Living With Food Allergies

School Health Care Plans for Food Allergies (IHCPs, ECPs, and 504 Plans)

If your child has a food allergy, you may have concerns about their care when they are at school. Many schools already have policies in place to manage food allergies. Partner with the school to set up a school health care plan.1 It is an important part of your child’s food allergy management plan.

School nurse and student image

  1. Types of school health care plans
  2. How to choose a school health care plan
  3. How to create a school health care plan for food allergies
  4. What to do if the school will not work with you
  5. Stay positive and proactive

 

Types of School Health Care Plans

A school health care plan is a set of documents that outlines your child’s medical condition and needs. The plan usually lists information about your child’s food allergy, how it should be managed, and what to do if your child has an allergic reaction. It may also include school staff responsibilities, training, and services needed to help keep your child safe. A school health care plan often includes several forms and documents.

Three common types of school care plans are:

  • Emergency care plan (ECP) – This is a medical plan from your child’s doctor for the school to follow to treat food allergy reactions while your child is at school.
  • Individual health care plan (IHCP or IHP) – This is a type of nursing care plan. For a student with a food allergy, this would also include an ECP. An IHCP addresses what the school will do to create and maintain a safe environment for your child.2
  • 504 plan – This is a legally binding plan written by the school in collaboration with you and your child.3 Similar to an IHCP, this plan lists guidelines for changes in the classroom or other school locations to reach the goal of providing a safe education.

Emergency Care Plans (ECP)

An ECP is a medical plan your child’s doctor writes for the school nurse to follow. ECPs usually use terms a person with a non-medical background can also understand and follow.

Your child’s ECP should have:

  • Your child’s food allergens
  • Symptoms that require emergency treatment with an epinephrine auto-injector
  • Instructions on calling 911 to transport your child to the hospital
  • Emergency contacts

The ECP should include your child’s Anaphylaxis Action Plan. An ECP is usually part of an IHCP or 504 plan and is signed by your child’s doctor.1

Individual Health Care Plans (IHCP or IHP)

An IHCP (sometimes called an IHP) is a nursing care plan that serves both administrative and clinical purposes. It will probably have an ECP for managing and treating an allergic reaction.

The school nurse will work with you, your child, and their doctor(s) to write the IHCP.1

An IHCP lists what the school will do to create and maintain a safe environment for your child. For example, an IHCP will detail what school staff will do to reduce the chance your child will be exposed to their allergen(s), recognize symptoms of an allergic reaction, and give the appropriate treatment. An IHCP is not a legally binding document.

504 Plans

A 504 plan, sometimes called a “Section 504 plan,” is a legally binding plan between a school and a student. A 504 plan addresses what the school will do to create and maintain a safe school environment for your child.

The 504 plan is from Section 504 of the Rehabilitation Act of 1973. This is a federal law that states schools that get federal funding cannot exclude or discriminate against a student with a disability just because of their disability.4

A disability under Section 504 is defined by the Americans with Disabilities Act (ADA) as a “physical or mental impairment which substantially limits one or more major life activities.” A “major life activity” includes speaking, breathing, learning, and eating.5 A food allergy is considered a disability under the ADA because it can interfere with eating.

The purpose of a 504 plan is basically the same as an IHCP. But a 504 plan is legally enforceable. It also offers safeguards a traditional IHCP doesn’t. With a 504 plan, the family is allowed due process hearings (with legal counsel, if desired) and parental notice and review requirements. If you continue to be unhappy with the plan as implemented by the school district, you can seek contact the Office of Civil Rights (U.S. Department of Education) or file a suit in a federal court.3 An IHCP can be integrated into either a 504 plan or an IEP to make the IHCP’s terms enforceable.

