Going Nuts.

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Most parents are aware of the benefits of nuts, particularly almonds, peanuts and pecans, for our health and our kids’ health. These powerful pieces of nutrition provide essential fatty acids, proteins, fiber, and Vitamin E and help raise good cholesterol, known as HDL. However, the one drawback to this nutritious diet staple is that nuts can also cause a potentially fatal allergic reaction, known as an anaphylactic reaction.

Due to the potential seriousness of allergies, many schools have started to enforce restrictions on the kinds of foods students are allowed to bring to school. This raises some complicated questions for parents hoping to send their children off to school with healthy, nutritious food. What do we do as parents when our child’s school has banned nuts? For some kids, going without nuts means missing their vegetarian protein source. Should we pack our kids dairy every day and risk raising their LDL cholesterol? Should we send tofu and soy butter, which are more processed than natural nut butters? Should we send sunflower butter, which is also highly allergenic and can also cause anaphylaxis? Should we focus on peanut-free and not tree nut-free?

In addition to the immediate challenges these kinds of bans place on nutrition, they also have the potential to affect the ways our kids interact with one another.  Do we advocate for a nut-free table in the cafeteria, which would set kids with allergies apart? While a “nut-free” table would be organized with students’ safety in mind, in enforcing this rule we risk ostracizing them from their classmates. I have heard some moms in Connecticut are fighting with their children’s schools to allow their child with a nut allergy eat with the other kids. Do we go along with the nut -free school zone? Do we recommend establishing this nut-free zone on a class-by-class basis, pending if someone has an allergy?

Where do we draw the line? I understand this is a sensitive subject, and should be — the risks are very high. I do think a nut free elementary school is advantageous. However, when my son’s school proposed a ban on all food products made in a factory that may be in contact with peanuts (at a school where the children eat lunch in their classroom and there may be no allergy in many classrooms) I felt at a loss. I am a mom, RD, CDE and I am now going to have to take on the responsibility of feeding my kids as if they had an allergy, possibly decreasing their immunity to such foods. Busy parents are challenged enough as it is to feed their kids healthy, let alone nut- free food, and our choices are narrowed even further when we are expected to avoid products from facilities where peanuts may have been processed. I would gladly comply if a child in the class had a documented allergy, but to go through hoops and hurdles when it may not be necessary seems overboard.

This excessive caution seems all the more extreme when we consider how allergens and contamination are regulated (or aren’t).  Avoiding food processed in the same facility as nut products is not always effective. According to a recent article by a panel of experts from the National Institute of Allergy and Infection Diseases:

The FALCPA does not currently regulate voluntary disclaimers such as “this product does not contain peanuts, but was prepared in a facility that makes products containing peanuts” or “this product may contain trace amounts of peanut.” Such disclaimers can leave consumers without adequate knowledge to make objective decisions.

The EP identified 10 studies that examined whether standards for precautionary food labeling are effective in preventing food-induced allergic reactions. No study explicitly attempted to infer a cause-and-effect relationship between changes in frequency of severe symptoms from unintentional exposure (for example, to peanut) as a consequence of implementing food labeling. The identified studies mostly assessed knowledge and preferences for food labeling.1

If this labeling is voluntary, unregulated, and therefore possibly inaccurate, does it make sense for schools to use the kinds of labels to inform their policies regarding allergies? Many of my clients with peanut allergies still have tree nuts, and even peanut butter, in their homes and simply know how to prevent cross-contamination. Many of my clients with these allergies still eat foods processed in a facility that may share equipment with nuts, wheat and other common allergens.   So are our schools being too authoritarian? Are they smart for playing it safe, or is there such a thing as too much caution? Should sweets be forbidden from schools for fear of hyperglycemia or hypoglycemia, conditions that are just as threatening for someone with Type 1 Diabetes? Should grapes be forbidden since they are a choking hazard?

Instead, I recommend schools practice peanut/nut free or safe policies.  Focus on education, emergency plans for allergic reactions and having the epi pen to administer if there is an allergic reaction. Avoiding nuts or rather nut free facilities is not the best answer. Yes, precaution is necessary but we also need an action plan for as we know with voluntary labeling, kids still may be exposed and have an allergic reaction.

What do parents think? Do you believe in nut-free schools?  Do you believe in nut free schools banning food products made in a facility made that may have processed nuts?

