Bordentown Regional Board of Education
BORDENTOWNREGIONALSCHOOL DISTRICT POLICY MANUAL
POLICY & PROTOCOL FOR LIFE THREATENING FOOD ALLERGIES
GRADES PREK-125026
Food allergies can be life threatening. The risk of accidental exposure to foods can be reduced in the school setting when the school works with students, parents/guardians, medical personnel and staff to provide a safe educational environment for food-allergic students.
I.Protocol
The following protocol shall be followed when a student has a life threatening food allergy.
A.The parent/guardian notifies the district that the student has a life threatening food allergy.
B.The information is relayed to the school nurse. The school nurse communicates with the parent/guardian and collects medical documentation, medication, physician’s instructions and written authorization and consent forms required by law.
C.The school nurse reviews the information and sends it to the school physicianfor review.
D.After the medical inspector confirms that the student does have a life threatening food allergy, the school nurse notifies the building principal, teachers, supervisors, staff members and transportation department.
E.The school nurse develops an individualized Food Allergy Action Plan (Attachment #1) and an Individual Healthcare Plan (IHP) for the student. (See Section II, Nurse’s Guidelines for IHP’s and Attachment #2, and Individualized Healthcare Plan).
F.The school nurse educates instructional staff members, cafeteria assistants, playground aides and school bus drivers on the signs and symptoms of anaphylaxis, including how children may describe their symptoms (see Section III), and appropriate responses (call the school nurse or dial 911). District school nurses, as well as delegates, participate in CPR/AED training workshops annually to maintain up-to-date, contemporary certification in these areas. Also, school bus drivers will be issued a Life Threatening Allergies laminated card for their school bus with the student’s picture, asthmatic status, emergency protocol, signs and symptoms of an allergic reaction list, and words children may use to describe a reaction, if the parent/guardians give their consent. (Attachment 12) Teachers will be reminded to encourage students to wash hands before and after lunch as part of an appropriate hygiene procedure.
G.The Director of Buildings and Grounds educates and trains all custodial staff regarding the procedures for keeping all designated surfaces sanitary and allergen free.
H.The Transportation Coordinator notifies school bus drivers who are transporting a child with a life threatening food allergy. When a child shows signs or symptoms of anaphylaxis the following School Bus Emergency Action Plan will be followed:
1.The bus driver will call 911.
2.The school bus driver will notify the transportation department of the situation and the bus route.
3.The transportation department will contact the building principal and school nurse.
4.The school will notify the parent/guardian.
5.The school bus driver, in cooperation with the transportation department, will decide whether to meet a first responder or proceed to the school, the home, or the hospital or medical center, depending on which can be reached the most quickly.
The Transportation department will send home, along with the district bus passes, the principal’s letter (Attachment #3) to all parents/guardians who have students on the affected bus route(s).
I.The building principal sends a notification letter (Attachment #4) to parents/guardians whose child is in the food-allergic student’s class.
J.The building principal will contact the food-allergic student’s parents/guardians to ask for consent (see Attachment #5) to post “Medical Alert” posters in designated classrooms andin the food serving area if the parents/guardians give their consent (see Attachment #6, Medical Alert.)
The building principal will arrange for the student’s picture to be
taken for use on the posters if the parents/guardians give their
consent.
- The parent/guardian notifies the school nurse in writing of any changes in the student’s condition, such as changes in medications or dosages, or a change in the number and severity of the items to which the child is allergic.
The district will follow the appropriate steps to ensure that the most current information available is reflected in the student’s records.
II.Nurse’s Guidelines for Completing Individual Healthcare Plans
The Individual Healthcare Plan (IHP) should include the following information (see Attachment #2, Individual Healthcare Plan.)
- Student’s health history
- Current information and assessment
- Preparer’s signature and the date
- Goals, such as:
avoiding contact
controlling the environment
recognition of symptoms
accessing medication in an emergency
educating faculty and staff
- Nursing diagnosis and/or student problems, along with suggested intervention and the outcome/evaluation. Some examples of diagnosis/student problems and suggested interventions are:
Parties: Teacher will notify parent/guardian, building administration and school nurse of all upcoming parties so appropriate food can be provided for child by parent/guardian.
