Tuesday, May 5, 2009

Two Posts in One Day

I had David ask how proactive we should be regarding the sunflower seed allergy and daycare/preschool. Though he broke out in hives from contact with Sunbutter when he was 18 months his test score is extremely low. As parents are now trained to use Sunbutter instead of peanut butter I wondered what I should do about preschool. Our Dr. said Sunbutter should be banned from the classroom as well.

I'm not sure if I should take this hard line. We want other parents to be empathetic to our children's health needs however when is it crying wolf? With low scores (we're talking .37), no history of anaphylaxis from or even ingestion of sunflower seed, do I really need to have it banned from his classroom? Am I going to ban milk then? His RAST for that is 8.32. Or egg, for which he has needed a previous epi? Is this really fair?

If it was just a preschool where he was going two hours a day for a couple days a week I could see drawing a hard line because this wouldn't be too much of a hardship to go without for a couple of hours. Kids would go home and have whatever they wanted for lunch. But Owen will be at the school where I will also be interning next year. He will be in another classroom until 1 and then with the nappers until 3 when I get him.

What is fair to Owen? What is fair to the other children?


Marketing Mama said...

I can share my experience with our daycare. My daughter is 16 months and attends a home daycare that specializes in preschool ages and has curriculum, etc. Also abides by the state food program, so must serve appropriate portions of the food groups, etc.

My daughter is allergic to milk, eggs, peanuts/nuts and soy. Of those, she has had two past severe reactions to eggs, medium reactions to milk (heavy hives, eczema outbreaks, and mild to soy. She has not been exposed to peanuts yet, but her rast marks her very high and her allergist assures us she will have a reaction and to assume she will never outgrow it.

That said, I asked our daycare to become peanut and egg free. That does mean she won't serve anything at all with nuts or peanuts. It also means she won't cook eggs in the house or serve eggs. She will, however, serve the other children food with eggs already cooked into the ingredients. (my daughter has had reactions from me cooking eggs in our house once, it was awful).

Daycare still serves milk to the other children (I don't think they would ever, ever stop - no matter how severe the allergy) and soy is served regularly as it is an additive in almost everything.

We have mutually agreed to clean up policies of all the kids, how my daughters food is prepared and served and how she is kept out of reach of the other kids while they are eating. (i.e. strapped in her high chair).

It's overwhelming at first, but you can certainly manage it if you have a preschool that will partner with you. I believe it is TOTALLY fair to ask them not to serve eggs. Peanutbutter? yes. Sunbutter? um... I would say not... my daughter has had contact reactions to milk as well, so I just have to continue to push the cleaning up policies. I provide baby wipes for all the children to get wiped up before they leave the table... and then they go to the sink to wash up. Sorry this got so long, I hope it was helpful.

Red Dog said...

I sympathize. I've still got a full school year to go before enrolling the little one in preschool, and already I'm sweating it. It's a nut-free school that's been great for his big sister, but they're not egg-free, which is his allergy. They eat cookies and other goodies constantly (largely for celebrations - snacks are healthier - but they celebrate EVERY kid's birthday individually). Is it fair for me to ask them to ban egg, at least from his classroom? His RAST is 9.02 for egg; we KNOW he breaks out from eating egg, we're not sure what level of more casual contact might be a trigger, if any. I've had a hard enough time just trying to smooth over bringing a separate treat for Big Sister each birthday; do I now become The Birthday Mom and insist on making egg-free cupcakes for every kid's birthday? Will parents completely revolt if I try? (I'm guessing yes.) And I've got a sympathetic director whose own son (now a teenager) is peanut-allergic. So I can only imagine where you must be with this. I don't have a good answer, I just have a shoulder for you to cry on (or an ear to yell into, or whatever), because I totally get it.

9to5to9 said...

Hi! Found your blog through a Google alert this morning and thought I'd weigh in.

Isn't it weird on the low rast scores but having a reaction anyway? My son is the same way with garlic - very low rast scores but he's reacted to eating pizza and ketchup. It's strange!

Concerning food at preschool, here's what we did:

Nothing was banned, but he ate at a table away from anyone who had peanut butter. It also was served for snacks but, again, he was separated. The teachers were very, very, very careful to clean the tables afterward - the food tables also were used for classroom activities - as well as to scrub each kids' hands and change their clothes if they got peanut butter on themselves. On birthdays and holidays where parents provided goody bags with candy, no child was allowed to eat the candy at school. It would have been a nightmare for the teachers to try to figure out which candy was safe and which wasn't.

Peanut is the only substance to which he's contact allergic, so the rest - egg, some tree nuts, garlic - we never worried about other than to make sure he had a cupcake on birthdays, as well as a variety of foods he could have for snacks. We also avoid dye, so I wound up providing most of his snacks. The day care had a huge freezer and was happy to store home-made goods there.