Back to school health care plan image

How to Choose a School Health Care Plan

Think about these factors when choosing a school health care plan:

  • Your child’s needs
  • The school’s policies and procedures for managing food allergies
  • State and federal disability laws, if applicable

If the school already has a solid plan in place for managing food allergies, your child may not need a 504 plan. But if your child is eligible for a 504 plan, you could request a 504 plan to make the terms of the management plan legally enforceable. In some cases, your child may not qualify for a 504 plan if their food allergy is not considered to be a disability or there is not a record showing they have a food allergy.4 You as the parent can partner with school personnel and your child’s doctor as appropriate to develop the contents of your child's IHCP or 504 plan based upon their unique allergy, health, and safety needs while at school.

How to Create a School Health Care Plan for Food Allergies

Your child’s school may already have a process in place for creating care plans.

Start by contacting the school to ask who to contact to create a school health care plan for your child. Then request a meeting with the school representative to talk about your child’s needs and to ask questions about the school’s food allergy management policies.

When approaching the school, use a positive tone. You are part of the team that will work together to keep your child healthy and safe at school. Communicate often, calmly, and confidently.

Make contact before the school year starts – the spring before is ideal. The first few days of school are very busy for staff. You’ll want to have everything in place before the first day of school.

Here are some questions you may want to ask at your meeting:

  • Does the school or school district have a nurse?
  • When can I meet with school staff responsible for my child, such as their teacher and dietary staff?
  • Where will my child’s epinephrine be kept? Will it be easy to access?
  • Are staff trained on how to manage food allergies and allergic reactions?
  • How does the school staff handle allergic reactions?
  • How is food allergy bullying handled?

If you feel your child needs a 504 plan, also write to the school district’s 504 coordinator. Ask to have your child evaluated for a 504 plan.

Your child’s school health care plan may include:

  • Signs and symptoms of an allergic reaction
  • List of all food allergies
  • Anaphylaxis Action Plan
  • Medicine authorization form
  • Special dietary meals accommodation form
  • What staff will be trained and how
  • Use and training of substitute teachers
  • When a school nurse is not on site, who will handle their responsibilities
  • Responsibilities of the parent, child, nurse, teacher, and other school staff
  • How school celebrations, recess, field trips, bus rides, etc. will be handled
  • Changes in the classroom, cafeteria, and elsewhere (such as handwashing after eating, “no food sharing” rules, etc.)
  • Avoiding the use of the child’s allergens in art projects and other lesson plans
  • Storage of safe snacks and a safe non-perishable lunch for special situations (such as forgotten lunches, evacuations, shelter-in-place situations)

A written school health care plan helps everyone understand their role in keeping your child safe while at school. It can reduce miscommunication, as well.

What to Do If The School Will Not Work With You

Public or private schools that get funds from the federal government have to follow Section 504 and the ADA. Public schools must provide a “free and appropriate education (FAPE) in the least restricting environment.”6

Regardless of if they receive federal funding, all non-religious private schools must abide by the ADA. While they do not have to provide a “free and appropriate education,” private schools are public accommodations under the ADA. They have to take steps necessary to make sure a child is not excluded, denied services, or treated differently due to their disability (unless they can demonstrate that taking such steps would fundamentally alter the nature of their facility or result in undue burden).7 As a recent agreement with the Department of Justice indicated, these obligations can include the requirements to administer emergency medicine such as epinephrine auto-injectors.

If a public school is not willing to accommodate your child, contact your school district’s superintendent or 504 coordinator in writing. If that is not successful, contact the Department of Education’s Office for Civil Rights (OCR).

Stay Positive and Proactive

Remember to focus on the goal: to ensure your child is healthy and included at school. Keep a positive mindset.

Work with the school on the best way to keep your child safe at school.

School planning is a process. The first year may take a little extra effort because you are starting from scratch. Once you have a plan, review it, and update it before each school year, or sooner if your child’s conditions change. You may have to repeat this entire process if your child changes schools and moves on to middle school and high school. Make this part of your annual prep for the school year so your child can have a safe environment that allows them to focus on learning and not their food allergy.

 

This is adapted from an article by Lynda Mitchell, MA, and reviewed by Laurel Francoeur, Esq., in 2014. The original version of this article was written in 2007 in collaboration with Maria Laura Acebal, JD.

Reviewed July 2021 by Naomi Seiler, JD, George Washington University

References

 

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