M
A. Definitions
1. Anaphylaxis - A serious allergic reaction that is rapid in onset and may cause death.
2. Epinephrine (adrenaline) - A drug that can be successfully utilized to counteract anaphylaxis.
3. Food Allergy - A group of disorders characterized by immunologic responses to specific food proteins. In the United States, the most likely common allergens in adults and children are cow’s milk, eggs, peanuts, wheat, soy, fish, shellfish, and nuts.
4. Individualized Emergency Healthcare Plan (IEHP) - A personalized healthcare plan written by the certified school nurse that specifies the delivery of accommodations and services needed by a student in the event of an emergency.
5. Individualized Healthcare Plan (IHP) - A plan written by the certified school nurse that details accommodations and/or nursing services to be provided to a student because of the student’s medical condition based on medical orders written by a health care provider in the student’s medical home.
6. School-Sponsored Function - Any activity, event, or program occurring on or off school grounds, whether during or outside of regular school hours, that is organized and/or supported by the school.
B. Policy and Regulation Development
1. Policy and Regulation 5331 address different allergens, varying ages and maturity levels of students, and the physical properties and organizational structures of schools in this school district. The components below were critical in developing Policy and Regulation 5331.
a. The school district nursing staff, in consultation with the school physician, if needed:
(1) Assessed the overall health needs of the student population at risk for anaphylaxis, particularly students with food allergies; and
(2) Assessed current and relevant policies and/or protocols regarding the care of students with life-threatening allergies and identified areas in need of development or improvement.
2. Policy and Regulation 5331 were developed using a multidisciplinary team that included various school district administrators, teachers, support staff members and parents.
3. Additional factors need to be regarded at the secondary school level in order to provide the best care for food-allergic teens. The multidisciplinary team should consider the factors below when developing Policy and Regulation 5331 as it pertains to food-allergic teens.
a. Students move to different classrooms, frequently in larger buildings and campuses, presenting needs for updated avoidance strategies, epinephrine availability, and designated assistance.
b. Students may have open lunch periods and accompany friends to local eateries.
c. Students may have access to vending machines.
d. Certain classes give rise to new avoidance issues, e.g., chemistry/biology labs, home economics/culinary class, etc.
e. The number of off-site school-sponsored functions increases, e.g., travel, sometimes to other States and foreign countries; athletic games and competitions, sometimes in other towns; dances; etc.
f. Risk-taking behaviors frequently accompany the independence of adolescent years.
g. N.J.S.A. 18A:40-12.6 provides for a delegate for the emergency administration of epinephrine even when a student is able to self-administer life-saving medication. Although teenage students will more than likely be permitted to carry and self-administer emergency medications, those students are not to be expected to have complete responsibility for the administration of epinephrine. A severe allergic reaction can completely incapacitate a student and inhibit the ability to self-administer emergency medication. Therefore, the school nurse or volunteer delegate shall be available during school and school-sponsored functions to administer epinephrine in an emergency in accordance with the provisions of N.J.S.A. 18A:40-12.5.e.(2).
4. The Principal and/or the school nurse will educate staff and the community regarding Policy and Regulation 5331; obtain feedback on the implementation and effectiveness of the Policy and Regulation; and annually review, evaluate, and update the Policy and Regulation, as needed or required by law.
C. General Regulations
1. Sharing of food is forbidden in all PreK-5 grade-levels and discouraged in grades 6-12.
2. Any food that is served as part of a classroom event or celebration must be store bought, with a label that shows ingredients and nutritional facts, and consumed in the classroom. No homemade food will be served as part of classroom events or celebrations. No food should leave the classroom to be consumed in unsupervised or less closely supervised situations, such as in hallways or at recess. In addition, distribution of “goodie bags” i.e., candy intended to leave the classroom or be consumed on holidays (Halloween, Winter Holiday, Valentine’s Day, etc.) is not permitted.
3. Discourage the use of food items for all classroom events/classroom celebrations, etc.
4. Teachers and other school staff, including substitute teachers and paraprofessionals, will not give food as a reward for good behavior and/or or good work to any student unless noted in that student’s Individualized Education Plan, Section 504 Plan or Behavioral Intervention Plan.
5. At the beginning of the school year, a notice informing parents of this policy and the presence of a food-allergic student will be sent home to students in elementary schools by the school nurse.
6. A notice reminding parents of this policy and the presence of a food-allergic student will be sent home by the classroom teacher prior to a holiday celebration in order to exclude allergens from the class celebration.
7. The use of food allergens as a part of lessons, demonstrations or craft projects is discouraged, including school-related enrichment programs or before and after school programs, such as Beyond the Bell, YMCA, etc. Such programs shall have in place, procedures to address food allergic students.
