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Food allergies are an area of growing concern for Child Nutrition Program (CNP) professionals. Facilities participating in USDA’s Child and Adult Care Food Program, School Lunch, and School Breakfast programs may be required to accommodate the special dietary needs of children with allergies. A recognized medical authority, such as a physician, must provide a written diet prescription. The diet prescription should be specific and provide clear information about what foods are to be excluded from the child’s diet. The CNP staff should follow the regular menu whenever possible in accommodating children with allergies. Good communication with the child, parents or guardian, and school health team are important in providing a safe environment for a child with food allergies.
A food allergy is the overreaction of the body’s immune system to a food substance, usually a protein. Food allergies may occur at birth or may develop at any age in life. Food allergies can be associated with any food. However, most allergic reactions are caused by the following eight foods: milk, eggs, fish, shellfish, soy, wheat, peanuts, and tree nuts. The physiological symptoms caused by a food allergy range from mild to life-threatening. There is no cure for food allergies. Avoidance of the offending food is the only way to prevent a reaction.
Symptoms of an allergic reaction to food may involve the skin, respiratory tract, gastrointestinal tract, and cardiovascular system. Types of symptoms include itchy skin or eyes, hives, difficulty breathing, abdominal cramps or stomachache, nausea, and vomiting. For a child who is severely allergic, even tiny amounts of the offending food can cause a reaction. Children who are allergic to the same food may exhibit very different reactions or symptoms when exposed to that food. The most serious type of allergic reaction is called anaphylaxis. Anaphylaxis is a severe, life-threatening allergic response resulting in lowered blood pressure, swelling, and hives. It is considered the most serious reaction because if left untreated, it can result in death. Immediate medical attention is the best practice when a severely allergic child has been exposed to a known allergen, even if the exposure does not appear to be causing symptoms. Medical attention should also be sought if an exposure has occurred and the CNP is uncertain as to the severity of the allergy.
Keep a file with historical information regarding severity of the reaction and types of symptoms, instructions from the parents or guardian regarding emergency treatment, and the diet prescription. This information can be invaluable to staff when providing care for the allergic child. Even if an allergic child has not had a severe reaction in the past, there is no guarantee that a severe reaction will not occur in the future. If food allergies exist among the children in your care, have a written policy regarding storage of allergenic foods to keep them separate from other foods. Keep any emergency medications and phone numbers accessible, even on field trips.
FOOD ALLERGY OR FOOD INTOLERANCE?
Learn the differences between food allergy and food intolerance. A food intolerance refers to an adverse reaction to food which does not involve the body's immune system. An example of a food intolerance is lactose intolerance. An intolerance is generally not life threatening and usually does not impair activities of daily living. An allergy is more serious and involves a reaction between a food protein and the body’s immune system.
KEY POINTS
- Good documentation is important. Check with your State agency regarding what documentation is required related to special needs or allergies. In addition to maintaining the diet prescription, other items to consider documenting are conversations with parents or guardians and conversations with medical professionals.
- Tailor dietary modifications to the needs of the individual child.
- If uncertain about how to handle food allergies, seek help from parents, community resources, State agency staff, and appropriate medical professionals to clarify the diet prescription and to provide needed training for the child care staff.
- Follow safe food handling principles when preparing, serving, and holding special foods for the allergic child.
- Have written emergency instructions and policies.
- Keep emergency medications and phone numbers accessible, even on field trips.
- Provide in-service training for staff who share responsibility for the allergic child.
- Children who are allergic to the same food may exhibit different reactions when exposed to the offending food.
Local Resources
State agency staff
Nutritionists or registered dietitians (RD)
Other Child Nutrition Professionals
Other Resources
Alabama Department of Education. (1999). CARE: Special nutrition for kids. (Revised by USDA). University, MS: National Food Service Management Institute.
American Dietetic Association, 216 West Jackson Blvd., Chicago, Illinois 60606-6995; 800-877-1600
www.eatright.org
Healthy School Meals Resource System (n.d.). Resources on food allergies, special diets & special needs. Retrieved August 28, 2001, from http://schoolmeals.nal.usda.gov:8001/Resources/specialdiets.html
International Food Information Council Foundation. (2001). Understanding food allergy. Washington, DC: Author.
Kansas State University and Kansas State Board of Education Nutrition Services. (n.d.). Special foods for special kids. [University, MS: National Food Service Management Institute].
National Food Service Management Institute (1997). CARE connection. University, MS: Author
Munoz-Furlong, A. (Ed.). (1999). The school food allergy program (Rev. ed.). Fairfax, VA: The Food Allergy Network.
National Food Service Management Institute Help Desk, The University of Mississippi, P. O. Drawer 188, University, MS 38677-0188; 800-321-3054; www.nfsmi.org
Organizations
Allergy & Asthma Network Mothers of Asthmatics
2751 Prosperity Avenue, Suite 150
Fairfax, VA 22031
Phone: 800-878-4403
Fax: 703-573-7794
American Academy of Allergy, Asthma, and Immunology
611 East Wells Street
Milwaukee, WI 53202
Phone: 414-272-6071
Patient Information and Physician Referral Line: 1-800-822-2762
For all general questions, e-mail: info@aaaai.org
Web: www.aaaai.org
American Academy of Pediatrics
National Headquarters:
The American Academy of Pediatrics
141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098
Phone: 847-434-4000
Fax: 847-434-8000
Washington, DC Office: (Department of Federal Affairs)
The American Academy of Pediatrics/Dept of Federal Affairs
601 13th Street, NW
Washington, DC 20005
Phone: 202-347-8600
Fax: 202-393-6137
Web: http://www.aap.org
The American Lung Association
61 Broadway, 6th Floor
New York, NY 10006
Phone: 212-315-8700
Web: http://www.lungusa.org
Asthma and Allergy Foundation of America
1233 20th Street, NW Suite 402
Washington, DC 20036
Phone: 202-466-7643
Fax: 202-466-8940
Web: http://www.aafa.org
The Food Allergy & Anaphylaxis Network
10400 Eaton Place, Suite 107
Fairfax, VA 22030-2208
Phone: 800-929-4040
Fax: 703-691-2713
E-mail: faan@foodallergy.org
Web: http://www.foodallergy.org/about.html
www.nfsmi.org
IFIC Foundation
1100 Connecticut Avenue, NW Suite 430
Washington, DC 20036
Phone: 202-296-6540
Fax: 202-296-6547
E-mail: foodinfo@ific.org
Web: http://www.ific.org
Written by Ensley Howell, M.S., R.D.
Page created 6/3/03
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