Download Meeting Children`s Special Food and Nutrition - K

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
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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
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Antihistamines/Bronchodilators
Epinephrine
Prevention and Strict Avoidance
Action Plan
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Food Item
Source of
Milk
Soy
Allergen
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 commoditiesfresh fruits/vegetables, highly refined oils
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Allergy Scenarios
• Read and identify problem areas
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One-spatula-gloves
Two-slicer
Three-knife cleaning-jelly/bread loaf
Four-check label
Five-substitute
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Regulations
Accommodations
Required
• Allergies with the
potential of
anaphylaxis
• Celiac disease
Accommodations with
Approval of Food
Service Director
• Allergies with no
anaphylaxis
• Food intolerances
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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.
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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 school’s 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 conditions1. 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
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Bureau of Student & Family Support Services, Iowa Department of Education
3/4/08