Now that he's in kindergarten, though, he is in a peanut-free classroom, for this reason: The teacher does not have time to do the near-surgical scrub on tables and students that the preschool staff had. The afternoon class also is peanut-free.

He sits at a peanut-free table at lunch, and I also send a disposable place mat, just in case!

Sheena, queen of the jungle said...

My dd has a life threatening contact allergy to dairy, and less serious allergies to about a thousand other things so I sympathize...hard to know where to draw the line.

Personally I would shy away from banning foods from the classroom unless it's a life threatening situation. I feel like I have to pick my battles, or risk other parents just shutting down and not taking my dd's really dangerous allergies seriously.

All Adither said...

I struggle with this same issue. If you ban too much, people just get resentful....let us know what you decide.

Miryam (mama o' the matrices) said...

oh, there's no easy choices here. And I think that it's good to let the preschool see that you are struggling, so that they know that you are working hard to be fair. Makes it easier for them to talk to you about the allergies, because they won't feel like they're talking to a zealot allergy mom.

oh, the stereotype.

I think you are right - of course, obviously, absolutely - to try and find balance. We calculate degree of risk (how allergic is the kid? how nasty does this allergen tend to be?) with the ease of containment (crumble? spill? leave sneaky greasy bits?). The higher the risk, the more likely we are to ask the daycare/preschool/grade school to keep the food out of the classroom. The harder it is to contain the food, same thing.

But, i make a point of talking this through with the teachers and director. After I train them in EpiPen use, and impress on them the risk, tell a story or two about anaphylaxis, etc. Then we talk. I review the risk (allergen via ingestion or from rubbing food into eyes, nose mouth = potential reaction), and remind them that allergies are unpredictable. The rest is a group decision: I know allergies, they know their classroom. And, if I feel they aren't taking me seriously enough, I can always throw the question back to the allergist. And just in case it helps, I provide a list of (currently) safe snacks. because sometimes people can't get past the NO to see what their options are, you know?

No matter what you do, at the end of the day, you are going to be unfair to someone. The problem is, who? And what are the stakes? It's kind of brutal, but I think that if there's a risk of anaphylaxis that can't be safely managed with cleaning, etc, then that's it: game over. That item can't be in the classroom. For the Eldest, those items were peanuts, tree nuts and sesame (all crumbly, could be a flour or could be small and tricky to clean up/spot), but not dairy or eggs (easier to spot, and good cleaning would take care of leftover smears of either on surfaces and kids). That was our calculation, anyway, based on our kid and the preschool's capacity. His grade school banned all of his allergens from the classroom (see the link below) because they wanted to have more freedom for the kids, and less stress for the teachers. So, they came up with a different compromise - and it's worked amazingly.

And damn, woman: if soy is a false positive, then you need to know! Soynut butter, soy oils, oh man, the list goes on...as you know. And it would make a huge difference to the classroom options.

I'm trying to think of where I have posts on this subject, but here's what I can find on the fly: http://breedingimperfection.blogspot.com/2007/09/hedumacation-and-bread.html

Speedbump Kitchen said...

Therein lies my frustration with the allergy docs...what do the numbers really mean, are we talking rashes or death? It is so easy for them to say 'strict avoidance' and rush out the door...see ya in a year, try not to kill your kid or die from anxiety yourself.

Kristin, Cooking for Life said...

HI, I just wanted to let you know that we recently launched a new website with recipes for food allergies and health conditions. Each recipe is approved by naturopathic doctors and tagged for 9 of the most common allergens the recipe is free of. Check it out: www.nourishthis.com :)

Stacia said...

how do you know how "serious" the allergy is based on the RAST test scores?

purplemommy said...

Speedbump Kitchen - Ha, exactly. After the Meredith Brousseau incident last year, I just kept saying "I'm only as fearful as my allergist makes me."

purplemommy said...


You asked how serious allergies are based on the RAST test and the thing is the blood and skin tests can't tell you the seriousness of the allergy. They just tell you that you are likely to react. Of course the higher the test value the more concerned you should be but that doesn't mean a .55 can't cause a serious reaction because it still could. Confusing? Yep. Welcome to life with food allergies. History is the best indicator of severity and your allergist should help you determine the best time to challenge a food.

Shannon said...

Unfortunately, we have run into the same problems. We tried and tried to find a compromise between what the school was able to do and what we felt comfortable with. I am now homeschooling. Here is our story, http://blog.kramernet.org/treenutallergy/ I have some school policies on there that we came up with to address these issues. Hope that helps!