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

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

• Summarize key components regarding food
  allergies.
• Explain ways food service personnel can prevent
  exposing children with allergies to the allergen.

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Food Allergies

• Definition
• Symptoms
• Anaphylaxis

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Common Food Allergies

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

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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

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Treatment for Allergies

• Antihistamines/Bronchodilators
• Epinephrine
• Prevention and Strict Avoidance
• Action Plan

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Food Item Source of Allergen
Milk Soy Egg
Meatballs
Crinkle cut fries
Biscuits
Chicken nuggets
Mashed potatoes
Creamed corn
Hotdogs
Hotdog buns
Cheese ravioli
Tacos
Cheese pizza
Carrot/celery ranch dressing
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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

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Allergy Scenarios

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

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Regulations
Accommodations with Approval of Food Service
Director
Accommodations Required

• Allergies with no anaphylaxis
• Food intolerances

• Allergies with the potential of anaphylaxis
• Celiac disease

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Food Intolerance
Definition Food intolerance is an adverse
reaction to food that does not involve the immune
system. Examples

• Lactose Intolerance
• Gluten Intolerance

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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

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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.

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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 schools emergency plan if
  anaphylaxis should occur in a child with a life
  threatening food allergy.

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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.

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Special Dietary Needs in Child Nutrition Programs
Lesson 4 Understanding Inborn Errors of
Metabolism
Learning Objectives

• 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.

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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

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Phenylketonuria (PKU)

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

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Galactosemia

• Cannot process the sugar galactose
• Dietary treatment no milk or dairy products

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Hereditary Fructose Intolerance

• Cannot process the sugar fructose
• Dietary treatment
• no fructose (high-fructose corn syrup, honey,
  fruit)
• no sucrose (table sugar)

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Maple Syrup Urine Disease

• Cannot process branched chain amino acids
  leucine, isoleucine, valine
• Dietary treatment
• low-protein diet
• special formula to provide protein

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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

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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

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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