Lunchroom Seating: Grades Pre K- 3: Parent/guardian will determine if child sits at the “acknowledge specific allergy free table”.
Grade 4 – 5: Parent/guardian will determine if child sits at the “acknowledge specific allergy free table”.
Grades 6 – 12: Student will self-determine where he/she will sit.
Alert Poster: Parent/guardian will determine if he/she wants to utilize poster for child.
Bus:Transportation department will determine seating location.
Self Administration: As per physician’s instructions.
Notification of Staff: Obtain parent/guardian consent to notify staff regarding the life threatening allergy when student picture is used on a BRSD document
and if no picture is used, notify staff regarding the life threatening allergy.
Field Trips: Discuss appropriate strategies with appropriate chaperoning faculty and staff for managing the food allergy.
Establishment of
Cleaning Procedures:In consultation with Maintenance
In case of allergicChild will be medicated as determined by
reaction:physician authorizing treatment.
911 call for transport to Emergency Room.
Vital signs will be monitored.
Parent/guardian will be called.
District will follow K-12 Protocol.
III.How A Child Might Describe An Allergic Reaction
Children have unique ways of describing their experiences and perceptions including allergic reactions. Precious time is lost when adults do not immediately recognize that a reaction is occurring or do not understand what the children might be telling them.
Following are examples of the words a child might use to describe a reaction.
- I can not breathe.
- I do not feel good or I do not feel right.
- This food is too spicy.
- My tongue is hot (or burning).
- It feels like something’s poking my tongue.
- My tongue (or mouth) is tingling (or burning).
- My tongue (or mouth) itches.
- My tongue feels like there is a hair on it.
- My mouth feels funny.
- There’s a frog in my throat.
- There’s something stuck in my throat.
- My tongue feels full (or heavy).
- My lips feel tight.
- It feels like there are bugs in my ears (describing itchy ears).
- My throat feels thick.
- It feels like a bump is on the back of my tongue (or throat).
IV.Additional Attachments
The following Attachments can be used in conjunction with Attachment 6, Medical Alert.
Attachment 7Classroom Sign
Attachment 8Notice for Food Service Employees
Attachment 9Cafeteria/Lunchroom Signs.
The following Attachments contain additional useful information.
Attachment 10 Directions for EpiPen Use
Attachment 11 School Guidelines For Managing Students With Food
Allergies
Attachment 12Laminated Life Threatening Allergies Bus Information
Sheet
Attachment 13Laminated Life Threatening Allergy Classroom Information Sheet
- Information Resource
For additional information, visit the Food Allergy and Anaphylaxis Network website
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Policy Adopted
Attachment 1: Food Allergy Action Plan
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BRSD Life Threatening Allergy Policy
Bordentown Regional Board of Education
Attachment 2: Individualized Healthcare Plan
INDIVIDUALIZED HEALTH CARE PLAN
STUDENT:AGE:MEDICAL DIAGNOSIS:
Health Rx:Triggers: / Current Information and Assessment:
Prepared By: Date:
Goals:
Nursing Diagnosis and/or Student Problem: / Interventions: / Outcome/Evaluation:
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BRSD Life Threatening Allergy Policy
Bordentown Regional Board of Education
Attachment 3: Sample Letter to Parents/Guardians of Students on Bus Routes
Dear Parents/Guardians:
Some children in the BordentownRegionalSchool District have allergies to (acknowledge specific allergy)nuts, peanuts and peanut based products. Consultation with our pediatric allergists and our own research shows (acknowledge specific allergy) nuts, including peanuts and peanut butter, can cause an allergic reaction that is among the most severe of any food allergies. The food does not have to be ingested to cause a reaction. Simply touching someone or something that contacted (acknowledge specific allergy) apeanut based product can result in severe consequences. Even trace amounts of these materials on a table or toy may induce a reaction.
