By Gina Mennett Lee, M.Ed.
Ever since news of the death of Amarria Johnson hit, my heart has been very heavy. There’s really no other way to describe it. As a former teacher, I find it especially upsetting that an unnecessary death could happen once again in a school. School is meant to be a safe haven for children, not a place of danger. I have the greatest respect for the people that have chosen to serve our society by working in our schools. Many of these people are my closest friends. I also know that most educators are very kind and loving people who would never wish any harm on a child. Nonetheless, many parents of children with food allergies continue to deal with resistance when trying to keep their children safe at school.
I believe this ultimately stems from ignorance about the seriousness of food allergies. Most educators have not (yet) witnessed an anaphylactic reaction, nor do they live with the day-to-day challenges of living with food allergies. Quite honestly, I wouldn’t expect someone who doesn’t have a child with a food allergy to understand what it’s like. I didn’t. But I do expect people to listen and to try to understand. I expect that when a parent is saying what their child needs, that school personnel believe the parent. School administrators may need medical documentation to confirm the child’s diagnosis and I understand, but every conversation should begin with listening.
If I could convey just two pieces of information to school administrators, or to the general public for that matter, regarding food allergies, it would be these. One, food allergies truly are life-threatening. Two, they can become life-threatening within minutes. If everyone understood, and believed, these two important facts, there would be no need for advocacy. Furthermore, because an allergic reaction can occur up to 2-4 hours after ingestion or exposure, there is no point during the school day in which a child with food allergies is free of risk from an allergic reaction.
I began to worry about school the moment my daughter had her first anaphylactic reaction (at age 2). Because of my intimate knowledge not only of how schools function but also of the multitude of responsibilities that school staff have, I knew there were too many opportunities for a child with food allergies to be left unprotected.
Below I have outlined what I believe every school should have in place in order to keep children with food allergies safe. This is not meant to be comprehensive list, but instead a starting point. I make these recommendations based on my experience both as an educator with extensive experience teaching in public schools, and as a parent that has witnessed and had to respond to life-threatening allergic reactions. Until these are in place, children with food allergies will continue to be at risk.
- All schools should have a nurse present at all times.
- All schools should have a “stock” Epipen available.
- All school districts should have a clearly defined school policy regarding keeping children with food allergies safe and included.
- All school districts should have detailed protocols in place that follow the school’s policy. (In other words, now that this policy is in place, what does this it “look like” in the classroom, on the bus, in the cafeteria, on the playground, etc…?)
- Parents of children with food allergies should be a part of the “team” that develops these protocols, and should be used as a sounding board for new protocols and issues that arise.
- All policies and protocols should be clearly communicated to all school staff, accessible to parents, and consistent across the district.
- There should be a clearly defined way of assessing the efficacy of these policies and of ensuring that they are being followed.
- Every person that works in the school building should be trained to recognize the signs and symptoms of an allergic reaction and how to use an Epipen*. This includes all teachers, aides, specials teachers, lunch workers, secretaries, custodians, and the principal. If you will be on school grounds with children at any time, you need to know.
- Anyone directly responsible for a child with a food allergy at any point during the day, not only should be trained, but should be trained using an expired Epipen into an orange. The first time a person feels the “kick-back” of a real Epipen should not be in an emergency situation. This is especially true given that one must not only inject the needle, but also that they hold it for 10 seconds. It is also quite possible that the child may be kicking or squirming at the time of the injection. **
- It should be a prerequisite that all substitute teachers be trained as stated above.
- All supplies should be checked for the presence of food allergens. This includes crafts supplies, art supplies, hand soaps, cleaning materials, etc…
- There should be drills for medical emergencies. Most schools have drills for lock downs and fires. It only makes sense that there should be drills for a medical emergency.
- There needs to be a direct phone line to emergency medical services (911) from every room in the building. When outside of the building, a cell phone should be available with the number for the local ambulance programmed into the phone to avoid a delay.
- A 911 script should be posted at every phone (or carried with the cell phone) with address of the school, and what to say in case of an emergency.
- There should be posters in every room with a list of the symptoms of an allergic reaction as a visual reminder. When witnessing an allergic reaction, it is sometimes hard to believe what you are seeing. Having this list is a quick and helpful way to confirm.
- A large poster (or posters) should be hung in the cafeteria with signs and symptoms of an allergic reaction and a reminder to students not to share food.
- There should be a designated staff member solely devoted to monitoring children with medical conditions at each lunch wave. This person should be trained, should have an Epipen available, and also should be able to identify and locate all the children with food allergies at each lunch.
- All children should wash their hands before and after eating.
- Staff members involved in food service should be trained how to read a label, and how to prepare and serve food without cross-contamination. They also need to know who has an allergy and what they are allergic to.
- There should be a designated, trained staff person on any bus that transports a child with a food allergy. No food should be eaten on the bus.
- Every child who has a history of anaphylaxis should have a 504 plan. I firmly believe this; it is written documentation of a very important conversation that needs to take place. The needed accommodations are listed in a clear and concise manner using language that both the parents and teachers understand. Schools are obligated to inform parents of their legal rights, and there is a clear system in place if parents feel their child’s needs are not being met. It also moves with the child from school to school so parents don’t have to repeatedly ask for needed accommodations.
- Any child that has been prescribed an Epipen should have his or her Epipen immediately available at all times (in the same room, on the bus, on the playground, etc…). I have never understood why an emergency medication would be kept away from the person who needs it. I know for a fact that, many times during the day, a nurse may be out of his or her office (and that’s if the school has a nurse to begin with). There may not be sufficient time to bring the child to the nurse, or to call the nurse to the room. In addition, the moment that a staff member realizes a child is having an allergic reaction is the exact moment that action must be taken (not a minute later, or even a second later).
- There must be developmentally appropriate educational programming regarding food allergies, accepting differences, and anti-bullying for the children every year.
- Time should also be spent educating parents about food allergies. It truly takes a community to keep all children safe. People need to understand why children with food allergies need their support and compassion.
*Note: I use “Epipen” for epinephrine auto-injector. There are several epinephrine auto-injectors currently being prescribed in the United States; Epipen is one of those options. School personnel should assess their training based on the auto-injectors prescribed to the students in their respective schools. This may mean that training for more than one type of auto-injector is required.
** Research indicates that retention of training drops significantly after 6 months. For this reason, training should also be given at the halfway point in the school year.