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Back to School Basics
School planning for food allergic childrenby Beth Puliti
As parents of children with food allergies, you know that as summer draws to a close, there is more on your mind than stocking up on school supplies. Excitement surrounding the first day inevitably leads to anxiety as visions of cafeteria chaos, classroom birthday parties and snack sharing run amok in your head.
Concerns such as these are understandable and valid. It isn't easy to "let go" of your food-allergic child, especially if it's his first year at school. By entrusting your child's health to unfamiliar staff he can enjoy a safe school year—but you need to go beyond purchasing your child the coolest backpack, newest calculator and trendiest shoes for it to happen.
You must check off your own back to school list—one that involves obtaining a letter from your child's pediatrician or allergist; contacting and meeting with the principal, school nurse and teacher; and creating a school health plan—well before your child's first day at school.
"Don't wait for the start of the new school year," recommended Ellie Goldberg, M.Ed, educational advocate and consultant. "Getting off to a good start in school depends on a little extra thought, information, planning and communication. September is a hectic time for both schools and families. Planning ahead will help school entry go smoothly for everyone."
Start planning the year before your child enters the school system, suggested Goldberg. Write a letter to the school principal to request a meeting to introduce your child. Create a school profile (with a photo) to highlight your child's strengths and interests as well as medical information. The school administrator is responsible for identifying your child's health and educational needs and planning support and services such as identifying the best teacher or classroom characteristics that match your child's needs.
"Schedule an introduction and planning meeting with the school nurse as well. You want the nurse's full attention, so make an appointment. Don't just drop in," advised Goldberg. "The school nurse can help you obtain appropriate services and ensure that school staff receives the information they need to understand how your child's condition might affect learning or behavior."
Bring a letter from your pediatrician or allergist with you to this meeting. "An effective letter from your child's physician includes the precautions and the treatment recommendations that are medically necessary for your child's health and safety and everyone's peace of mind," said Goldberg.
If there is no school nurse, the physician can also advocate for a full-time school nurse noting that the decisions for planning and medical assessment, as well as saving your child's life in the school, depends on a qualified person with appropriate training. Some states limit the administration of emergency medication to licensed personnel. Many states have "Good Samaritan" protection for teachers who administer EpiPens® or Twinjects®. The Massachusetts manual, Managing Life Threatening Food Allergies in School (requires Adobe Reader ), is a good example of comprehensive guidelines and especially rules for safe delegation.
FORMING A PARTNERSHIP WITH THE SCHOOL IS KEY
A good relationship with a school is the most essential key to success in keeping your child safe at school. "No matter what the form or content of your school's plan for your child, the biggest factor in your child's safety is the quality of communication and trust between parents and school staff," emphasized Goldberg.
Any plan is only a tool. It needs to change over time and as your child's needs change. Parents and teachers need to work as partners. They help each other because they have the same goals: reducing risk and finding out what works best for each child.
Don't go it alone. To understand a school's “potential for partnership” you need to meet other parents and evaluate the culture, advised Goldberg.
"Form a community from the day your child is diagnosed with food allergies—through support groups, through community groups, through the library, or through your nurse practitioner or doctor," she said. "Find other people in your community who have school-related experience they can share with you. School cultures vary enormously. A school can have a competitive dog-eat-dog, survival-of-the-fittest culture, or it can be a wonderful community where everyone works on the principle that ‘it takes a village to raise a child.’" This type of supportive school setting is described by Goldberg in the article,
Including Students with Chronic Health Conditions: Nebulizers in the Classroom.
COORDINATION OF CARE
The goal of meeting with the school nurse is to develop a coordinated care plan for your child. A coordinated care plan needs to include all of the physician-recommended precautions and treatment recommendations. The school nurse identifies the responsibilities, training and services to implement the recommendations to keep your child safe during all activities throughout the school day. An Individualized Health Care Plan (IHP) is part of a comprehensive coordinated care plan.
