August 30, 2013

Why Do Kids Have to Eat Peanut Butter At School?

Why do kids have to eat peanut butter at school?  This is such a controversial subject in the food allergy world, though I can't for the life of me figure out why it's so heated.  I've read the reactions to food allergy parents who have given their opinions in the past.  I know what peanut butter advocates think.  I know that on the extreme side of this argument, peanut advocates think that severely food allergic children should not even be allowed in school--that they should be homeschooled.  In fact, I've heard this opinion so many times that this type of verbiage no longer fazes me.

How many times have I heard a parent say, "But she'll only eat peanut butter for lunch!"  I just can't figure this out.  Because if my kid looked at me and told me he would only eat one thing for lunch, and that one thing was something that could potentially kill another student, I'd tell him no way.  Forget that, if my kid told me he would eat only one thing for lunch, period, I would tell him no, that's not acceptable.

I just can't wrap my head around parents who insist that peanut butter sandwiches are the end all. Do their kids eat these for breakfast and dinner too?  Do they have a peanut butter sandwich waiting for them when they get home for snack?

Okay okay, I get it, I do.  People have rights.  They want to eat peanuts and they should eat peanuts.  Just not at school.  There are personal rights and then there's social responsibility.  What are we teaching our children if we're only teaching them one side of the coin?

I mean, if my son was playing in the park with friends, found a long sharp stick and proceeded to wave it around recklessly at the other kids, I would tell him to put it down.  Sure, he has the right to play with sticks, just not around other kids.  Hey, it's unlikely that he'll poke someone's eye out, but it's possible.  He could also unnecessarily scratch or puncture someone.  Wouldn't we rather avoid the risk altogether and tell the boy to put the stick down?  Or would we all sit around on the edge of our seats waiting to see what would happen?  If your child was the one with the stick pointed at her, would you just sit around and do nothing so as not to offend the rights of the stick-brandishing child or his parents?

Do we share the responsibility of helping to keep our kids safe?  Every day, my kids go to school and I pray that I don't get a phone call from the school office.  When I see the number flashing on my phone, I'm immediately filled with dread.  I'm hoping the caller is not about to describe an allergic reaction, and that I won't need to rush myself over to the pediatric ER to meet my child.

So why the peanut butter?  Of course, 99.9% of the time, peanut butter sandwiches in the school cafeteria aren't hurting anyone.  It's the less than one percent of the time, the time that after eating a peanut butter sandwich, a classmate accidentally spits into the mouth of a peanut-allergic child during a conversation they are having in line about to leave the cafeteria.

Yep, it happened to my kid, yesterday at school.

Within moments, my son developed a stomach ache, told the principal, and was whisked away to the office.  While I was on the phone with the principal (thank God I answered my cell!), my son reported trouble breathing, so I told him he needed the epinephrine injection, which my son administered himself.  I told the principal that he needed to go directly to the ER, and I would meet him there.

My 9-year-old son is officially a rock star.  He recognized his symptoms, got help, related his symptoms clearly, and administered the Auvi-Q auto-injector successfully and calmly.  He rode an ambulance alone to the ER, readied himself for a four hour stay, and worried that he didn't have his books to do his homework.

Why can't we just say that there are no nuts allowed in school?  Because we know people won't follow the rules?  Because we know people won't like it?  Because we're worried about people's right to eat what they want for lunch?

All schools have drop-off and pick-up procedures which are not to everyone's liking, and which are probably going to be challenged by a few parents, but we still have them.  We have them because we know it's the right thing to do, and because we know if we didn't, we'd have a lot more accidents.  If we could avoid just one accident with rules about how to pick up our children from school, would that help to justify their existence?  Do we even feel the need to quantify how safe we could be with the implementation of a particular rule?

How many food allergy accidents have to happen before we change our food policies at school?

I don't think most people mean to put food allergic children at higher risk of reaction at school; I just think they don't understand.  They haven't had to respond to an emergency situation--adrenaline pumping, hands shaking.  They haven't had to live through the ups and downs of managing food allergies on a daily basis, spend literally thousands of dollars every year on medications, ER visits, and specialty foods...in a constant state of worry.

I've always known that food allergy education is a slow evolution.  One step forward, two steps back.  We had our two steps back yesterday, I'm looking forward to that step forward.

26 comments:

  1. How scary! :( First, I am proud of your son for recognizing the symptoms and handling things...and I'm glad he is okay. It's such a blessing to see FAAP's followed with a good outcome, and children able to be clear and know what is going on.