8. Nothing in these regulations shall prohibit the distribution of food for consumption outside of school or in the cafeteria to address food insecurity among students, such as Backpack Pals, Cougar Cares, or the CHS Food and Toiletry Pantry.
D. Prevention Measures
1. Planning Regulations
At the beginning of the school year (for a student who is already in school or immediately after the diagnosis of a life-threatening allergic condition), the parent/guardian will meet with the school nurse assigned to the student’s building to develop an Individualized Healthcare Plan (IHP) or an Individualized Emergency Healthcare Plan (IEHP).
The student may also be referred for a Section 504 Plan.
For new students entering the school, an IHP and IEHP will be developed in consultation with the school nurse.
2. Considerations for the Cafeteria
The Principal, in consultation with the school nurse, teaching staff members, food service staff members, and other appropriate staff members, will work to make the cafeteria environment as safe as possible for food-allergic students. This process includes making determinations about serving foods with known allergens and identifying steps that can be taken to reduce the chance of accidental exposure. The steps may include:
a. Training will be provided to food service personnel, by the end of the first week of school, on food label reading, safe food handling, and safe meal substitutions for food allergic children and how to identify students with food allergens on the point-of-sale monitor.
b. Appropriate school staff (certified and non-certified) and contracted employees (i.e., paraprofessionals, cafeteria staff, and lunch monitors) will be educated about food-allergy management and will be informed of the presence of students with life threatening allergies. By the end of the first week of school, these staff will be instructed and trained in understanding allergies to food and other substances, to recognize symptoms of an allergic reaction, and to understand the school’s general emergency procedures steps to take should a life-threatening allergic reaction occur.
c. Implementing standard procedures for cleaning tables, chairs, and trays, particularly those designated as allergen-safe, after lunch periods using dedicated soap and water or all-purpose cleaning agents and disposable supplies to avoid cross contact.
d. Discouraging students from sharing or trading food, snack items, drinks, straws or utensils.
e. Implement use of at least one allergy free table in all K-5 school cafeterias and, if possible, one for each grade level during lunch. Student may have competing allergies. Lunch staff will work to address the different allergies of students seated at the allergy free tables. Students with food allergies will be able to invite a friend or friends (whose lunch does not contain allergens of students eating at the table or zone) to sit with them. With written consent, a parent may opt-out of having his/her child eat at an allergy free table.
f. Students will be encouraged to wash hands using soap and water before and after eating or handling food.
g. All lunch and recess monitors and the nutrition manager/director, will be provided information that identifies students with food allergies by picture, name, and lunch period.
h. Consider the benefits and ramifications of serving and/or removing allergen- containing foods or removing a particular food item from the school menu.
i. Make accommodations in the event a student cannot be in direct proximity to certain allergens that are being cooked/boiled/steamed.
3. Considerations for the Classroom
Provisions have been developed for the protection of food-allergic students in the classroom. The school nurse will work with teachers so they understand and are able to initiate the student’s IEHP, as necessary.
a. Training will be provided to teachers, paraprofessionals, volunteers, substitutes, and students about food allergies.
b. A letter will be developed and sent to Parent(s) or legal guardian(s) of classmates of food allergic students (without identifying the student), particularly in lower grades, explaining any prohibitions on food in the classroom.
c. The use of food allergens for classroom projects/activities, classroom celebrations, etc. is discouraged. Teachers are encouraged to use non-food items for classroom projects/events, as a way to avoid the potential presence of major food allergens.
d. Students with a food allergy will have a medical icon in PowerSchool for the purpose of notification.
e. Substitute teachers will be notified that they are prohibited from bringing into or consuming allergen-food items in any classroom that they are covering.
f. Substitute teachers will be alerted to the presence of any students with food allergies and any accompanying instructions, regardless of whether the student has a Section 504 Plan.
g. If an animal is present in the classroom, special attention must be paid to the ingredients in their food, as many animal feeds contain allergens.
h. Encourage students to wash their hands before and after eating or handling food.
i. Desks, chairs, trays and tables must be cleaned before and after eating (lunch, snacks, etc.) using disposable cleaning supplies.
4. Consideration for Celebrations
The Principal, in consultation with the school nurse, teaching staff members, food service staff members, and other appropriate staff members and contractors, will work to make the school environment as safe as possible for the food-allergic student to include:
a. For classroom parties/celebrations, parents of food-allergic children will be notified in advance. In addition, parents who may be providing a snack will also be reminded of the food allergens in the class in order to avoid them in the celebratory food.
b. All food must be store bought, in its original package, with the label clearly visible. No homemade food will be served during classroom celebrations.
c. PTO/PTA/HSA events will conform to these regulations and will not use food as a reward or incentive. For example, PTO/PTA/HSA celebrations during school hours will be food free or food will be safe for all participating students.