SCHOOL FOOD ALLERGY MANAGEMENT POLICIES
Many schools and school districts now have developed their own school-wide policies to address students with food allergies, especially in schools and school districts where state guidelines like those in Massachusetts are in place. Parents should find out if such a policy exists for the school where their food allergic child will attend. Their child's individualized care plan can usually be based on — but not limited to — the school policy.
INDIVIDUALIZED HEALTH CARE PLANS (IHP)
An IHP (sometimes referred to as an IHCP) is a type of nursing care plan that fulfills both administrative and clinical purposes for students with health management needs. An IHP details what measures the school team will take to reduce the risk of allergen exposure, recognize symptoms of an allergic reaction and promptly intervene with the appropriate emergency treatment (for example, the Food Allergy and Anaphylaxis Network's Food Allergy Action Plan). IHPs should be written by the school nurse in collaboration with the student, his family and the child's health care providers. Every student with prescribed epinephrine should have an IHP.
SECTION 504 PLANS
Generally speaking, a 504 Plan is reserved for individual situations that can not be accommodated by a well thought out school policy or in situations where an IHP is not sufficient and a good relationship with a school does not exist in the absence of a school policy. A 504 Plan is another type of plan written by the school in collaboration with a student and his family. While the purpose of a 504 Plan is essentially the same as that of an IHP, a 504 Plan differs from an IHP in that it provides guidelines for changes in the classroom and in other locations or activities that achieve the goal of providing a safe education.
For example, the IHP details the student's medical needs and the 504 Plan details the roles and responsibilities of the classroom teachers, and playground or lunch room monitors. It may also explain how snacks should be served and stored, when hand washing should take place, how surfaces should be cleaned, whether outside groups should use the classroom after school, how substitutes should be trained, etc.
The 504 Plan is an additional step in school planning between the school, child and family when the standard policies and procedures do not meet a child's needs. (For example, a 504 Plan would be necessary if the school needed a ramp to give a child with mobility impairments access to the classroom, lunch room or gym. For the child with food allergies, the changes would be those that identify and remove the barriers to safe participation.)
The 504 Plan takes its name from Section 504 of the Rehabilitation Act of 1973, a federal law that prohibits schools that receive federal funding from excluding or otherwise discriminating against a student with a “disability” solely on the basis of that disability. A “disability” under Section 504 is defined as a "physical or mental impairment which substantially limits one or more major life activities.” A “major life activity” includes “walking, seeing, hearing, speaking, breathing, learning and working” as well as “eating.”
Parents may be required to provide documentation to the school from the child's pediatrician or allergist regarding the child's food allergies or asthma in order for the school to determine whether the child meets the definition of disabled under Section 504.
"In order to receive federal funding, the school assures the federal government that it does not operate in a way that privileges some groups and disenfranchises or discriminates against individuals or other groups," Goldberg said. "Section 504 gives parents the right to notify the school when it is doing something that is creating a barrier to a child's access to education. You can ask the school to do something it isn't doing, or to stop something that it is doing. Section 504 gives you the right to go up the chain of command if the school resists or refuses to cooperate. The U.S. Department of Education Office for Civil Rights is the agency with responsibility for Section 504 complaints."
ITEMS TO ADDRESS WHEN DEVELOPING PLANS FOR SCHOOL
A school plan for a child with food allergies needs to include guidelines and responsibilities for precautions and for emergency care during all school locations and activities.
Examples of items to include in a school plan:
As always, starting from scratch is the hardest. Once your child's plan is created, you will need to update it at key transition times or whenever there is a problem or incident that reveals a gap in the plan.
Use the following to help guide you on your way:— KFA School & Preschool Resources
— KFA Support Forums: Include a dedicated forum for parents of school-age children
For more information about Ellie Goldberg's advocacy and consulting, visit http://www.healthy-kids.info
Beth Puliti is a professional writer for a national healthcare trade magazine.
This article first appeared in the Fall 2008 edition of Support Net™ and is available to download (requires Adobe Reader ).
Approved by KFA Medical Advisory Team August 2008. Updated July 2009.