Special Dietary Needs in Child Nutrition Programs Lesson 3: Managing Food Allergies

1. Special Dietary Needs in Child Nutrition ProgramsLesson 3: Managing Food Allergies • Summarize key components regarding food allergies. • Explain ways food service personnel can prevent exposing children with allergies to the allergen. Learning Objectives

2. Food Allergies • Definition • Symptoms • Anaphylaxis

3. Common Food Allergies • peanuts • tree nuts (almonds, pecans, walnuts) • milk • eggs • soy • wheat • fish (bass, cod, flounder) • crustacean shellfish (crab, lobster, shrimp)

4. Anaphylaxis • Sudden, severe, potentially fatal reaction • Potentially life threatening can occur after person with allergies is exposed to a specific allergen • Collection of symptoms affecting multiple body systems, may occur immediately or up to 2 or more hours following allergen exposure • Most dangerous symptoms-breathing difficulties and blood pressure drop or shock, can be fatal • Anyone with a previous history of anaphylactic reactions is at risk for another severe reaction

5. Treatment for Allergies • Antihistamines/Bronchodilators • Epinephrine • Prevention and Strict Avoidance • Action Plan

7. Food Allergen Labeling Laws • January 2006 law requiring manufacturers clearly identify on food labels • 8 major allergenic foods and food groups • Milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, soybeans (90% of all food allergies) • Applies in schools, not if label before Jan ‘06 • Exemptions-raw agricultural commodities-fresh fruits/vegetables, highly refined oils

8. Allergy Scenarios • Read and identify problem areas • One-spatula-gloves • Two-slicer • Three-knife cleaning-jelly/bread loaf • Four-check label • Five-substitute

9. Allergies with the potential of anaphylaxis Celiac disease Regulations Accommodations with Approval of Food Service Director Accommodations Required • Allergies with no anaphylaxis • Food intolerances

10. Food Intolerance Definition: Food intolerance is an adverse reaction to food that does not involve the immune system. Examples • Lactose Intolerance • Gluten Intolerance

11. Celiac Disease • Inherited autoimmune disorder, cause unknown • Affects 1 in 133 Americans • Affects digestive process of small intestine and causes gluten intolerance • If consumes gluten (protein in wheat, rye, barley), immune system attacks small intestine and inhibits absorption of important nutrients into body • Symptoms • Recurring abdominal pain and bloating • Chronic diarrhea/constipation • Weight loss • Pale, foul-smelling stool • Treatment gluten-free diet-eliminate grains such as wheat, rye, barley, possibly oats,* and derivatives of these grains

12. Food Services Preventing exposure to allergens in the kitchen. • Read food labels. • Know what to avoid and how to substitute. • Designate kitchen allergy-free zones. • Follow safe food handling practices.

13. Food Services Preventing exposure to allergens in the cafeteria and throughout the school. • Understand the allergy plan. • Identify children with documented food allergies. • Develop standardized cafeteria cleaning procedures. • Learn to recognize signs of anaphylaxis, and know how to activate the school’s emergency plan if anaphylaxis should occur in a child with a life threatening food allergy.

14. Distribution of Peanut Allergen in Environment • Ara h 1-major peanut allergen-none on water fountains, none on desks/cafeteria tables. Nonallergic volunteers ate peanuts /peanut butter in cafeteria. No airborne Ara h 1 detected. • Cleaning Ara h 1-found common household cleaning agents, such as Formula 409®, Lysol® Sanitizing Wipes, Target brand® cleaner with bleach, removed allergen from tabletops (except for dishwashing liquid, which left traces of allergen). • Removal from hands, liquid soap, bar soap, commercial wipes were very effective. Plain water/antibacterial hand sanitizer left detectable levels of peanut allergen. • Conclusions-Ara h 1 is easily cleaned from hands/surfaces and does not appear to be widespread on cafeteria tables/desks in preschools/schools. Airborne peanut allergen was not detected, despite testing levels in multiple simulated environments, but more research needs to be done in order to make firm conclusions about exposure to peanut allergens in schools. Source: Journal of Allergy and Clinical Immunology, Vol. 113, No. 5.

15. Special Dietary Needs in Child Nutrition ProgramsLesson 4: Understanding Inborn Errors of Metabolism • Define inborn errors of metabolism, identify the more common errors, and explain dietary treatment for children with inborn errors of metabolism. • Describe accommodations for these children and understand the need for a professional consultant in difficult cases. Learning Objectives

16. Inborn Errors of Metabolism • Rare genetic disorders in which the body cannot metabolize food normally • By-products of metabolism, amino acids, sugars, fatty acids build up in the body, causing serious complications • Dietary treatment: strict diet management to avoid toxic buildup of dietary by-products • Special foods or formulas may be needed

17. Phenylketonuria (PKU) • Cannot process the amino acid phenylalanine • Dietary treatment: • low-protein diet (to prevent increase in phenylalanine) • special formula to provide protein

18. Galactosemia • Cannot process the sugar galactose • Dietary treatment: no milk or dairy products

19. Hereditary Fructose Intolerance • Cannot process the sugar fructose • Dietary treatment: • no fructose (high-fructose corn syrup, honey, fruit) • no sucrose (table sugar)

20. Maple Syrup Urine Disease • Cannot process branched chain amino acids leucine, isoleucine, valine • Dietary treatment: • low-protein diet • special formula to provide protein

21. Food Services • Maintain communication among food personnel, parents, teacher, school nurse, and consultant if needed • Understand dietary restrictions prescribed in the plan and keep on file and with the school nurse • Obtain and serve special formula or foods • Follow prescribed portion sizes • Report mistakes immediately • Keep information confidential

22. Snack • Generally, provided by family (unless all students provided snack) • Student needing snack during school day- ‘right to a snack’ under Section 504 as an accommodation depending on severity • Must allow to obtain (eat when, where, how, time necessary accommodation-bus) Special Ed Connection, January 16, 2008

23. A special diet could be a related service under IDEA,Letter to Williamson, 211 IDELR 419 (OSEP 1986),but under following conditions- 1. Special diet must be related to a child's disability. 2. Special diet must be determined by IEP Team as a related service that is required to receive a free appropriate public education. While a physician's note might be required for meal substitutions, etc., only IEP team can conclude that a service (diet, transportation, nursing, etc.) is a "related service" that would be funded by special education dollars. 3. LEA's nutrition service, as a "related service" provider, should participate in IEP Team discussions of special diets as a related service. 4. Special diet must be based on "peer reviewed research to extent practicable". Controversial dietary therapies may be lacking in peer-reviewed research. Some dietary therapies have been shown to have negative health effects. IEP team must consider any research brought to its attention about dietary therapies. 5. Special education is payer of last resort. If there are other funds available, those must be used first. 6. Special education funds must supplement, not supplant other state, federal, and local sources of funds. For example, if USDA provides funds for a student's meals, and student's special meals cost $5.00/day, amount that special education funds could pay would be difference between USDA payment and daily cost. If special education funds paid entire amount, that would violate IDEA's supplement-not-supplant clause. Thomas A. Mayes, Legal Consultant Bureau of Student & Family Support Services, Iowa Department of Education 3/4/08