national food service management institute. managing food allergies in school nutrition programs
TRANSCRIPT
National Food Service Management Institute
Managing Food Allergies in School Nutrition Programs
An Overview of Food Allergies, Reading and Managing Food Labels, Accommodating Students with Food
Allergies, Avoiding Cross Contact, and Promoting Food Allergy Management in Your
School.
An Overview of Food Allergies, Reading and Managing Food Labels, Accommodating Students with Food
Allergies, Avoiding Cross Contact, and Promoting Food Allergy Management in Your
School.
Topics for Today
Pre-assessment:
Test your food allergy knowledge
Lesson 1: All About Allergies
Describe a food allergy, and its symptoms and treatments.
Distinguish between food allergy and food intolerance.
Identify the “Big 8” food allergens. Demonstrate reading food allergens on a food label.
All About AllergiesObjectives
What is a Food Allergy?
Food Allergy An immune-mediated adverse reaction to
a food protein
Body’s Immune SystemBody identifies a food protein as dangerous creates antibodies (Immunoglobulin E
(IgE)) against the protein
EVEN A BITE can result in an allergic reaction.
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.My tongue (or mouth) itches.My mouth feels funny.There is a frog in my throat.There’s something stuck in my throat.My lips feel tight.My throat feels thick.It feels like there is a bump on the back of my tongue.
How a Child Might Describe Symptoms
One or more symptomscan occur within minutes up to 2 hours and can be MILD to SEVERE
Trouble swallowing
Shortness of breath
Repetitive coughing
Voice change
Nausea & vomitingDiarrhea
Abdominal cramping
Drop in blood pressureLoss of consciousness
Death may occur
SwellingHives
EczemaItchy red rash
Allergic Symptoms
A serious allergic reaction Rapid in onset May cause death
Food Insect Venom Medications Latex
Anaphylaxis
An epinephrine auto-injector is used to treat anaphylaxis.
Trade names for this device include EpiPen, Emerade, Twinject, Adrenaclick, Anapen, Jext, Allerject, and Auvi-Q.
Medication to treat Anaphylaxis
Reaction and Epinephrine
Concerns
Where are the devices kept in the school; are they accessible?
Do you need to be trained to administer an autoinjector?
What if it inject the person, and they are not really having an allergic reaction?
How do substitutes know how to respond? Do the phones near you get an outside line to
call 911? Will local EMTs have epinephrine when they
arrive?
What is a Food Intolerance?
Food IntoleranceAn abnormal physiological response to eating
Involves the Gastrointestinal System
Food intolerance presents with symptoms affecting the skin, respiratory tract, and gastrointestinal tract; individually or in combination. Detrimental reaction (nausea, diarrhea, vomiting).
Come on gradually, not life threatening, affect the body’s organs
Symptoms are often confused with food allergies.Medical name: Non-allergic Food Hypersensitivity
Absence of an enzyme to digest food Irritable bowel syndrome Food poisoning Sensitivity to food additives Recurring Stress Celiac Disease
Treatment is determined between the Licensed Physician and the
patient.
Causes of Food Intolerance
• An immune reaction in the small intestine only to eating gluten, a protein found in wheat, barley and rye.
• There is no cure.
• Follow a strict gluten-free diet to manage symptoms and promote intestinal healing.
• It is not considered life-threatening, but can have acute neurological symptoms.
Celiac Disease
Food Allergy Background
More than 3 million children have some type of food allergy.
Prevalence of food allergies among children increased 18% during 1997–2007.
Allergic reactions to foods have become the most common cause of anaphylaxis.(1,6)
Food allergies affect an estimated 4%–6% of children in the United States.1 (1, 2)
The “Big 8” Food Allergens
EggsMilk
PeanutsTree Nuts
FishShellfish
Soy Wheat
Only one (1) way to Prevent
an Allergic Reaction
Strict Avoidance
of Known Food Allergens
Food Allergen Labeling and Consumer Protection
Act (FALCPA)
Food labels must declare major food allergen in plain language: Milk, eggs, fish, shellfish, peanuts, tree nuts, soy, and wheat
Either in the ingredient list by either of these two methods:
“Contains” followed by the name Example: “Contains: milk and wheat”
Parenthetical statement in the list of ingredients
Example: “albumin (egg)”
Label Samples
Contains…..Parenthesis…
Subscribe to food allergy recall notices and a have system to take action if you serve the product being recalled
www.foodsafety.gov
Recall Notifications
Not regulatedNot safe for people with known food allergies
“May Contain” statement
“..made on equipment that also makes….”
Precautionary Labeling
Hide and Seek Label Reading Activity
1. Work in small groups to read product labels.
2. Identify major allergens in each product and review food allergy handout.3. Select a spokesperson for the group to share 2 observations with the large group.
Describe a food allergy, and its symptoms and treatments.
Distinguish between food allergy and food intolerance.
Identify the “Big 8” food allergens. Demonstrate reading food allergens on a food label.
Lesson 1: All About Allergies Review
What questions do youhave before we proceed?
