Salad Bar and Allergies

[denstar]

Good morning,

Well, last Friday, I had the moment I've had dreams about since starting school nursing - a student with an anaphylactic reaction at school. Staff did everything perfectly, and student is well now. Student complained throat "didn't feel good" at the end of lunch and then staff member noted bottom lip swelling. Student was immediately brought to me and needed his epipen. Really proud of my staff for recognizing the severity of the reaction, especially as the student was not yet in any obvious distress.

Going forward, however, we're hoping to prevent any further reactions. This student (who is young), has known food allergies, and one of the foods he is allergic to was served in our school salad bar. The salad bar is open to all students, and students self serve (even the younger ones). Although we avoid peanut/tree nut products, we have a number of students with random, atypical allergies, and so we cannot guarantee these foods are not sometimes served in the salad bar. In looking to prevent reactions though, we want to see what we can change/improve on. Do any schools have salad bars and young students? Do you have any policies or advice on preventing reactions? If so, please feel free to PM as I would love to discuss. This is our 4th year of having the salad bar and the first time we've had an issue. Hoping to make it the only time. Thanks!

[ruby_jane, BSN, RN]

Yay you - your plan worked! Waiting for Old Dude to chime in here, because he does it best.

So - salad bar- was the student aware s/he was eating something s/he was allergic to? Or was it a complete surprise? I think...that the salad bar is a privilege, not a right. Given the exposure, perhaps a conversation with the student and parents? The school is required to offer the student a nutritious lunch with substitutions for allergens. Not sure you're able to do that with a salad bar setting.

[JenTheSchoolRN, BSN, RN]

Yay you - your plan worked! Waiting for Old Dude to chime in here, because he does it best.

So - salad bar- was the student aware s/he was eating something s/he was allergic to? Or was it a complete surprise? I think...that the salad bar is a privilege, not a right. Given the exposure, perhaps a conversation with the student and parents? The school is required to offer the student a nutritious lunch with substitutions for allergens. Not sure you're able to do that with a salad bar setting.

This. I have a student with a few allergies that are likely present on that salad bar. My plan would be for that student to avoid the salad bar and have another allergy free option at lunch. Does this student always get school lunch? Does this student bring lunch? Is the salad bar the only food option at lunch for students that do not bring a lunch?

[denstar]

The student has a chickpea allergy, and knew not to eat hummus, but had never actually seen a chickpea, and so, didn't know what it was. I have the parent in touch directly with our food services manager to discuss as well.

Not sure if it makes a difference, but we are not only a private school, but also receive no state/federal funding whatsoever.

[denstar]

The student sometimes brings lunch and sometimes takes hot lunch. I agree it would be best for the student to avoid the salad bar altogether, but mom seems to want him to use it still. He does always have some sore of an allergy free hot lunch option.

For now, we are taking out chickpeas completely, but we can't feasibly do that for every allergy in school - we wouldn't have much of a salad bar left!

[Flare, ASN, BSN]

i tend to think that the parent does have a bit of a responsibility in teaching their child a bit about their allergy. If your child has an allergy to chick peas, then you show them what they look like so that they don't decide to get brave at the salad bar one day, while knowing that hummus is simply a NO food. The two just don't resemble one another. I have discussed with many the kindergarten parent that "may contain peanuts" should be the first words that their child learns how to read. Teach them from an early age how to read labels and be proactive in this world.

Another thought is that salad bars have a high chance for cross contamination. I'm not saying to take it out. As the OP wrote, in the years since it's been in, this is the first incident. But if you have an allergy and your allergen is present at that salad bar, then you assume the risk by making a salad there. Yes, you can argue the point that the school has a responsibility to keep the students safe, but the student doesn't HAVE to eat off of that salad bar.

[OldDude]

BAM! Another kid snatched from the jaws of death!! School nurses - that's what we do! Awesome job denstar. Because of you, life and smiles go on!

We don't have a salad bar on the elementary level but this could have been avoided regardless of what food is served from what line; since this was a known allergen. I'm sure districts have all kinds of methods but our lunch cashier's screens lock when a student tries to purchase a food he/she is allergic to; a double manual override is required to move forward. It's more work for food service but that's what they do so it'll be incumbent upon them to identify all ingredients of all foods they serve each day and initiate those safeguards. It's not OK to say, "we don't know what ingredients will be in this line" so just don't come through this line if you have food allergies.

Great job NURSE!!

[OyWithThePoodles, RN]

Is it possible to ask mom what he likes in a salad, and have the cafeteria prepare him one on salad bar day? It doesn't take long, kid is safe, mom is happy, salad bar stays.

[MrNurse(x2), ADN]

i tend to think that the parent does have a bit of a responsibility in teaching their child a bit about their allergy.

This. I feel for children with allergies, but this world is not going to eliminate the allergen, therefore the child must learn the allergen. I don't think it unreasonable for a Kindergartener to be able to identify their allergen by appearance and hopefully reading. This is timely, as this week we will be meeting with parents who feel everyone else's rights need to be protracted because their child has allergies, wants the school "free of the allergen". Problem is, there are students here that wouldn't have lunch because that is all they eat. Thankfully, the student's allergist is on board and says what we are doing is sufficient for the health and well being of the child.

[OldDude]

i tend to think that the parent does have a bit of a responsibility in teaching their child a bit about their allergy. If your child has an allergy to chick peas, then you show them what they look like so that they don't decide to get brave at the salad bar one day, while knowing that hummus is simply a NO food. The two just don't resemble one another. I have discussed with many the kindergarten parent that "may contain peanuts" should be the first words that their child learns how to read. Teach them from an early age how to read labels and be proactive in this world.

Another thought is that salad bars have a high chance for cross contamination. I'm not saying to take it out. As the OP wrote, in the years since it's been in, this is the first incident. But if you have an allergy and your allergen is present at that salad bar, then you assume the risk by making a salad there. Yes, you can argue the point that the school has a responsibility to keep the students safe, but the student doesn't HAVE to eat off of that salad bar.

This. I feel for children with allergies, but this world is not going to eliminate the allergen, therefore the child must learn the allergen. I don't think it unreasonable for a Kindergartener to be able to identify their allergen by appearance and hopefully reading. This is timely, as this week we will be meeting with parents who feel everyone else's rights need to be protracted because their child has allergies, wants the school "free of the allergen". Problem is, there are students here that wouldn't have lunch because that is all they eat. Thankfully, the student's allergist is on board and says what we are doing is sufficient for the health and well being of the child.

You Bet!! If a 5 year old can navigate their way through an Ipad, they're certainly intelligent enough to be taught how to avoid a food, and its derivatives, that has the potential to kill them.

[ruby_jane, BSN, RN]

The student has a chickpea allergy, and knew not to eat hummus, but had never actually seen a chickpea, and so, didn't know what it was. I have the parent in touch directly with our food services manager to discuss as well.

Not sure if it makes a difference, but we are not only a private school, but also receive no state/federal funding whatsoever.

I'm kind of impressed that 1) there were chick peas on the salad bar and 2) that the student was adventurous enough to try one! Unfortunately, it all went wrong but...save the salad bar!!

[OyWithThePoodles, RN]

We had a high schooler have an anaphylactic reaction when the school put peanut butter cookies out instead of the advertised sugar cookies. One touch is all it took. She knew her allergy, and knew to avoid. But sugar cookies and peanut butter cookies look an awful lot alike. As soon as she picked it up she could smell the peanut butter. Yes, kids need to be responsible, but it is also our job as a school to help keep them safe.