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


Treatment for Allergies. Antihistamines/Bronchodilators. Epinephrine ... Allergies with no anaphylaxis. Food intolerances. Accommodations Required ... – PowerPoint PPT presentation

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

Special Dietary Needs in Child Nutrition Programs
Lesson 3 Managing Food Allergies
Learning Objectives
  • Summarize key components regarding food
  • Explain ways food service personnel can prevent
    exposing children with allergies to the allergen.

Food Allergies
  • Definition
  • Symptoms
  • Anaphylaxis

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

  • Sudden, severe, potentially fatal reaction
  • Potentially life threatening can occur after
    person with allergies is exposed to a specific
  • 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

Treatment for Allergies
  • Antihistamines/Bronchodilators
  • Epinephrine
  • Prevention and Strict Avoidance
  • Action Plan


Food Item Source of Allergen
Milk Soy Egg
Crinkle cut fries
Chicken nuggets
Mashed potatoes
Creamed corn
Hotdog buns
Cheese ravioli
Cheese pizza
Carrot/celery ranch dressing
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
  • Applies in schools, not if label before Jan 06
  • Exemptions-raw agricultural commodities-fresh
    fruits/vegetables, highly refined oils

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

Accommodations with Approval of Food Service
Accommodations Required
  • Allergies with no anaphylaxis
  • Food intolerances
  • Allergies with the potential of anaphylaxis
  • Celiac disease

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

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

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.

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
  • 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.

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.

Special Dietary Needs in Child Nutrition Programs
Lesson 4 Understanding Inborn Errors of
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.

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
  • Dietary treatment strict diet management to
    avoid toxic buildup of dietary by-products
  • Special foods or formulas may be needed

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

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

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

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

Food Services
  • Maintain communication among food personnel,
    parents, teacher, school nurse, and consultant if
  • 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

  • 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

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
  • 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
  • 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
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