    I am also a food allergy parent. My son outgrew his peanut allergy in preschool, but remains anaphylactic to milk/dairy, and has multiple other allergies. Imagine my fear in knowing that the majority of the kids in the lunchroom (and class!) are drinking milk, eating pizza, pudding, goldfish crackers, cheese, etc...on top of his other allergens. There is no safe table to eat at.

    I do not typically support food bans, though I am okay with restricting (even eliminating) food from the classroom. I do think shared food (class parties/rewards, etc) should be safe for all the kids in the room. At our school, they do nut free classrooms if there is a nut allergy. This also means no homemade food, and nothing with the (voluntary) label "manufactured in a facility with nuts"/"may contain nuts", even for personal consumption. It's easy enough to eliminate peanut butter and use a safe substitute. But, many times our only safe option for things is homemade. My son's safe milk is technically not allowed for his own consumption because it "may contain nuts", but everyone else can have regular milk which absolutely DOES contain his anaphylactic allergen.

    Don't get me wrong, shared foods (parties, rewards) should always be safe where all the kids in the class can be safely included. (I also think they should be limited...we use food way too much!) I also think age plays a factor. Preschool students are not old enough to abide by all the food allergy rules, they don't always have the best hygiene and they often use their hands to explore (and put their hands in their mouth!). But as kids grow, they are more aware and can better navigate and control their environment.

    I do think schools need to make changes - being more educated and allergy aware, promoting good hygiene and health practices, and being able to recognize reactions and promptly respond per FAAP's with confidence. Accidents can happen whether there's a ban or not, I'd rather them put efforts into practices that will help keep ALL kids safe and help minimize the risks.

    Many people talk about making things better for food allergies, but the only thing addressed is peanut allergies/banning nuts. We need to help open their eyes that ANY food can be life threatening to a person with a severe enough allergy to it...and teach them about practices to help prevent cross contamination, recognizing reactions and how to handle those situations. I hope you don't mind this alternate perspective, and I hope your son has a great (and reaction free) rest of the school year. You are a great mom, and I know that situation had to be so emotional and scary. I'm sorry you had to face that.

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    1. Thanks for your comments! They mean so much. They are much in line with mine, as my son is also anaphylactic to dairy (and egg and shellfish). So the lunchroom is a scary place, no matter what. I was personally not for a nut ban until yesterday's incident. It takes an incident (even for us food allergy parents) to help us shape our views and practices. Of course, if we could have all around education AND implement rules, that would be great. But you're right, we need to pick our battles! Take care and hoping for a safe school year for your family!

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    2. Thank you! I know there are some situtations where bans can be necessary; and I can understand your feelings after that crazy incident (seriously, who thinks THAT would happen). You have a good post, and I appreciate you addressing the the things people say about FA's. (My personal favorite is "food allergies didn't exist when I was a kid, so I don't believe in them"...iPhones didn't exist either, so I suppose they don't believe in those?!) I also realize it's pretty easy to do without peanut butter and use a safe substitution. Kids adjust to the changes and handle it well, it's the adults that fight it. I wouldn't put another child at risk, and realize the concerns I brought up wouldn't apply to most other students. We have been in nut free classroom situations, and worked things out with the teacher/parents where we can all be comfortable (we've had some exceptions on the homemade and the 'may contain'/'produced in a facility' for personal consumption). It's so important to be able to calmly communicate and discuss our needs for school and better yet to feel satisfied over a good solution! I look forward to reading more of your posts. Thank you!

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  2. I was so happy to hear my sister-in-law say that her son's preschool served sunbutter at school. Easy solution, thank you to that school, lets hope others follow in that direction! I have often found peanuts being served on planes to be insane! Even before I personally knew anybody allergic to peanuts. Now my own child is and it's terrifying when somebody opens peanuts on a plane.

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  3. I wish all allergy children were ingestion allergic. We are part of the unlucky severe where contact causes reactions. We were at the ER on Tuesday night. Today I took him out of school for lunch and had a "picnic" in the car. He is in Kindergarten. We have an aide. His table has buffers. He is still reacting. Hive on Thursday from only being in the cafeteria for less than twenty minutes. He doesn't wait in line. Garbage is across the room and so is the kitchen. Sometimes I think they thought I was playing when I told them he is deathly allergic by contact alone. They are getting the picture but at what cost. Two reactions. Huge allergy eczema sores on the creases of his arms when his skin was clean and healthy on Monday. Nose going like faucet with Benedryl and Allegra at max doses and inhaler three times a day too. God help our kids somehow get someone to who will listen where they are not sitting next to their poisons...