5. General Considerations for the School Environment
Teaching staff members, food service staff members, custodial staff members and other appropriate staff members and contractors will work to make the school environment as safe as possible for the food-allergic student to include:
a. Develop and implement cleaning procedures for common areas (i.e., libraries, computer labs, music and art rooms, hallways, etc.).
b. Food fundraisers (i.e. bake sales, candy sales, etc.) that are held on school grounds should include foods which are store bought with a label that shows ingredients and nutritional facts.
c. Staff shall not use food products as displays or components of displays in hallways.
d. Develop protocols for appropriate cleaning methods following events held at the school, which involve food.
E. Field Trips and Other School Functions
N.J.S.A. 18A:40-12.6 requires a school nurse or delegate to be available during school and school-sponsored functions in the event of anaphylaxis. Students with food allergies should participate in all school activities and will not be excluded based on their condition. The appropriate school staff member(s) will:
a. Communicate, with parent’s or legal guardian’s permission, relevant aspects of the IEHP or Section 504 Plan to staff, as appropriate, for field trips, school- sponsored functions, and before- and after-school programs, such as Beyond the Bell enrichment.
b. Encourage long-term planning of field trips in order to ensure that food-allergic students receive needed services while away from school.
c. Evaluate appropriateness of trips when considering the needs of students, e.g., a trip to a dairy farm should not be scheduled for a class with a milk-allergic student.
d. Parent(s) or legal guardian(s) of food-allergic students are encouraged, but not required, to accompany their children on school trips.
e. Implement the District’s procedure for the emergency administration of medications. Epinephrine auto-injectors and a copy of the student’s IEHP must accompany the student on field trips.
f. Implement the District’s procedure for emergency staff communications on field trips.
g. Inform parent(s) or legal guardian(s), in advance when possible, of school events at which food will be served or used.
h. For school dances or socials, caterers or restaurants will be notified that food- allergic students will be attending and that allergen free options must be available for accommodations.
i. No student will be excluded from Board of Education sponsored after-school activities due to the risk of allergen exposure. Beyond the Bell teachers will be trained to recognize signs and symptoms of anaphylaxis.
F. Bus Transportation
The district administrative staff and transportation personnel will consider the needs of students with life-threatening allergies while being transported to and from school and to and from school-sponsored activities. The appropriate school staff member(s) will:
a. Educate transportation drivers and paraprofessionals/aides about food-allergy management and will be informed of the presence of students with life threatening allergies. By the end of the first week of school, these staff will be instructed and trained in understanding allergies to food and other substances, to recognize symptoms of an allergic reaction, and to understand the school’s general emergency procedures steps to take should a life-threatening allergic reaction occur.
b. Advise bus drivers of the students that have food allergies, symptoms associated with food-allergic reactions, and how to respond appropriately.
c. Ensure that all transportation vehicles are equipped with functioning emergency communication devices (e.g., cell phones, two way radios and/or walkie-talkies)
d. Consider assigned bus seating, i.e., students with food allergies can sit at the front of the bus or can be paired with a “bus Buddy”.
e. Publicize that food may not be eaten on school buses except as may be required by a student’s IEP, Section 504 Plan or Behavioral Intervention Plan. Notice of the prohibition and its enforcement must be given to all parents.
f. Permit the student to self-carry Epinephrine and inform the bus driver of its location. Bus drivers, bus aides and paraprofessionals will be trained to recognize signs and symptoms of anaphylaxis. Bus drivers, bus aides or paraprofessionals who have been trained and have volunteered to do so will administer epinephrine.
G. Preparing for an Emergency
The Principal and school nurse will establish emergency protocols and procedures in advance of an emergency. These protocols and procedures will:
a. Provide training for school personnel, including contracted paraprofessionals, transportation staff, and cafeteria and recess staff, about life-threatening allergic conditions.
b. Create a list of volunteer delegates trained by the school nurse in the administration of epinephrine and willing to administer epinephrine, ensure that a delegate is present at school during school hours at all times, and disseminate the list appropriately.
c. Ensure that epinephrine is quickly and readily accessible in the event of an emergency. If appropriate, maintain a backup supply of the medication.
d. Coordinate with local EMS on emergency response in the event of anaphylaxis on school grounds and on bus routes to school.
e. Consider conducting anaphylaxis drills as part of the district or school-wide emergency response plan.
f. Ensure access to epinephrine when developing plans for fire drills and evacuations.
g. Ensure that reliable communication devices are available in the event of an emergency.
h. Adhere to Occupational Safety and Health Administration (OSHA) and Universal Precautions Guidelines for disposal of epinephrine auto-injectors after use.
