Even if you pick the safest school in your neighborhood, accidental exposure to a food allergen is always a possibility. To limit the risk of accidental exposure, you can work with your school to implement some proactive preventive measures. No matter which school you choose, the school should have some sort of food allergy policy in place.

Many schools have existing food allergy policies influenced or even established by parents of allergic children who’ve attended the school. These policies often range from dangerously deficient to very thorough and useful, so carefully review the school’s existing food allergy policy in the light of the guidelines I lay out.

A school’s food allergy policy merely sets out procedural guidelines. A policy is no replacement for specific information you provide to the school about your child’s food allergy and detailed instructions on what to do in the event of a reaction.

General procedures

A school’s food allergy policy must include general procedures to ensure medication is stored in a safe, convenient location and that staff members are properly informed. Review your school’s food allergy policy to make sure it answers to the following questions:

• Where are medications stored? The school should store the medications in a convenient location accessible to all staff members at a moment’s notice, and all staff members should be aware of the location.

• Where is each student’s emergency health care form filed? In the event of an emergency, staff members should be able to pull up the form for immediate reference. Consider storing the form with the school nurse or administrator and having a copy available for your child’s teachers. Storing a copy of the emergency form along with the medications is also a good practice.

• Who should know about the food allergy and how will they be trained? All teachers, coaches, cafeteria workers, office personnel, playground supervisors, bus drivers, and other staff members who have regular contact with your child should be informed of what your child is allergic to, how to prevent accidental exposure to a food allergen, and what to do in the event of an emergency.

If your doctor prescribed epinephrine autoinjectors, two or more staff members should be properly trained on administering shots.

• Who will train substitute teachers (if applicable)? The food allergy policy should specify how substitute teachers are to be trained when your child’s teacher misses a day of school.

During the day, most students have some sort of break for lunch and perhaps even a snack time. Every school’s food allergy policy must answer the following questions:

• Where do students eat their lunch and snacks? A policy that keeps food out of the classrooms is best, but if your school does not have a central eating facility, this may not be an option.

• Who provides the snacks? School-only provided snacks are best. All snacks must have clear, understandable labeling of all ingredients. If the school has a policy in which students can bring their own snacks, then you may need to deal with this issue with your child’s teacher.

• Can the classroom be allergen free (for example, peanut free)? Although your school’s food allergy policy may not ban a particular food, it should include a statement that a particular classroom can be made allergen free at the parent’s request.

• What are the specific cafeteria procedures?

• Peanut free tables and other seating arrangements should be spelled out.

• If the school prepares and serves its own food, preparation and serving procedures should be in place to clearly identify foods that may contain ingredients that your child is allergic to and to prevent cross-contamination.

• The policy should describe who’s in charge of cleaning the tables, when tables need to be cleaned (before the first lunch room shift and after each shift), how tables are to be cleaned (scrubbed thoroughly), and what cleaning solution to use.

• How and when are students to wash their hands? The school should require that all students wash their hands before and after eating.

Prevention is not always 100 percent effective, so your school’s food allergy policy must have a plan B in place that details the following:

• Where should the student go for help? If your child begins to experience a reaction, she needs to know ahead of time where to go for help — the teacher, the main office, nurse’s office, or somewhere else.

• Who should accompany the child? When experiencing a reaction, even if it appears mild at first, your child should never be left alone. A teacher or fellow student who knows what to do if the reaction intensifies should accompany the child to seek help.

• Who is to stay with the other students? Most schools do not allow students to remain unsupervised, so a plan should be in place for another teacher or staff member to remain with the other students should the teacher need to leave the room immediately.

• What should be done if the student is in the lunch room, classroom, or gym? The food allergy policy must specify a separate plan for any scenario in which your child may find himself in at school, including the gym or lunch room. Who’s the go-to person in each scenario?

• Who’s responsible for calling the nurse? If your school has a nurse, who’s in charge of contacting her — the teacher, administrator, or someone else? What does this person need to do to contact the nurse in an emergency?

• If the nurse is not present, who’s next in line for action? A backup emergency person should always be in place in case the nurse is out for the day or cannot be contacted.

• When should the person in charge call 911? Instructions should spell out the conditions under which the person handling the situation should call 911. Whenever epinephrine is administered, a call to 911 is mandatory.

Schools have drills for fires, tornadoes, and even, unfortunately, school ground intruders. Very few schools have drills for treating medical emergencies. Consider staging a drill for a severe allergic reaction. A brief rehearsal or two can ensure that everyone knows the role they play, that the medications are accessible, and that the people administering the medications are able to do it properly.