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  4. Sarah, I started crying when you wrote about T riding in the ambulance by himself...the image of him going through this terrifying experience alone. I have a real problem with T's school staff not being prepared for this situation. They should have administered Auvi-Q, called 911, then called you!! Precious minutes went by.

    I am totally biased because of Ryken's peanut allergy, but I would love a nut ban at schools, too. Other food allergies can be serious and deadly but statistics show that peanuts.nut allergies are by far the most life-threatening.

    As you know, both boys are also dealing with severe milk allergy so they could never be truly safe. I appreciate the allergy table at our school as another line of defense for my milk-allergic kids. They do sit there with a couple others who may be allergic to peanuts/nuts but may have packed dairy foods. My oldest also has two good friends who bring a dairy-free, nut-free lunch everyday so that they can sit with him. (Bless them!!) At least in our school, the allergy table is wiped down constantly and staff are well-informed about the kids allergies, remind them to wash hands before eating, and carry around emergency medication. Also there is plenty of room for the kids to spread out there (because so few kids have food allergies) and I've asked my boys to make sure to not sit right next to someone who has brought dairy products. I was very concerned to visit the lunchroom and see all other kids packed like sardines at their lunch tables -- hardly any space between them.

    Still, none of what I mentioned above could have prevented T's accidental exposure to peanuts except for a ban on peanuts/nuts in school. Will you have a meeting with the principal to lobby for this? I wonder if a 504 plan would be critical in your situation.

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  5. JenniferS, I'm so sorry to hear of your son's life-threatening contact reactions. Just awful. It amazes me how resilient our kids are. We FA families take on so much, but still, we cannot keep our loved ones safe by ourselves.

    JenniferS, do you know if your son is developing reactions while in the classroom (not just the lunchroom)? Is your son's class a food-free class and are students be required to wash or wipe hands before reentering? I wonder if there would be a way for him to have lunch safely in the classroom with a special buddy who has also brought a safe lunch.

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  6. Why do kids have to eat peanut butter? Well, they don't "have" to, but give peanut butter its due. It's full of protein and healthy fats. It requires no sweetener to be palate-pleasing (unlike sunflower seed butter). It's shelf-stable, weathering weeks without refrigeration, let alone a morning in a hot locker. There's no mercury in it. It's actually hard to think of another protein that parents can keep in their pantries and slap on bread for lunch that's as good for their kids as peanut butter.

    Peanut butter is the only heart-healthy, shelf-stable protein I can think of that's widely available for pennies per serving (an important consideration for many parents that I don't see addressed here at all). In fact, I'd wager it's just about the healthiest food that American kids eat in quantity.

    So those are the points it make sense to address.

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  7. You're missing the point, Anonymous. I don't believe the author is disputing the benefits of PB. The point is that her child had an anaphylaxis reaction AND COULD HAVE DIED because of what some other child brought for lunch. This is unacceptable when it can so easily be prevented.

    I agree, a ban on nuts is definitely a good idea for your school, Sarah.

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    1. You're missing the point as well. Some people can NOT afford Sunbutter or deli meats. I have children that are highly allergic to mushrooms, cinnamon, and mint. I am also recently unexpectedly widowed and was previously a stay at home Mom for 12 years. I can afford PB. My kids complain about it, but it's unfortunately necessary if they want to eat lunch at school. When you start buying my groceries, I will gladly send something other than PB.

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  8. Your son is an Indiana Jones of the allergy world. What maturity, calmness, and smarts he had. How scary for you. *hug* I'm glad he is fine.

    I guess there are parents who don't like to be told what their child can't bring food wise to school. I feel lazy sometimes in the morning and want to make my daughter a PB&J but I then remember how such a taken for granted item can be lethal to someone's baby. Your posts and FB posting have really opened up my eyes to food allergies. Mahalo.

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  9. Sarah,
    I also teared up as I read about T riding that ambulance alone! What a brave and smart boy you have raised. You have definitely taught him well. It's so easy to forget how easy life is when you DON'T have a loved one with severe allergies. I feel very convicted that I will NEVER send my kiddo to school with peanut butter in his lunch. Thanks for sharing from your heart and for spreading the word.

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  10. Sarah,

    How old is your son? I can not imagine my daughter's school allowing my daughter to ride alone in the ambulance. The principal or the clerk in the office, someone would have gone with her. My child's elementary school quit serving peanut products a couple of years ago. They still allow it to be brought in, but they don't serve it in the cafeteria. We have a new principal and I think I will print your blog and take it to her. She might be willing to take this on.

