiring parent learns is that University Synagogue Preschool is a nut-free facility, which is plastered on signs throughout the location. It’s also a kosher facility, so the food restrictions in place aren’t all allergen-related.

All preschool and synagogue staff — including clergy, custodians and front-office personnel — meet at the start of the school year to discuss the specifics of each special-needs student. Among other things, they learn how to recognize and treat an allergic reaction and where emergency medications are kept (in an unlocked drawer in an unlocked, centrally located office).

Snacks are provided for students, with menus set two weeks in advance and sent to parents of food-allergic students for review (parents can opt to send in their own snacks with the children). Tables and hands are washed before and after the children eat. Teachers sit with the students, and some food-allergic children use special placemats or may be seated at the head of the table, where there’s a little extra space and an easier exit if the need arises.

In terms of environmental allergens, perfume and furry pets are not allowed. An air filtration system is available for classrooms. Hand wipes and nontoxic, environmentally safe cleaners are used at the facility. The outside play area has synthetic turf and a small, fenced-in vegetable garden.

So far, no student has experienced a severe allergic reaction at the preschool. Heidi says the up-front, non-negotiable “No Nuts” policy helps. Encouragingly, the preschool hasn’t had problems with cooperation from the parents whose kids don’t have food allergies, and “anyone who shows hostility at the parent intake meeting is simply not allowed to enroll,” Heidi says.

‘Allergy Free’?

What about a preschool that bills itself as “An Asthma and Allergy Friendly Place,” as you’ll read at, the website of St. Stephen ECD (Early Child Development) & Preschool? A chat with Program Director Laura Schulte reveals extensive efforts behind that claim.

Schulte founded this St. Louis, MO preschool in 2002 after she was unable to find an appropriate preschool for her severely food-allergic son. Since then, St. Stephen has been a refuge for children with a wide variety of food and environmental allergies — but notably, of the about 70 students now enrolled, only 40% have asthma and/or allergies. Schulte says it’s a credit to the preschool. “My staff has created such a great early childhood education program that other parents don’t care about the restrictions,” she says.

The “top 8” food allergens for students — peanuts, tree nuts, milk, egg, wheat, soy, fish and shellfish — are off-limits at the preschool. If a child is allergic to some other food, the school will work to accommodate the specific need. All staff are trained in allergy and asthma management.

Students are not allowed to bring food to the preschool, and staff do not eat on the premises. The preschool purchases and provides fruits and vegetables from a local grocer and prepackaged snack and lunch foods meticulously selected to avoid any of the “top 8” allergens.

St. Stephen also takes a number of steps to reduce or eliminate common environmental allergens: hardwood floors throughout, no stuffed animals, no fabric draperies. Everything in the facility is latex-free. Each room is independently heated and air conditioned, and air goes through a triple filtration system before it reaches the classroom.

Staff members wear no scented products, and none smoke. Parents who smoke are not allowed to enter the building; children who arrive with cigarette smoke residue on their clothing are asked to leave their coats on an exterior coat rack. Lysol® and bleach are used for cleaning, but only when children aren’t in the building — and the air filtration system is “cranked up” afterward.

The small outdoor play area is covered with blacktop and spongy rubber — no grass, dirt, sand or plants. There’s another play area indoors. Children wash their hands and faces when they enter the building in the morning or after playing outside.

So far, none of St. Stephen’s students have experienced a severe allergic reaction while on campus, similar to University Synagogue’s experience. Cost-wise, the preschool has been able to keep tuition “fairly competitive” for the St. Louis area, Schulte says.

What YOU Can Do

Your attitude has a big impact on your relationship with your child’s preschool staff. Set the right tone from the start! Be friendly and enthusiastically positive, and get organized before you make that first call to a preschool director. Have and refer to a written emergency action plan from your child’s allergist. Practice describing your child’s special needs in detail, including the severity of his or her allergies.

Heidi suggested some things for parents to ask about and discuss when searching for a preschool for their severely food-allergic child.

  • How many students with severe food allergies are enrolled or have been accommodated in the past? (You may be able to speak with those students’ parents about their experiences.)
  • Is it a nut-free school? (Peanuts and tree nuts are the most commonly known food allergens, and the answer will help you gauge the preschool’s sensitivity and tone regarding food allergy issues.)
  • Has a student ever had a severe allergic reaction at the preschool? If so, ask what happened. Find out who at the school is trained to handle a food allergy emergency, and ask if the school is willing to partner with you to create an individualized plan for your child.

If you find a preschool experienced in managing severe food allergies, great! Just determine if its policies and procedures are appropriate and sufficient for your child. If the school has never accommodated your child’s specific needs, work with the staff as a partner to create a plan that meets everyone’s needs.

A former food allergy support group leader for more than 13 years, Linda Marienhoff Coss is the mother of a son now in his senior year of college who has multiple, life-threatening food allergies. She is author of “How to Manage Your Child’s Life-Threatening Food Allergies: Practical Tips for Everyday Life” and two milk-, egg- and nut-free food allergy cookbooks. Her books are available at

First published in Allergy & Asthma Today magazine, Volume 10, Issue 1; Spring 2012

Reviewed by William Berger, MD and Andrea Holka