Field trips

A field trip transports your child out of the relative safety of the school grounds and places him in a challenging, less-controlled environment. Your school’s food allergy policy should address this challenge:

• Who’s responsible for carrying and administering the medications? When your child is away from school, her regular emergency treatment person may not be readily available. In such a case, who’s going to play that role on the field trip? The teacher or the parent in charge of chaperoning your child’s group may need additional training.

• Are you able to attend? If you’re able to go on the field trip with your child, this may be the best option. You can ensure proper prevention, carry the medications yourself, and you know what to do in the event of a reaction.

• What steps can be taken to minimize risks? As with other activities, the key issues revolve around eating. Make sure you know what snacks or meals may be needed and what food exposures may inadvertently occur during a specific trip. Packing your child a lunch for the field trip may reduce much of the risk.

After-school activities

After school, your child may be involved with extra-curricular activities, such as the school newspaper, yearbook, sports, or student government. Another teacher or a parent may be supervising this activity. Your school’s food allergy policy should address how food allergies are handled during after school activities:

• Who’s in charge if a reaction occurs after school? The most important step in ensuring safety after school is to inform the person in charge of the after-school activity about your child’s food allergy and what to do in case your child experiences a reaction.

The food allergy policy should specify that the coach or other activity supervisor is to be properly trained. In addition, whoever may substitute for the coach or activity supervisor also requires proper training.

• Where are medications stored? If medications are normally stored in the nurse’s office, which may be locked after school, the policy must specify a convenient, readily accessible location for the medications after school, or the activities supervisor should be required to carry a separate, fully stocked emergency kit.

• Who should the activity supervisor report a reaction to? When other emergency personnel leave the school at the end of the day, who should the activity supervisor contact in the event of a reaction?

• What steps should be taken during a reaction? The policy should lay out the specific steps the activity supervisor needs to take if your child experiences a reaction.

The best food allergy policy, if not properly implemented, is useless. As a parent of a child with food allergy, your role is to ensure that everyone in the loop remains well-informed. Before the school year is scheduled to kick off or preferably near the end of the previous school year, prepare for a meeting with teachers, administrators, and other school personnel. In preparation, gather the following materials:

• Food allergy policy: Make a copy of the school’s food allergy policy for each person who’s planning to be at the meeting. Staff members may not even be aware that the school has a food allergy policy. On your copy, highlight and annotate the areas you want to focus on.

• School-required forms: Most schools have their own forms you must complete and keep on file with the school. Obtain these forms early, so if they require your doctor’s signature, you can have the forms completed before your meeting.

• Your child’s food allergy sheet: Every staff member at the meeting should know your child’s face, what she’s allergic to, and the basic rules to follow to prevent exposure to the problem foods. See "Food Allergies On Daycare And Pre-School" for a sample food allergy sheet. Complete it and make a copy for each person planning to attend the meeting.

• Food allergy emergency action plan: Whoever’s in charge of administering medications and treatment should have a food allergy emergency action plan customized for your child. "Symptomatic Relief In Food Allergy" provides the form you need, unless your school requires that you file a different form.

• Medications: Have all the medications you plan on storing at the school with you at the time of the meeting, especially if your doctor prescribed epinephrine autoinjectors. Bring a copy of the instructions for the autoinjector and one or two trainers to demonstrate their use.

• Food preparation and serving instructions: Cafeteria workers must get up to speed on proper food preparation and serving procedures to prevent accidental cross-contamination.

For additional materials that can help a great deal with educating school staff members, visit the Food Allergy & Anaphylaxis Network Web site at foodallergy.org. In the spring near the end of the school year is typically the best time to meet with school administrators and staff. Gathering all required personnel during the summer is nearly impossible.

If you miss the spring and summer vacation, try to set up something just prior to your school’s opening day. Meet with the principal or other school administrator and request a meeting with all staff responsible for keeping your child safe:

• The school administer responsible for developing and implementing the school’s food allergy policy.
• The school nurse or nurse’s aide and anyone else responsible for dispensing medications and providing emergency treatment.
• Your child’s teacher(s).
• Food service personnel if the school prepares its own lunches. (If your child is going to brown bag it, include food service personnel in the meeting to discuss the need to thoroughly clean the table your child will be sitting at.

With food allergy information and medications in hand, you’re well prepared for your food allergy presentation. You can handle the meeting however you think is best, but many parents have found the following agenda useful:

• Discuss food allergies in general.
• Discuss your child’s particular food allergy, highlighting preventive measures and what staff members can do to help ensure your child’s safety.
• Review your child’s food allergy emergency action plan, emphasizing the role that each person plays in providing immediate, effective treatment.
• Review the school’s food allergy policy, highlighting meal times, allergenfree tables, hand washing, and how you expect snacks to be handled.
• Open the floor to questions and keep notes in case staff members request additional information or instructions that you don’t have with you.