This letter is to inform you that there is a student on your child’s bus who has a food allergy. This student is highly allergic to(acknowledge specific allergy)nuts of any kind, including peanuts and peanut butter. Due to the possible allergic reaction, it is imperative that this child avoid these foods completely. If the student comes in contact with any of the above foods, he/she may suffer a life-threatening reaction.
It is extremely dangerous for this child to even come in close proximity to the offending foods. Therefore we are requesting that all snacks or treats that are brought on the bus remain in your child’s backpack and not be taken out until the appropriate time at school. Sharing or eating any food on the bus, as always, is prohibited.
Hand washing is an important practice. By frequently washing your hands you wash away germs that you have picked up from other people and from contaminated surfaces. When dealing with food allergies, hand washing with soap and water is an essential detail. We ask, for the benefit of your child as well as all the students on the bus, that your child washes his/her hands prior to getting on the bus from home.
We thank you in advance for your cooperation with this situation.
Sincerely,
Principal’s Signature
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BRSD Life Threatening Allergy Policy
Bordentown Regional Board of Education
Attachment 4: Sample Letter to Parents/Guardians of Students inClass With Food-Allergic Student
Dear Parents/Guardians,
We have some children in the BordentownRegionalSchool District that have allergies to (acknowledge specific allergy)nuts, peanuts and peanut based products. We have learned through consultation with our pediatric allergists as well as through our own research that (acknowledge specific allergy)nuts and/or peanuts can cause an allergic reaction that is among the most severe of any food allergy – ranging from hives and itching, to difficulty breathing and possibly cardiac arrest. The seriousness of the allergy is compounded by the fact that the food does not have to be ingested to cause a reaction. Simply touching someone or something that has had contact with (acknowledge specific allergy) apeanut based products can result in severe consequences. Even trace amounts of residue of these foods (e.g. on a table or toy) may induce a reaction.
This letter is to inform you that there is a student in your child’s class who has a severe allergy. This student is highly allergic to (acknowledge specific allergy)nuts of any kind, including peanuts and peanut butter. Due to the severity of this situation it is imperative that this child avoid these foods completely. This allergy is so severe that if he/she comes in contact with any of the above foods he/she may suffer from a severe, life-threatening reaction, which may require immediate medical attention.
Please be aware that it is extremely dangerous for this child to even come in close proximity to the offending foods. When you wish to send in a snack for all students in the classroom, it is your responsibility to please notify the teacher in advance so he/she can ask this child’s parents to send in a “safe snack/food” for the allergic student.
At this time we are requesting that all snacks or treats that are brought into the classroom for any reason do not contain (acknowledge specific allergy)nuts, peanuts, or peanut butter. Please carefully check the ingredients of all snacks sent as peanut products are used widely in snack foods which may have no peanut taste. If a parent chooses to give their child a peanut product, we request that they notify the school so that we are aware of precautions we need to take.
One other important item to acknowledge is hand washing. By frequently washing your hands you wash away germs that you have picked up from other people and/or from contaminated surfaces. When dealing with food allergies, hand washing with soap and water is an essential detail. We ask that you have your child wash his/her hands prior to getting on the bus or entering the school from home to help prevent any reactions.
We thank you in advance for your cooperation with this situation.
Sincerely,
Principal’s Signature
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BRSD Life Threatening Allergy Policy
Bordentown Regional Board of Education
Attachment 5: Sample Letter to Parents/Guardians/ Requesting Consent to Post
“Medical Alert” Posters.
Dear Parents/Guardians:
Attached please find the “Medical Alert, Life Threatening Allergy Alert ” poster that we would be willing to post in the following locations if you choose to provide us with a signed informed consent form.
- In the cafeteria for the serving staff
- In your child’s teacher’s substitute folder
- With the bus driver for your child’s bus route
Your child’s picture would appear under the words “Medical Alert.” If you wish for us to post your child’s picture with the information in those locations, please sign below and return to the principal’s office.
