Peanut allergy issue

[Csn2016]

So typically I try to do my own digging around and research before posting here but in a bit of a dilemma as I am currently hospitalized with preterm labor, doing research on my iPhone is not so easy and don't you know the unexpected circumstances has the health office in a huge mess right now.

i got a call from my health room aid that our local private school (who utilizes us as their school nurse for inquiries) is having an issue. They have a student with a severe peanut allergy (not just consumption but contact as well). They wrote up a letter and sent it home to all the parents indicating the school is peanut free now and asked that parents return the paper signed and ONE parent is down right refusing saying she will continue sending pbj sandwiches every day for her child. This child is also in the same grade as the child with the peanut allergy (they are a VERY small school of k-5 with 15-25 children per grade)

any insight on how this should be handled?

[KatiejonD, RN]

I understand that this is frustrating to many parents. My child LOVES his PB&J's, and it would certainly be an inconvenience. But hey - it's a little one's life. That parent sounds like an absolute treat! I do question what sounds like the school almost 'guaranteeing' a peanut butter free school - how does administration actually think that's an attainable goal? Best of luck to you!

[palli]

What happens when this parent goes to Shoprite or an amusement park or the mall ? just wondering, not stirring up anything controversy but it is impossible to prevent any interaction with any possibility of nuts....

[AngelfireRN, MSN, RN, APRN]

I have a God-awful allergy to onions, if you run a raw (or cooked) onion over my skin, I whelp up. If I get any on my food, I break out in hives. It's literally no joke, but people think 'oh, she just doesn't like them, she'll never taste them in this' and then want to act indignant when I have to start popping Benadryl and get epinephrine shots.

That being said, my parents educated me at a tender age that 'the world is not going to adapt to you, you have to adapt to the world'.

I read awhile back about a teenager who had peanut allergies and knew what was 'safe' to eat. One of the 'safe' foods was chewy Chips Ahoy. The child went to a friends house and ate a cookie out of an open package, that was red like the chewy Chips Ahoy. Only, it was not chewy, it was Reese's peanut butter cup Chips Ahoy. It was plainly printed on the label, but the label was folded back, and she went by color alone, despite there being little peanut butter cup designs on the rest of the label. She died as a result. I think she was 15. Old enough to be responsible for checking labels. The article said her mother was petitioning Nabisco for 'plainer packaging' but how much plainer could they have made it?

I agree, if you remove every food with an allergy attached to it from schools, they won't have anything left to serve. Sad but true.

[AdobeRN]

What happens when this parent goes to Shoprite or an amusement park or the mall ? just wondering, not stirring up anything controversy but it is impossible to prevent any interaction with any possibility of nuts....

I always wonder about this also.....

[RedKat]

There's a student with the same issue in my district. Like many others here, I feel that a peanut-free school is not realistic. There could easily be times when a parent with good intentions sends something in their child's lunch that they didn't realize contained peanuts or manufactured in a non-peanut-free facility. I don't know all the details of how things are handled for the student in my district, because he's not my student - but I do know that he doesn't eat in the cafeteria (agreed on by him, his mom, and the school). I know that a child shouldn't have to be singled out, but if it's in the interest of keeping him safe, is there any chance he could eat somewhere else?

[mc3, ASN, RN]

Gotta agree with Mr. Nurse x2. We have a peanut free table in our cafeteria also. They get to pick a friend to sit with them - of course that friend does not have PB&J. Nobody to my knowledge has ever felt left out or ostracized. The kids feel special because they have a special table. Most of the parents will pack their child's lunch. Parents will supply snacks for the child to eat for class parties, etc. If the allergy is that severe have the child sit at a peanut free table during the party - with a non-peanut eating friend of course. Other parents are understanding, of course but there's always one or two that won't be.

On the other hand, I had a Mom the other day ask the school to only provide sugar free, gluten free, low calorie foods to her daughter because she was overweight and she wanted to see if it would help. I told her we needed a doctor's order before we could do that. I also suggested she should consider packing her child's lunch to make sure she's eating the correct foods in the correct amounts. Food allergies aside, sometimes we just can't be all things to all people. She hasn't been back yet...

mc3

[Summers_Off]

Years ago my son, who is very small for his age due to Crohn's and growth hormone deficiency, inhaled peanut butter sandwiches. In addition, he had many academic issues, including ADHD and behavior issues AND became hypoglycemic very easily. When hyperglycemic, he could not make a good choice--completely beside himself. The one protein source that I was confident he would actually eat was peanut butter. Quite a quandary. Soy butter and sunflower butter were suggested as alternatives, but he wouldn't touch them. I ended up just letting him have the school lunch, which was almost completely devoid of any kind of nutrition, but at least it was calories in his body.

Fast forward a few years later and he was diagnosed with a shrimp allergy. Guess what? School continues to serve popcorn shrimp as a meat-free alternative to this day. He had an epi at school and that was the extent of the accommodation.