Lesson 2: Reading and Managing Food
Labels
Discuss how to determine allergens that are not the “Big 8” in bulk items and USDA foods.
Outline methods for managing food labels.
Objectives for Lesson 2
Bulk Foods, USDA Foods, and
Not the Big 8 Allergens Read ingredient
statements SOP for handling bulk Bulk and USDA – SAME
labeling requirements Prevent cross contact:
Multiple Lots Scooping out of
bulk Cleaning bulk
containers
90% = Big 8 10% = Not the
Big 8
Examples: Sesame Strawberries Mustard Sulfites
Strategies to Manage Labels and Ingredient
Lists
Communicating Food Allergy Label Information
School Nutrition StaffSchool NurseStudents, Parents or GuardianWebsite , handouts, other
With Whom?When?What method?
(face-to-face, phone, e-mail)
Managing Allergies in a School Video Clip
Discuss how to determine allergens that are not the “Big 8” in bulk items and USDA foods.
Outline methods for managing food labels.
Lesson 2 Review
Lesson 3: Accommodating
Students with Food-Related Disabilities
Review laws essential to accommodating students with food allergies.
Develop a food allergy action plan.
Describe ways to work with distributors, brokers, and manufacturers to purchase foods to meet the needs of students with allergies.
Objectives for Lesson 3
Respect and Protect Children with Food
Allergies Civil rights and privacy
must not be violated
Prevent a child with food allergies from being singled out
Be alert to prevent and address bullying from other children and/or adults
Federal Laws
Prohibits discrimination against qualified persons with disabilities in programs or activities of any agency of the federal government’s executive branch or any organization receiving federal financial assistance.
[Examples of programs receiving federal assistance: National School Lunch Program, School Breakfast Program, Fresh Fruit & Vegetable Program, After School Snack Program]
Rehabilitation Act of 1973
Federal Laws (continued)
Individuals with Disabilities
Education Act (IDEA) 1975, Part B
2006Requires a free and appropriate public education be provided for children with disabilities aged 3-21.
Americans with Disabilities Act (ADA) 1990 and 2008
Amendments
Broadens and extends civil rights protections for approximately 50 million Americans with disabilities.
Respect Privacy Laws
HIPAA The Health Insurance Portability & Accountability Act (1996)- Requires all medical records disclosed be kept properly confidential.- Gives the patient rights control how health information is used.
FERPAFamily Educational Rights and Privacy Act (1974)- Protects the privacy of health information entered into a student’s record
Student’s Rights and Responsibilities
Rights
Be provided nutrition services at school without discrimination.
Responsibilities
Be Proactive in allergy avoidance.
Notify adult if: Ingestion of known
allergen Bullying because of
allergy
Tools Schools Use to Implement Laws
Individualized Education Plan (IEP)
504 Plan (Section 504 of the
Rehabilitation Act of 1973)
http://origin.www.fns.usda.gov/cnd/Guidance/special_dietary_needs.pdf
Accommodating Children with Special Dietary Needs in the School Nutrition Programs
Guidance from USDA
Recognize:Know the symptoms of an allergic reaction, who is authorized to administer medication and where the medication is stored.
React:Quickly administer medication or call emergency services, delay could result in deadly consequences.
ReviewAfter an allergic reaction emergency, review with those involved what went smoothly and what needs improvement.
Preparation is the Key to Success
Five (5) priority areas1(4): 1.Ensure the daily management of food allergies in
individual children. 2. Prepare for food allergy emergencies. 3. Provide professional development on food allergies for staff members. 4. Educate children and family members about food allergies. 5. Create and maintain a healthy and safe educational environment.
Food Allergy Management Plan
Food Allergy Action Plan 1 (5)
Recommended for each child with a known food allergy
Strategies to Accommodate Students
with Food Allergies
Menu planning, label reading, follow HACCP principles
Know the requirements for serving food to students with special dietary needs. USDA FNS Guidance for serving children with disabilities and special dietary needs in child nutrition programs
www.fns.usda.gov/cnd/guidance/special_dietary_needs.pdf
STEP 1
STEP 2
School Meal Requirements
Schools must make substitutions in the reimbursable meal for disabled students whose disability prevents them from consuming the school meal as prepared.
No extra charge
A disability determination can only be made by a licensed physician.
Child’s Safety
Licensed Healthcare Professional
SchoolAdministrator
NurseSchool
NutritionFacultyOthers
Family
Parents
Child
Comm
unication
/ Education Comm
unicatio
n
/ Educa
tion
The PartnershipCommunication / Education
Step 3
Implement the directives in the Special Dietary Form signed by a licensed physician.
If the form indicates the student has a DISABILITY, School Nutrition Services is required to make the accommodation.
If there is no disability, the accommodation is optional.
Step 4: Accommodating Students with Food-Related
DisabilitiesStep 4
Licensed Physician Provides
5 Key Elements What the disability is How it restricts the diet Major life activity affected Food(s) to be omitted Food(s) to be substituted
Accommodating Students with Other Food-Related
Disabilities
Food Related Disabilities
Diabetes
Phenylketonuria (PKU)
Food Anaphylaxis
Celiac Disease
Other Accommodations Texture
IV
Tube Feeding
Allergenic Foods Accommodating Students
Activity
1. Work in small groups to identify the allergens listed on the product ingredient statements from three manufacturers.
2. Record on the activity sheet which product can be served to which student. 3. Select a spokesperson for the group to share 2observations with the large group.