Sincerely,
Principal’s Signature
I give permission for my child’s picture to be placed on the Life Threatening Allergy Poster which will be posted in the above locations.
Parent/Guardian SignatureDate
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BRSD Life Threatening Allergy Policy
Bordentown Regional Board of Education
Attachment 6: “Medical Alert” Poster
MEDICAL ALERT
Life Threatening Allergy Alert
SEVERE ALLERGY TO ______.
NO ______
OR
______PRODUCTS IN DESIGNATED AREA.
IF ANAPHYLAXIS OCCURS, CALL 911 IMMEDIATELY
CONTACT SCHOOL NURSE
EPIPEN IN HEALTH OFFICE AND, IF PERMITTED TO SELF-ADMINISTER, WITH THE STUDENT
Attachment 7: Classroom Sign
PLEASE WASH HANDS
BEFORE ENTERING
THIS ROOM IS USED BY A STUDENT WITH A LIFE THREATENING ALLERGY.
DO NOT BRING ______
FOOD PRODUCTS INTO THIS ROOM.
Attachment 8: Notice for Food Service Employees
PLEASE WASH HANDS.
THIS AREA IS USED BY A STUDENT WITH A LIFE THREATENING ALLERGY. DO NOT UTILIZE ______
FOOD PRODUCTS IN THIS AREA.
Attachment 9: Cafeteria/Lunchroom Signs
______
(Life Threatening Allergy)
FREE TABLE
Attachment 10: Directions for EpiPen Use
Attachment 11: School Guidelines for Managing Students With Food Allergies
Attachment 12: Laminated Life Threatening Allergies Bus Information Sheet
______
LIFE THREATENING ALLERGIES TO
______
Asthmatic _____Yes _____No
- EMS, Advanced Life Support and Epi-pen is needed if:
- Contact with above foods suspected
- Complains of symptoms listed on back of sheet
- Stop bus and call “911” (stay on phone with “911”), if
possible radio transportation and advise them of situation.
If unable to reach “911” on cell phone then radio
transportation & they will call “911”.
- State nature of emergency - tell them symptoms
The child is having & what you are seeing
- Give child’s name
- Give your bus location
- Request EMS with Advanced Life Support response
- Tell them child has life threatening food allergy and
asthma (if checked off above). Stay on phone
with “911”.
- Transportation will contact building principal, parent(s)/
guardian, or second/third emergency contact.
Keep in secure location for substitute driver to view.
Attachment 13: Laminated Life Threatening Allergy Classroom Information Sheet
SIGNS AND SYPMTOMS OF AN
ALLERGIC REACTION INCLUDE
MOUTH:Itching and swelling of the lips, tongue
and/or mouth drooling.
THROAT:Itching and/or a sense of tightness in the
throat, hoarseness, squeakiness or change in voice
quality, difficulty swallowing .
SKIN:Hives, rash, swelling about the face
or extremities flushed face, followed by
paleness.
GUT:Nausea, abdominal cramps, vomiting
and/or diarrhea.
LUNG:Shortness of breath, coughing, or
wheezing.
HEART:Rapid heart beat, dizziness, unsteadiness,
passing out
GENERAL:Fear, apprehension, sudden fatigue, chills,
loss of consciousness, coma, death.
Words children may use to describe a reaction
I don’t feel right.
I don’t feel good.
This food is too spicy.
My tongue is hot (or burning).
It feels like something is poking my tongue.
My tongue (or mouth) is tingling (or burning).
My tongue (or mouth) itches.
It (my tongue) feels like there is hair on it.
My mouth feels funny.
There’s a frog in my throat.
There’s something stuck in my throat.
My tongue feels full (or heavy).
My lips feel tight.
It feels like there are bugs in there (to describe itchy ears).
It (tongue) feels thick.
It feels like a bump in the back of my tongue (throat).
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BRSD Life Threatening Allergy Policy