H. Sensitivity and Bullying
A food-allergic student may become victim to threats of bullying related to his/her condition. N.J.A.C. 6A:16-7.9 requires each Board of Education to develop, adopt, and implement a policy prohibiting harassment, intimidation, or bullying on school grounds, including on a school bus or at a school-sponsored function, pursuant to N.J.S.A. 18A:37-15. The appropriate school staff member(s) and contractors will:
a. Remind students and staff that bullying or teasing food-allergic students will not be tolerated and violators will be disciplined in accordance with SOMSD Policy 5512: Harassment, Intimidation and Bullying (HIB).
b. Offer professional development for faculty and staff, including contractors, regarding confidentiality to prevent open discussion about the health of specific students.
c. Discourage needless labeling of food-allergic students in front of others. A food- allergic student should not be referred to as “the peanut kid,” “the bee kid” or any other name related to the student’s condition.
I. Protocol for Community Use of District Buildings
All outside groups (including, but not limited to, Beyond the Bell, PTO/PTA/HSA, and before and after-care programs) will be advised of the requirements of this Regulation. All written agreements for use of school buildings will require adherence to these Regulations, including respecting allergen aware classrooms and cleaning up after any food is served.
J. Roles and Responsibilities for Managing Food Allergies
The risk of accidental exposure to foods can be reduced in the school setting if schools, students, parent(s) or legal guardian(s), and physicians work together to minimize risks of exposure to allergens and provide a safe educational environment for food-allergic students.
1. Family’s Role
a. Notify the school of the student’s allergies.
b. Provide written medical documentation, instructions, and medications as directed by a physician, using the Food Allergy Action Plan as a guide. Include a photo of the child on written form.
c. Work with the school team to develop a plan (IHP, IEHP, and/or Section 504) that accommodates the student’s needs throughout the school, including the classroom, the cafeteria, before and after-care programs, during school- sponsored activities, and on the school bus.
d. Provide properly labeled medications and promptly replace medications after use or upon expiration.
e. Educate the child in the self-management of their food allergy including: safe and unsafe foods; strategies for avoiding exposure to unsafe foods; symptoms of allergic reactions; how and when to tell an adult they may be having an allergy-related problem; and how to read food labels (as age appropriate).
f. Provide current emergency contact information and update regularly.
2. School’s Role
a. Review the health records submitted by parent(s) or legal guardian(s) and physicians.
b. Identify a core team including the school nurse, teacher, and Principal to work with parent(s) or legal guardian(s) and the student (age appropriate) to establish an IEHP. Changes to the IEHP that promote food allergy management may be made without full core team participation, except that no change will be made without parent or guardian participation.
c. Assure that all staff and contractors who interact with the student on a regular basis understand food allergies, can recognize symptoms, know what to do in an emergency, and work with other school staff to eliminate the use of food allergens in the allergic student’s meals, educational tools, arts and crafts projects, or incentives.
d. Coordinate with the school nurse to ensure medications are appropriately stored and ensure an emergency kit is available that contains a physician’s standing order for epinephrine. Epinephrine should be kept in a secure but unlocked location that is easily accessible to delegated school personnel.
e. Students who are permitted to self-administer should be permitted to carry their own epinephrine in accordance with State regulations and district policy.
f. Designate school personnel who volunteer to administer epinephrine in an emergency and ensure the presence of a designee at all times.
g. Be prepared to handle a reaction and ensure there is a staff member available who is properly trained to administer emergency medications during the school day, regardless of time or location.
h. Review policies and prevention plans with the core team members, parent(s) or legal guardian(s), student (age appropriate), and physician after a reaction has occurred.
i. Work with the transportation administrator to ensure that school bus drivers receive training that includes symptom awareness and what to do if a reaction occurs and assess the means by which a bus driver can communicate during an emergency, including proper devices and equipment.
j. Discuss field trips with the family of the food-allergic child to decide appropriate strategies for managing the food allergy.
k. Follow Federal and/or State laws and regulations regarding sharing medical information about the student.
3. Student’s Role
a. Be proactive in the care and management of their food allergies and reactions based on their developmental level.
b. Do not trade or share food with others.
c. Do not eat anything with unknown ingredients or known to contain any allergens.
d. Notify an adult immediately if they eat something they believe may contain the food to which they are allergic.
e. Self-administer medication (as appropriate), which requires that the student keep up to date medications and supplies with him/her, and requires parent authorization.
Issued: 25 May 2018