By SHERRI GORDON, CLC
HEADING BACK TO SCHOOL IS AN EXCITING TIME for most parents and their kids. Not only is there the anticipation of meeting their new teachers, but there is also the fun of gathering school supplies and making plans to reconnect with friends. However, for parents of the nearly 6 million children with food allergies, it can also be a time of fear and anxiety—especially if this is their child’s first time attending school.
A number of questions top their list of concerns, such as how will my child be kept safe? Who will administer epinephrine should it be needed? And how quickly can it be accessed? If this sounds familiar, fortunately there are things you can do to ensure your child has a safe and healthy learning environment—including avoiding key allergens and having access to epinephrine if needed.
When it comes to reversing a life-threatening reaction to a food (anaphylaxis), epinephrine is not just the first line of treatment—it is the only line of treatment. While this drug does not necessarily cure a reaction, it can quickly reverse life-threatening responses like difficulty breathing, swelling of the throat and tongue, and low blood pressure.
Without early intervention with epinephrine, kids can die after ingesting just a small amount of a food they are allergic to. Yet despite that fact, people still get confused about when to administer the drug even though intramuscular auto-injectors are safe, fast, and effective with minimal side effects, says Stephanie Leonard, M.D., director of the Food Allergy Center, Food Allergy Immunotherapy Clinic at Rady Children’s Hospital–San Diego.
“We encourage using epinephrine early to prevent the development of serious symptoms,” Dr. Leonard says. “The easiest way to think about when to use epinephrine is the phrase ‘more than skin, epinephrine goes in.’”
“Don’t forget to check in with your child about how they are feeling about their food allergy at school. Knowing that you are there for them and will advocate for them makes a big difference.”
— Stephanie Leonard, M.D.
This means that if someone develops more than just a rash or itchiness on their skin—such as difficulty breathing, trouble swallowing, vomiting, diarrhea, dizziness, or fainting—epinephrine should be used immediately. If their reaction is limited to the skin, then antihistamines (like diphenhydramine or cetirizine) can be used while they are monitored for additional symptoms, Dr. Leonard says.
Whether this is your child’s first time attending school or they are returning to the same school they have attended the past few years, the first step toward a safe school year is to ensure that your child knows how to manage their food allergy. This includes not accepting food from other kids, learning how to recognize symptoms of a reaction, and asking for help when they need it.
You also need to put a plan in place at the school and provide staff with several auto-injectors to have on hand. To start, ask for a meeting to learn more about how food-allergic kids are kept safe and where important medications like epinephrine are stored. Also, find out who is trained to use the auto-injectors and how quickly they can be accessed in an emergency—even if the nurse is gone or there is a substitute teacher.
If your child is not carrying their medication on them (and most aren’t until they’re between the ages of 12 and 14), make sure that it can be accessed quickly if needed. For instance, many schools store epinephrine in the nurse’s office. But if the office is far from your child’s classroom or the nurse is not there every day, ask that the teacher also have epinephrine in their classroom, says Ruchi Gupta, M.D., MPH, professor of pediatrics and medicine at Northwestern University Feinberg School of Medicine and clinical attending at Ann & Robert H. Lurie Children’s Hospital of Chicago.
You also want to make sure that anyone in charge of your child for field trips and after-school activities also has access to epinephrine. And find out how snacks, lunch, and treats at school are handled.
Knowing this information will give you insight into what requests you would like to make, Dr. Gupta says. “If the school’s policies are not sufficient or if [you] still have concerns, then a 504 plan may be considered,” she says.
A 504 plan is different from an Anaphylaxis Emergency Care Plan. This document is a legally binding agreement that provides special accommodations on how your child will be cared for, says Trisha Saha Ray, M.D., a clinical instructor at Harvard Medical School and an allergist at Allermi. Deciding whether or not your child needs one will depend on the severity of your child’s allergies and your school’s current policies and resources.
It is also important to build a strong support network for your child at school, Dr. Leonard says. “Having friends who know about their allergy and watch out for them, teachers who help to make sure they are safe and feel included, and staff who are trained to recognize and treat allergic reactions are key to a positive school experience.”
Also, look for other food allergy families. Together, you can support one another and advocate for certain policies to be changed, she says. “And don’t forget to check in with your child about how they are feeling about their food allergy at school. Knowing that you are there for them and will advocate for them makes a big difference.”
Remember, living with a food allergy can be overwhelming at times. Not only are their food choices restricted, but they can also experience a life-threatening reaction if they eat the wrong thing. Even sitting at an allergen-free table at school can make kids who have allergies feel like outsiders, Dr. Ray says.
Especially since it’s not unheard of for kids to be teased about their allergy. “Unfortunately I have taken care of children who have been bullied due to their food allergies,” says Dr. Ray. “A classmate once tried to sneak peanut butter into my patient’s lunch as a prank. Children need to realize that a prank like this could be life-threatening.”
If your child is being bullied at school due to their food allergy, you should speak to their teacher as well as other leadership at the school, Dr. Ray says. “A physician can also advocate for a patient in this situation.”
The key is to make sure that the situation is addressed in a manner that keeps your child safe, without causing additional distress. Some schools will attempt to prevent bullying by restricting the food-allergic child instead of disciplining the person who is bullying.
On the flip side, though, research shows that those with food allergies tend to feel more responsible and become better advocates for themselves and others, Dr. Gupta says. Having food allergies can also make them more appreciative of the foods they can eat and encourages them to choose nutritious options.
Overall, the best way to support your child is to instill confidence so that they feel empowered managing their food allergy at school and at extracurriculars—even if their usual network of support is not present, Dr. Gupta adds. “Help them practice how to speak up and advocate for themselves whenever possible. Sharing information with their peers and key professionals—and making sure these individuals are aware and trained on how to respond in the event of a food allergy emergency—will help you and your child feel better supported,” she says.
Photos: Lumina/onairjiw/Alto Images/LWA