Feel free to make special requests of administrators or staff members for any additional safety measures not already in place. In most cases, you can simply negotiate a solution that works for everyone. In other cases, you may need to supply a letter from your doctor or resort to more formal, legal action, if the school is unwilling to cooperate, which is rare.

Don’t make your food allergy meeting a one-time event. Do an encore performance at least once a year, even if all the personnel are the same as last year and everything worked to perfection. Review policies and procedures; provide updated forms, if needed; and check on the medications.

When problems arise, a follow-up meeting is a must, but even when everything is running smoothly, schedule a meeting to provide reassurance, say thanks, answer any questions, and, perhaps, even treat the staff to a batch of cookies — allergenfree, of course — for a job well done.

Not all staff members may be willing or able to attend your presentation, so be prepared to contact staff members individually to set up meetings.

With unwilling staff members, a non-confrontation approach is best. By explaining the seriousness of your child’s food allergy and mentioning that the staff member may need the information to keep your child safe and alive, you can usually gain the person’s full cooperation.

People are usually uncooperative simply because they don’t fully understand how important this is. If the staff member is still unwilling to cooperate, contact the principal — one of the principal’s main jobs is to attend to parent concerns, and they’re usually well aware of their legal obligations to do so.

Every school stores and dispenses medications for students who require them during the day. In most cases, the school requires that you send medications in their original package, clearly labeled, and often with your doctor’s instructions or a permission slip signed by the doctor.

With most medications, a missed dose doesn’t pose any risk to the student’s life. In the case of food allergies, however, if sufficient quantities of the medication are not readily accessible, and the staff member in charge of administering the medication is unavailable, the situation can pose a significant risk to your child.

Prior to the beginning of the school year and a couple times during the year, check to make sure that your child’s medication supplies are fresh and fully stocked. If the school keeps medications under lock and key, which I recommend against doing, find out who has the key, and make sure your child’s teacher knows who’s holding the key.

Don’t just call into the school. Ask to see where the medications are stored. By asking to see the medications yourself, you can get a pretty good idea of how accessible they are. If the office has to hunt around for the key to the medicine cabinet for ten minutes, you’ve just observed a problem that the school needs to address.

In addition, you may discover that the school has misplaced your child’s medications. Inspect in person with your own two eyes. Storing your child’s medications in an easily accessible, central location may be adequate, but if your child is stuck out in a satellite classroom at some point during the day.

Then you may need to supply a second or even a third set of medications to provide easy access at any point during the day. In some cases, having your child carry his own medicines may be best, but it’s not always the optimum solution.

Work with your doctor to fine-tune the Food Allergy Emergency Plan or to complete whatever emergency treatment form your child’s school requires. Some forms are better than others, and some doctors take more care than others to complete these forms.

If the school’s generic forms are inadequate or your doctor provides only sketchy instructions, don’t be shy to ask for something more detailed. Some schools allow older students to carry their own medications, as long as the school has this in writing signed by your doctor.

In fact, many states have laws that give students the right to carry their own medications, assuming the situation requires it. Carrying medicines obviously has the advantage of guaranteeing that the medicines are immediately available. This approach, however, is not ideal in all situations.

Consider the following:

• Can you trust your child? Some kids lose everything and others can’t resist the temptation to show other kids what they have in their bag. I’ve seen several inadvertent injections of epinephrine with this sort of show and tell.

• Can your child administer her own medications? Pre-teens may not be able to give themselves their own medication, particularly an epinephrine autoinjection. In such cases, the medicine does no good unless a responsible adult is immediately available.

• Is your child willing to carry the extra baggage? Toting around fanny pack or some other bag with medications may cramp your child’s style. As long as the medicine is readily available in a matter of minutes, which usually is the case at most schools, then burdening your child with this responsibility may not make sense.

The school bus has become an icon of Americana — a relatively safe mode of transportation that carts the kiddies off to school every morning and drops them back at home in the early evening. For students with food allergies, however, even a relatively safe bus ride can be a source of anxiety.

If your child is a responsible teenager and the school allows its students to carry medications, your child can carry his own medications and take most of the worry off your plate. If not, then you may face a tricky predicament due to the following complications:

• Few school systems require their bus drivers to carry or be responsible for administering medications.
• If the bus driver agrees to take care of the medications, you still have the hassle of handing the driver the medications in the morning and having the driver pass the medications to the school, pick them up after school, and return them to you.
• Storing epinephrine on the bus is not a good idea, because it would be exposed to hot or cold weather.
• A substitute bus driver may show up who’s heard nothing about the food allergy or the medicine.