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  11. wow your son sounds like an absolute champion. In Australia the schools often have a nut free and egg free policy. Its not mandatory, its optional for the schools. The school my daughter will go to for prep next year is one of the nut and egg free schools and the nurse says they have no more than one incident a year where someone might bring the wrong thing for lunch. It gets thrown out and they are given safe food. The kids are also all really aware and police each other, looking out for their allergic mates. I guess it makes it easier in a school environment where kids generally bring their own food from home. But it is possible! It is about the only thing that is making me not have a nervous breakdown about her starting school! I don't know how you USA dwellers cope, it must be so hard!

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  12. What a difficult way to start the school year. I can't believe this happened! Sounds like you have a very brave and level-headed kid. So glad he's OK! -Heddi

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  13. So thankful your son is ok!!
    Kudos to you mom and dad!! You have taught your son to protect himself and his health. Your son IS a rock star! Our son is 4 and I already go thru scenarios in my mind of what he may or may not do or what kind of things he may encounter when he starts kindergarten. I wish all schools could be nut free. It wouldn't solve all problems (we are also legume, sesame and egg allergic), but it would certainly lessen the risk. We have already taught him to not eat ANYTHING unless mom or dad give it him; I think that's a good start. We are working on other things too. Hopefully by the time our son is in school, we will have covered a few more bases with him. I will surely tell him the story of your son, and how he knew what to do and followed his "gut".
    Thank you for sharing your story.

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  14. Hi Sarah,
    I work for SF Unified and I told one of our school district nurses about this. Are you still in SF? Can you email me with the name of the school, if it's public or charter it will help our nurse make the claim that staff need specific training. My work email is vargasL2@sfusd.edu
    Thanks!
    Laurie

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  15. Laurie,

    So awesome that you are sharing about the experience with SFUSD. I think that all school district nurses and principals can benefit from reading about this serious, in-school reaction. I immediately shared Sarah's son's experience with our nurse who is going to meet with staff tomorrow to review the food allergy action plan again. It's a good reminder to know food allergy action emergency plans and to walk through exactly how to react.

    So many responsibilities are falling on office & teaching staff that we should not assume they will remember the emergency steps to take (like administering epinephrine, calling 911, designating an adult to ride with the child, THEN trying to contact the parent) from one year to the next. And each moment of waiting to administer life-saving medication can be critical. Educate, educate, educate!

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  16. I cheat and send my kid with peanut butter.

    He always eats peanut butter, and so far, no child has died. Or even coughed.

    This is compelling evidence that most food allergy stuff is related to new-age parents who need valium.

    For those very few kids have life-threatening allergies, the way to deal with it is for parents to be required to return a medical form with a real doctor supporting the life-threatening allergy.

    Then, of course, I would keep my peanut butter at home in this rare instance.

    But for all the loo-loos out there with imaginary allergies.....the peanut butter keeps coming.

    (Yesterday my kid was not allowed to eat a hard boiled egg because a boy told the teacher "I have an egg allergy").

    I think I have a food-ban allergy.

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  17. Sarah, Can you delete obnoxious comments like the one above? I think you should definitely delete rude and clueless people's comments as they are not worth anyone's time!

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  18. Hi Kathryn!

    This is Irene, co-author of Get Allergy Wise. As much as I don't agree with the anonymous comment and found the sardonic tone unnecessary, I do think it is important to let a comment like his/hers stay. If we want to protect our kids with food allergies -- and they are real -- anonymous, did you read through Sarah's whole post above? -- we need to be able to know what people affected by food ban rules are thinking and feeling. We need to figure out ways to bridge the understanding and provide education or else we risk angering and alienating parents whose cooperation we really need to keep our kids safe in shared classrooms and lunch rooms.

    I have written personal letters to class families and stood up at Back to School Night and IDed myself as a mom managing my kids' severe food allergies. In my communication, I talk about what my kids' allergies are, the steps we take to prevent contact or ingestion reaction (e.g. my kids only eat what I have packed, they are NEVER allowed to share, they always wash their hands before they eat, they have emergency medication). I tell parents that as much as we do, we need help to keep them safe because our kids are in a group environment. I have found that these introductions have helped parents put a face on food allergies and food restrictions -- parents then see my kids -- kids that their own kids are friends with -- and they want to help. And I thank them profusely for supporting us every chance I get.

    Anonymous commenter, I wonder if hearing directly from parents of food-allergic kids would make this more real for you?