 

1. “Guidelines for the Diagnosis and Management of Food Allergy in the United States” Report of the NIAID-Sponsored Panel.”  The Journal of Allergy and Clinical Immunology 126.6, Supplement (2010): Pages S1-S58.

7 Replies to “Going Nuts.”

  1. Hi Laura, this is such an important post and an issue I struggle with all the time! I am fortunate enough to have 2 allergy-free children, but my niece is allergic to peanuts, tree nuts, and eggs, so I have some insight into how difficult it is. Whenever I will be feeding her, it is an intense project of reading tons of labels and finding the right brand of each ingredient, coordinating with her mother, and planning a menu carefully so that she will be able to eat the meal. That being said, I think it is unrealistic to expect every parent to go to these lengths when packing daily lunches for their own kids. Skip the pb&j sandwich or trail mix in the lunchbox? No problem. But avoid any ingredient processed in a facility where there is a chance of cross contamination? That is so limiting, and as someone who already has strong feelings about the quality of foods I prefer to feed my children, and who makes a lot of foods from scratch (in my non-nut free kitchen), I can’t even imagine if I could only send lunches where every component was totally safe for a child with nut allergies. That being said, the idea of a child dying due to exposure to an unsafe food at school is terrifying. But it is so hard to check every ingredient and avoid cross contamination, even well meaning parents might miss something, which means even the strictest school policies do not guarantee no nuts, and nut-free schools do not protect kids who are allergic to other foods anyway. So I agree with you that there needs to be other methods for keeping kids safe – things like teaching children from an early age never to share or trade food, training teachers and lunch aids to monitor allergic kids carefully, and considering extra precautions when a child with allergies is in a classroom. Plus, I think school activities should never include food – birthday cupcakes, holiday parties, etc. provide additional opportunities for risk kids with allergies and put them in the position of potentially eating something not safe or feeling left out (not to mention infringing on the rights of other parents who may have other religious, health related, or other dietary preferences that would lead them to want their kids to avoid food the are not providing). Eliminating situations where one parent is bringing in food for all children would go a long way towards helping to keep all kids safe and healthy.

    1. Excellent response, Alissa. You offer some good solutions and bring up valid points. My child is anaphylactic to milk and also allergic to eggs (thankfully outgrew the peanut allergy). I’m also the aunt to a couple children with multiple food allergies, including peanut. This is such a hot topic. I like the idea of having food-free activities (holidays/birthdays/rewards) – focus on the event, or the accomplishment, not the treat.

      I struggle with some things about a peanut/tree nut free room or school, though understand how scary it is for any food allergy parent to deal with the potential risks of having their child’s allergen present (whatever that allergy may be). One example of my frustration is the individual soy milk we buy is now labeled that it’s processed in a facility that handles tree nuts…so, this is not allowed in my child’s class. My child can’t bring this milk because it “MAY contain” something another child is allergic to (even though it wouldn’t be shared with anyone else); yet the 20+ other kids can have their milk, cheese, chocolate, yogurt, doritos, goldfish crackers, ice cream and rice krispy treats that (for sure) DO contain the allergen my child is anaphylactic to, and these are things that are often brought in for the parties/shared snacks for the class. We aren’t supposed to bring in home baked goods, but the only alternative my child has to many foods sent in to share as a class HAVE to be homemade to be safe. To the other parents in the class who may not be aware or educated in food allergies, it gives the false impression that other allergies are less serious – otherwise, why wouldn’t the class be dairy free or egg free (or whatever other allergy a child may have), too?

      I also think that age plays a factor with what type of rules are necessary for a class – lower elementary kids are constantly touching things and putting their hands in their mouth, they aren’t able to read labels for themselves or determine what is safe, they also may not have the knowledge or the words to describe what is going on if they do have an allergic reaction. They are also usually at shared tables, rather than individual desks. I think stricter rules for that age group are necessary to help keep their environment safe. Older elementary kids can read labels (though adults should still check to be safe), and need to be given a little room to safely begin managing their own food allergies. I’m not saying they are on their own, but they should be growing in knowledge in how to safely manage things – they know to wash their hands, clean the table before they set their food on it, and they know they shouldn’t eat things without knowing the ingredients or asking if it’s safe. Next, many schools will allow their facilities to be used for church groups, girl scouts, etc….who is monitoring what food is being brought in with those events? It’s hard to truly have a “peanut/tree nut free” facility.