That being said, here are your options:

• Drive your child to school yourself to avoid the whole situation.
• Pick up and move to one of those rare school systems that have trained all their bus drivers to treat an allergic reaction.
• Lobby your school system to train their bus drivers and organize a system to store and transfer medicines.
• Make the bus safer by putting the following precautions in place:
• Be certain your child knows about her allergy and can be trusted to never, ever share food with other children.

• Inform the bus driver of your child’s allergies.
• Have your child routinely sit in the front seat where the bus driver can keep a better eye on her.
• Make sure the bus driver has cell phone access at all times to call for help if needed.

Even if you have no other option than to send your child on a bus without medications and without a bus driver who’s fully equipped to deal with a severe reaction, I believe it is an acceptable risk, especially if the bus ride is relatively short. Over time this situation will hopefully improve in more and more school systems.

Peanut-free tables

Peanut-free tables are now an option at many schools, and most schools are willing to provide one if requested. Should your child’s school have designated peanut-free tables or special allergen-free seating arrangements? This is for you, your child, and the school to decide, based on the following considerations:

• Do peanut-free tables help? Yes, especially for children younger than nine years old. By the time a child is nine or ten years old, I believe that these allergen-free tables no longer provide much benefit.

• What does your child want? Peanut-free tables and other seating arrangements may add to the stigma of having a food allergy. Ten years ago, I wrote letters requesting that schools provide peanut-free tables. Now I write a lot more letters to liberate kids from their peanut-free isolation wards.

• Does the school mandate peanut-free tables for students with food allergies? To protect the school from lawsuits and ensure safety, some schools require students with food allergies to sit at peanut-free tables. In other schools, the choice is up to the student and parents.

The specific arrangements for peanut-free tables vary widely from school to school. The more isolating the arrangement, the more distasteful it is for the child. In fact, this is the main reason that families ask to remove their child from peanut-free purgatory.

Following are a couple examples of allergen-free table arrangements that schools have implemented:

• Students are allowed to invite one or more friends to sit with them as long as they eat a peanut-free lunch. This makes the situation much more tolerable.

• All students with any sort of food allergy sit at the same table — typically a table that’s more frequently and thoroughly cleaned and better supervised. This provides students with a greater likelihood of sitting at a table with a classmate.

• Only students with peanut allergy sit at the table. This may be fine, but more often it results in some fourth or fifth grader getting stuck at a table with a first or second grader. This sure takes the fun out of lunch, and remember, for young kids, the favorite part of their day may just be lunch or recess.

Peanut allergy is definitely the scariest allergy in the cafeteria, due to peanut’s notorious reputation for triggering life-threatening reactions, but if your child is allergic to milk, egg, or some other food, you’re no less concerned about protecting her safety table, such arrangements are more difficult to implement and increase the odds that your child will be sitting at a cozy table for one. The solution?

The peanut-free table may still be the best option, simply because it’s typically cleaned more thoroughly and is better supervised. In the most extreme situations, you may be able to get an aide to supervise your child’s lunch. This would usually occur only with a 504 plan.

Public schools are required by law to provide a safe environment for your child, so administrators may overreact to your requests out of fear. If you request special accommodations, without specifying exactly what you want, you may be unpleasantly surprised at what you get.

If, for example, you request that your child not be exposed to a particular allergen in the cafeteria, the school may decide that your child needs to eat in the nurse’s office or library. Your child may find that a quiet lunch in solitude is perfectly acceptable, or he may look at it as punishment for having an allergy.

Unless you’re careful about what you ask for, you may find that you’ve backed yourself into a corner you can’t get out of. Be careful what you ask for. For most children, a few simple precautions are sufficient for ensuring safety in the lunchroom.

Consider the following precautions, and remain flexible, so you can modify the precautions based on the school’s facilities, your child’s age, and the nature of the food allergy:

• Make sure your child has a clean place to sit. This is especially a concern if your child is scheduled to eat during a later lunch shift. Your child should have a designated safe seat, where she sits every time she eats lunch. A properly trained adult should be in charge of cleaning the seat and table before your child’s lunch shift. Having a fellow student clean the table is usually inadequate.

• Create a buffer around your child. Seating your child at the end of the table next to a classmate who’s eating only safe foods is typically the best option.

• Have your child pack a placemat. Eating off of a placemat or plate can prevent your child’s food from picking up any allergenic remnants off the table.

By high school, your child can safely leave most of these precautions back in junior high. Your child should still avoid sitting at a dirty table with messy eaters, but special seating arrangements generally are unnecessary.