Work with distributors, brokers, and manufacturers to purchase foods to meet the needs of students with allergies.
Get specifications, ask for clarification, develop a relationship with your key partners.
TIP: When getting information for USDA Foods, call the manufacturer, not USDA or the State Agency.
Communication with Key Partners
Review laws essential to accommodating students with food allergies.
Develop a food allergy management plan.
Describe ways to work with distributors, brokers, and manufacturers to purchase foods to meet the needs of students with allergies.
Lesson 3 Review
Lesson 4: Avoiding Cross Contact
Distinguish cross contact from cross contamination.
Demonstrate strategies to avoid cross contact.
Discuss strategies to manage food outside of the cafeteria.
Objectives for Lesson 4
Cross Contact vs. Cross Contamination
Cross Contact
Allergen accidentally transferred from a food containing an allergen to a food or surface that does not contain the allergen.
Cooking does not reduce or eliminate allergen.
Cross Contamination
Microorganisms from different sources contaminate foods during preparation and storage.
Cooking does reduce or eliminate microorganisms.
Avoid Cross Contact – Potential Sources
Food handling and preparation Insufficient handwashing Insufficient cleaning Shared equipment and utensils Cutting boards, counters Griddles Splatter or steam from cooking Salad bars, buffets, serving stations
Color Coding Isolate ingredients containing allergens Individual preparation of menu items with
allergens Sticker or color code wrapped food Standard Operating Procedures for
handwashing and cleaning Include allergen risk assessment in the
Food Safety Plan based on HACCP
Avoid Cross Contact – Prevention Ideas
Standard Operating Procedures
Write, train, follow, monitor, and verify SOPs
Clean and Sanitize
Clean with soap, hot/warm water, and friction; WILL REMOVE ALLERGEN RESIDUE
Sanitize to reduce microorganisms that cause disease; WILL NOT REMOVE ALLERGEN RESIDUE
Of particular importance for managing food allergens.
Examples: NFSMI’s HACCP-based Cleaning
and Sanitizing Food Contact Surface SOPs
NFSMI’s Serving Safe Food to Student with Food Allergies SOP
Examples of Sanitation SOPs
Food Safety Plan based on HACCP
GOAL: Control/prevent/minimize food safetyhazards that may cause illness or injury
Biological Chemical Physical Radiological Bacteria Allergens Plastic Heavy metals Viruses Pesticides Glass Contamination Parasites Sanitizers Metal of water supply
Food additives
Step by Step Avoiding Cross Contact
Activity1. Work in small groups to put the ingredients in order of preparation to prevent cross contact.
2. Identify opportunities for cross contact and consider if cross contact could occur in your school.
3. Select a spokesperson for the group to share 2 observations with the large group.
4. Record findings on the handout.
Strategies to Manage Food from Outside Sources and Outside the
CafeteriaOutside food
sources contracted to serve in the
cafeteria Restaurants Caterers
Pot lucks Classroom
projects Club/Sports
events
Outside food sources served
outside the cafeteria
Nutrition Services food served outside the cafeteria
Breakfast in Classroom
Fresh fruit and Vegetable Program
After School Program
Reduce the Risk Food from Outside Sources
Activity
1. Work in small groups to determine how to provide services to a child with known life-
threatening food allergies.2. Each group has a different child and a different situation.3. On the flip chart paper, record the actions you would take to provide for
the child.4. Select a spokesperson from your
group to share the situation and the actions.
Distinguish cross contact from cross contamination.
Demonstrate strategies to avoid cross contact.
Discuss strategies to manage food outside of the cafeteria.
Lesson 4 Review
Lesson 5: Promoting Food Allergy Awareness
Identify food allergy resources to promote awareness in schools.
Objectives for Lesson 5
Determine knowledge level and training needs for school nutrition staff and school colleagues.
Verify process to respond to product recalls due to allergens.
Brainstorm what action to take after attending this course.
Identify food allergy resources.
Outline Methods to Boost Food Allergy Knowledge and Awareness
Provide professional development on food allergies for staff
Teach all children, parents, and families about food allergies.
Food Allergy Training CDC Recommendations for
Schools
RESOURCES
USDA
CDC
RESOURCES (continued)
National School Boards AssociationNational Education Association(NEA) Health Information Network
Managing Food Allergies in Schools - Video
Summary
Identify food allergy resources to promote awareness in schools.
Lesson 5 Review
Roundtable Discussion
Gallery walk
Roundtable Discussion
Post-assessment
Test your food allergy knowledge
What questions may I answer for you?
NFSMI Evaluation
Make sure you sign the class roster
Training Wrap-Up
National Food Service Management Institute
National Food Service Management InstituteThe University of Mississippi
www.nfsmi.org800-321-3054