      There are certainly a lot of things to consider and work through! Having a standard school wide policy (that is enforced and abided by!) makes it easier for everyone.

  2. The fact that the children eat in the classroom is very scary, and seems to be the reason your school is trying to be so vigilant on keeping peanut products out. They understand the seriousness of a life threatening peanut allergy and are working to keep those children safe.

    It sounds like they are banning bringing items that clearly state on the label, that they were “made in a facility.” Which would include certain items like granola bars, cookies, candy, chips, etc. These items can have traces of peanuts in them or a high probability of cross-contamination.

    The school is most likely doing this to:

    1. Increase safety for the child with the peanut allergy. They can help reduce accidental exposure by school staff and other classmates giving an unsafe product to the peanut allergic child.

    2. To avoid exclusion for the child with the peanut allergy. Many “treats” brought in for classroom parties and snacks are often unsafe for a child with a peanut allergy. It’s sad to see a child being left out and have to watch their classmates enjoy something they can’t have because of their allergy. Especially, with many “safe” snack options out there that all the children can enjoy.

    3. The severity of the child’s allergy. Some children could have a life-threatening reaction from even the tiniest exposure.

    Why are they doing it in every room?

    1. Most likely, they are trying to be consistent (what if a new student comes in during the school year with a peanut allergy. It’s hard to get people to suddenly change).

    2. They are trying to be fair to all the classrooms. I guarantee parents will voice their frustration and disappointment if they are “stuck” in the classroom with the child with the peanut allergy. “Everyone else can eat what they want, but not in my kid’s classroom, because we have to have someone with an allergy!” Parents will complain… and their children will start saying what they hear at home. The child with the peanut allergy has enough to deal with, and definitely doesn’t need to add having a classmate bully or make rude comments.

    You’re absolutely right when you say products don’t have a label stating how it was manufactured. But… if a product clearly states it, can’t they just choose a different product? There are plenty of healthy choices that wouldn’t cause life-threating allergic reactions. And yes, you never know what the parents did at home when preparing the lunch and if it had cross-contamination there.

    It’s so much easier to control accidental exposure, when students eat in the cafeteria. Eating at the peanut free table doesn’t have to ostracize the child with the allergy. At my nephew’s school, they made the peanut free table so cool, that many non-allergic children wanted to sit at it. You don’t have to have a peanut allergy to sit there; you just have to have a peanut free lunch.

    As for the mom who was fighting to have her child sit at a regular table, that’s a decision between the parents and school. As children mature and understand more about peanut allergy safety, they need to start gaining more independence and responsibility for their safety. Children should always be in the least restrictive environment that is the most beneficial for them.

    Allergy action plans and EpiPens are crucial to help save a child’s life. But, using action plans and EpiPens should be the last resort. Preventing exposure is the best way to help keep a child safe. It’s like looking at the grape/choking analogy…and what would be the best way to handle it. You could give a whole grape to a young child, and put up a poster on the Heimlich maneuver, and use it if needed. Or, you could just cut the grape into smaller pieces before giving it to the child.

    Trying to help a child avoid a life-threating situation should always be a priority. Doesn’t matter the child or the circumstance.

    I agree with you that more education is needed on preventing and handling allergic reactions! I know it makes life a little harder to have restrictions on food, especially when you’re trying to provide nutritional lunches. I do thank you for the effort that you are making. I also really appreciate your honesty on how you feel about it, and your openness to better understand it.

    At http://www.peanutfreezone.com we focus on helping increase allergy awareness and safety at school. If there’s anything we can help with, please let us know.

    1. Thanks for response. It is truly helpful to hear about this from the perspective of families touched by such allergies. So it seems the message is “all of the above”. Meaning do all of it, including to be sure schools still educate or don’t think by banning the products made in possible nut facilitiies that this prevents reactions.

  3. There should be a ban on nuts and food made in a facility that processes nuts at all schools for this simple reason: ALLERGIC CHILDREN CAN DIE FROM EXPOSURE TO NUTS. Having a child who has had anaphylaxis from food that was processed in a facility with nuts, I understand this. I just wish that other parents would put themselves in my shoes and understand the gravity of this issue.

    1. I am so glad people are talking about this. I honestly think its helpful to hear your perspective and fears esp. since many of the people I know do keep these foods in their homes. I assume the difference is someone can control what goes on in their home versus what may or may not happen at school? Thank you for sharing.

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