Wednesday, August 7, 2013

Peanuts: To Ban or Not To Ban? - Part 1

One of the hottest debates about food allergies is whether or not peanuts should be banned from schools.  Some parents of allergic kids are insistent than schools should not serve or allow peanuts in any form.  Period.  Other parents of allergic kids feel that is overkill.  Parents of non-allergic kids also have varying opinions.  The most vocal seem to feel that a ban on peanuts somehow violates their child's civil liberties.  (I'm still waiting for someone to show me where the right to eat peanuts is listed in the Constitution or any other body of laws!)  

My own opinion is that peanut bans are generally not necessary, and that they tend to create a false sense of security.  (Is there someone checking labels on every bit of food that enters the school to enforce the policy?)  I also tend to get annoyed because my overachievers have life threatening allergies to foods that could never be banned.  Today's example...chicken.  Can you even imagine the uproar that would occur with a ban on chicken fingers?!?!?!  Of course, chicken is really not an apples to apples comparison.  Peanut allergy is more common than chicken allergy, and it also causes anaphylaxis at a greater rate.  But still.  Life would be way easier if we didn't have to look for chicken protein eeeeeverywhere!  (Seriously.  Outside of desserts, chicken broth is ubiquitous.)

My preferred approach is to give allergic students the accommodations that are medically needed, while resisting the temptation to put accommodations in place that are more about making the adults feel comfortable than providing actual safety.  In my ideal world, accommodations will vary based on severity of the allergy plus the student's age, stage of develop, and maturity level.

The youngest students and others who lack the cognitive ability to understand or fully avoid their allergens will need more accommodations than others.  Also in this group would be those that are very reactive to trace proteins, those who are allergic to many foods, and those who are prone to intentionally eating allergens.  These students may require classrooms that are food free, or at least free of specific foods.  It may be necessary to implement some degree of hand washing to ensure that food allergens are not inadvertently introduced to the classroom via cross-contamination.  Depending on the specific allergy, it may be necessary to limit what supplies are used for lessons and art projects.  Think of it like this.  If you can set up a "safe home base" for the allergic student, then you've got an area where the student and the teacher can relax a bit about food allergies and focus instead on learning.  Additional accommodations will likely be needed for whenever these students leave the classroom and are therefore at more risk from their allergens, but for the bulk of the school day the concern for food allergy reactions is pretty low.
My 8 year old falls into the category above for several reasons.  In addition to an allergen free classroom, he requires specialized seating arrangements for lunch and considerations at other times when he is outside of his own classroom.
With time and experience, students can begin to take over little pieces of responsibility from the adults around them.  Those who can be trusted to eat only safe foods may be able to transition to more independence.  (Ex: Move from peanut free table to the main lunch table with an end seat where adults can monitor them for the development of an allergic reaction.)  Once kids can remember to keep their hands away from mucous membranes, they may be able to have limited skin contact with their allergens.  (Translation: They do not to suck thumbs, bite fingernails, pick noses, rub their eyes, create open wounds by picking scabs, etc.)  It may be possible to accommodate these students by substituting safe foods for allergens that are used in classroom activities.  (Ex: counting with Smarties rather than M&Ms)  These students may be able to sit wherever they want for lunch, with friends prepared to signal for a lunch monitor if an allergic reaction begins.
My 6 year old is now able to sit with his peers for lunch.  He doesn't read labels, but he knows to look for the safe symbol that I add to foods that are free of his allergens.  He continues to bite his nails and pick his nose like most boys his age, so he continues to require an allergen free classroom.  He is more independent than big brother partially because none of his allergies are anaphylactic in nature.
As students move from early elementary school and then to junior high and high school, their Allergy Action Plans can and should be adjusted to prepare them for the eventual reality of living on their own with food allergies.  But just as we transition our children from making their bed to cleaning their room to larger household chores, we need to help our kids transition from an adult-led control of food allergies to the self-management that is necessary for teens with food allergies to experience a full life while also attending to their medical needs.
Continued in Part 2

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