    I was thanked by a parent on my son's football team for emailing the team to explain about my son's milk and nut allergies. I was asking parents to avoid milk and nut snacks. I explained that if kids ate nutty or milky snacks during a game break, fiddled with their mouth guards during the game (which all the boys do!), then handled the football, then my son handled the football, then my son fiddles with his mouthguard, my son would accidentally be ingested a potentially deadly allergen into his mouth. (Again, something seemingly so minute, but read Sarah's post if you have not.) The parent who thanked me said she appreciated my email as many parents in past team sport experiences stated that their kids have food allergies but provide no further explanation.

    Anonymous, I hope to God that you do not start believing in the real dangers of food allergies only after a child at your kids' school or in your circle of family/friend dies from an anaphylactic reaction. Please, if you do not believe in food allergies, feel free to ask your school staff or teacher why there are food bans. Perhaps they can convey your anger and dismay to the parents of the kids at your school with food allergies and they can reach out to you and the class to explain about the allergies. Sometimes, a face to an illness or disease is all one needs to realize that this stuff is very, very real.

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  19. And another thing, Anonymous. Parents provide documentation signed by their child's physician that confirms their food allergy. If you see a nut ban or other food ban, you can assume that this has been confirmed by school staff/nurse.

    http://www.foodallergy.org/document.doc?id=234

    It's true that you may encounter a child that claims they are allergic -- they don't know what it means but they know they don't like a certain food and don't want to eat it. I have encountered that myself a couple of times with parents sheepishly shrugging off their kids' claims as, "Oh well, ha ha. She says that because she doesn't like it, but she's not allergic." Untrue statements like that do food-allergic kids and non-food-allergic kids no favors.

    So again, feel free to confirm the egg ban with your teachers.

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  20. First, let me preface this by saying, I *am* an allergic parent. Not only that, I am an allergic parent of a child with peanut and tree nut allergies. However, I do not agree that peanut bans are necessary to keep my child safe. Further, I think peanut bans put my child at greater risk. Why? Well first, peanut bans fails to remember that there are 8 foods or food groupings that are responsible for roughly 90%+ of food allergies in the US, as an example. Peanuts are NOT the only food that can trigger an anaphylatic response. Any allergy can. Banning peanuts tells the milk allergic child or the egg allergic child or the soy allergic child that THEIR allergies aren't taken as seriously - and really, would they be wrong to assume so? Yes, peanuts and tree nuts do trigger over half of the ER visits related to food allergic reactions. However, that means the other almost half of ER visits are triggered by some food OTHER than peanuts or tree nuts. This ought not to be overlooked or taken lightly.

    Now, why do I think a peanut-free school is LESS safe for my child? We avoid foods labeled for cross contamination for a reason. My child has reacted to them. There are allergic families that don't understand the research and risk on these labels - there are non-allergic families who don't even realize these labels exist. There are countless times we must pause and educate someone on the risk of these. Countless times when someone is trying to hand my child a bag of candy and saying "But these are not the peanut ones. These are plain. They should be fine." I need *my* child on high alert any time food is present. I need teachers and staff on high alert. Creating an assumed safe zone means some (my child included) may feel it's ok to let the guard down. It means the assumption of "I should be able to have this, we're in a peanut free school..." because more likely and THAT could mean a reaction to something that was cross contaminated - because it's happened before.

    I don't think people *need* to have peanut butter. But I do think kids *want* to have peanut butter and I don't agree that they can't. I think there ought to be education about how to carefully consume products that contain another students allergens. There ought to be allergen-free zones at a table or dedicated tables. There ought to be hand-washing. There ought to be teaching moments explaining what allergies are, what happens to the body during a reaction, what the consequences may be, etc. I don't think an all out ban, however, is the answer.

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  22. For me, it's very frustrating. I can understand peanut butter allergies and not harming a kid in your class. I can understand that, but it's become crazy. Now I have a long list of things I cannot send my child with for lunch. I don't have all kinds of money. Frankly, peanut butter is cheap and lasts a long time, but again, I wouldn't want a child to be harmed if my kid is eating it at school. However, when some teacher tells me she doesn't like the smell of tuna fish so those kind of sandwiches can't come to school, or someone doesn't like the smell of citrus fruit, etc etc, I'm starting to get annoyed. I do the best I can for my children and teach them to be caring people. But where can they eat the things they like safely? And what if they ONLY like peanut butter. You wouldn't complain if that child was a special needs child with autism who was focussed on that kind of food. You'd find a place for them to eat. So why shouldn't my child have a place to eat the food they like? Even smokers often have a room for smoking, and believe me, smoke is very harmful to a lot of people.

    I like what "anonymous" said about education and how to be safe about eating foods that cause allergies. This is a positive way of not creating resentment. There has to be a better solution.

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