Point being that if we cut out all allergens, there is going to be very little left for kids to eat. I take the attitude that this is our problem to deal with. We can't foist it on others. Even the American Academy of Pediatrics at the time recommended against making schools peanut-free for the reasons all of you mention above--it creates a false sense of security.

My heart goes out to the parents of these kids; it must be terrifying to send them out the door every day, but attempting to rid the world of peanut dust is not the answer.

My kid has a dairy allergy. I don't think requesting a dairy free elementary school would go over very well at all! 😆

[SmilingBluEyes]

What are these kids going to do in the big world? College/university, work---- life in general.

That story about the 16 year old eating a nut at Whole Foods has me concerned. By this age, he should be MORE than aware and able to control what goes into his mouth.

The world is not dairy/gluten/sugar/whatever-free. People shop at grocery stores, markets, farmers markets. These kids must be taught the skills to avoid the allergens as soon as they can read and write.

And yes, for some peanutbutter and jelly IS all they can afford.

My kids were fortunate to go to school in a district that provided food for ALL kids, no matter income status. And nuts were definitely excluded.

It's a big scary world. Time for moms and dads to step up and teach their kids to survive. They can't live in a bubble forever.

[K9lover, ASN, RN]

I realize that I am the minority on this, and will probably be blasted as narrow minded, but hear me out. There is NO WAY you can guarantee a peanut free environment. Despite what some school boards think, they can not control individual homes and the practices there, therefore latent peanut contact can still happen. You can make the space safer, and a peanut free table is more than enough control on this matter. We had an issue last year where a parent wanted this same demand, however we have at least a dozen (10% of students) that only eat PBJ every day. Should those students suffer when a safe alternative with the table exists? We had students in the class with the allergic student wash hands after lunch. The real world isn't peanut free and giving a false sense of security is detrimental in the long run. I understand the fear the parents of these highly allergic children must feel on a daily basis. It isn't fair that humans have devolved to the point of anaphylaxis, but it also isn't fair that someone else should go hungry when there is a safe alternative.

Oh you are not in the minority, my kids are grown so I had no idea schools had become 'nut free', oh the irony of the nut writing the nut free policy; sounds as if they were being guided by an attorney. Thank God I work in corrections, they will honor reasonable requests such as soft diet for an inmate with no teeth but...people complain all of the time; they arrive stating "lactose/ soy" free, if they have celiac dz they will get it but it is rare. Mostly they tell the chaplain they have religious reasons. When they tell me "too much salt, sugar, soy" et al I tell them it is institutional food; meets nutritional standards. I have just looked at guys and politely asked them if they realized they were in jail...

[StrwbryblndRN]

I am allergic to peanuts and other misc foods. It sucks. However I know that no one should have to adjust their menus to accommodate me. Nor do I believe a school should do it for kids. Peanut free table or whatever free table is all you should accommodate. However I have had to tell others that I was allergic if they ate something with peanut butter near my work space. It always worked out fine.

[kidzcare]

Agree that the phrase "peanut free" should not be used. "Peanut/nut aware" is better. No one can guarantee a peanut/nut free environment and you don't want to create a false sense of security.

This parent, however, is being selfish. A child could die next to hers and she is assuming a "not my problem" mentality. A completely safe environment cannot be guaranteed, but reasonable adults should make efforts to make things safe. Not to mention that this parent is sending a message to their child that their desire for a PB&J is more important than another student's safety. Talk about creating a sense of entitlement.

I have a student in preschool with 6cm of working small intestine (Hirschsprung's disease) and, as a result, she is highly susceptible to infections which can turn life-threatening quickly. So we ask that the kids wash their hands more frequently. Would this parent refuse to have their child wash their hands because it makes their skin dry? Send their kid in with a fever because they don't want to take the day off work to stay home with a sick child?

ETA: this is a private school? They should be able to deny admittance to anyone. If this parent does not want to follow a simple guideline, they can be asked not to return. Alternately, the allergic child could be asked not to return.

I have thought on this a bit more. Allergy aware table makes more sense than banning all peanuts/nuts. I spoke too soon.

I do agree that classroom snacks should be peanut/nut free and that the bus should be a food free zone. The only time I gave epi was to a student who was next to another student who was eating peanuts on the bus. It can be that dangerous.

A school I worked in had a student with a really severe allergy (ingestion and contact) and we decided that we could not feasibly watch 900+ students physically wash their hands after lunch (sanitizer will not remove peanut protein) so we used hand wipes that the kids took as they exited the lunchroom. Maybe that would be a good solution?

[hppygr8ful, ASN, RN, EMT-I]

I'm going to be controversial.

Peanut butter Jelly is an abomination and any child eating it should be home schooled instead.

I beg to differ - financially strapped families have relied on the PB&J for decades. The nutritionist at my facility calls it the perfect food with a balance of carbs, protein to keep a body going when nothing else is available.

Hppy