When a School Tries to Split Up Epinephrine Auto Injectors

Have you ever been in a situation where something comes out of nowhere and you are too surprised to react?  A parent recently shared an experience that had all of us in a private Facebook group for parents of children with food allergies up in arms.  I asked if I could share it here on their behalf to prepare others for questions that would otherwise catch them off guard.

To set the scene, imagine you are at your school’s “meet the teacher” night and dropping off medication, paperwork, and of course epinephrine auto-injectors:

“[They] promptly took out the [EpiPens] and split the two pack and handed one back to me. I kind of had a mini-meltdown […] I said what are you doing? You’re not supposed to split a two-pack. She told me that was [District] policy. She then checked with the nurse who said she’d been doing this for 17 (?) years and that they don’t ever keep the second one because, according to [District] policy, only a nurse is allowed to administer the second dose and that a nurse will almost never be on campus. I was a little shocked and replied that I was told NEVER to split the two-pack. They told me they could keep the second one, if I insisted. They told me they had been splitting the two-packs all morning and I was the only one who said something. […] This was new to me as last year they took the two-pack, no problem.”

The parent here, let’s call them Pat, is entirely correct.  Epinephrine auto-injectors come in packs of two for very specific reasons.  In researching for this post, I stumbled upon a 2008 post from “Our Story: The Good, the Bad, and the Food Allergies” by Janeen Zumerling where she discussed being faced with a pharmacy trying to fill one prescription for a 2 pack of EpiPens instead of more because they figured two pens came in one box.  So while this is the first time I’ve heard personally about this happening, it could happen at school, at the pharmacy, or elsewhere.

Suggestions as to How to Respond

(The following come with the overall caution to remain respectful, polite, and evidence based in your appeals to the decision maker in question – it may also not be a good idea to have these discussions in front of your child, depending on their age, if they are present when the attempt to split injectors occurs):

1) “This is how my doctor prescribed it.”

Sometimes people will back off if you tell them the instruction comes from someone other than yourself, like an allergist or physician.  My daughter’s allergist writes her prescription for a “two pack” – does yours?  In the story above, Pat was told that the school nurse had been doing it this way for years and that no one else had complained, so this response may not work.

2) Stock Epinephrine Laws

If your state has a stock epinephrine bill, as Nevada does, you can point to the bill’s language.  Nevada specifically references “two doses” of injectable epinephrine.  NRS 388.424 (I’m so used to calling it Senate Bill 453, I had to look up the final Nevada Revised Statutes citation, it makes me happy to see it nestled in the law on the legislature’s website!) reads (in part) as follows:

Each public school, including, without limitation, each charter school, shall obtain an order from a physician or osteopathic physician for auto-injectable epinephrine pursuant to NRS 630.374 or 633.707 and acquire at least two doses of the medication to be maintained at the school. If a dose of auto-injectable epinephrine maintained by the public school is used or expires, the public school shall ensure that at least two doses of the medication are available at the school and obtain additional doses to replace the used or expired doses if necessary. 

(emphasis added).

3) Clarify – EpiPen and Auvi-Q versus Twinject

If your injector is the Auvi-Q or EpiPen, that the Twinject is the only injector where the first dose of epinephrine is an autoinjector and the second is a traditional injection that might cause the concern regarding a nurse administering it.  (Source)  Even so, the doses should be kept together.

4) Look into self-carrying

If your child is responsible, they may be able to carry both doses on their person instead of having to wrangle a school when it comes to attempts to split doses.

5) Turn to your 504 Plan (or IEP)

Depending on the makeup of your school (public schools fall under this, for example, it is dependent largely on the receipt of federal money), you may qualify for a “504 Plan” for your student.  (Source, I discussed school accommodations in my overview of the Fox Chapel case FARE amicus brief as well.)  This is a shorthand reference to the accommodation to which you are entitled for your student.  Don’t have one?  Request a meeting.  Even if the person trying to split your injectors is a novice on the food allergy front, they should know what a 504 plan is (stay tuned for a post on what to do when you get blank stares after mentioning it, as happened to a friend of mine recently).  Does your plan reference both doses?  The plan we have for my daughter references a second dose after 10 minutes if emergency services have not yet arrived.  Some schools may not permit a 504 plan where an IEP (Individualized Education Plan) is in place to cover other accommodations, so your allergy procedures should be contained in that document instead.

6)  Go higher up

You can speak to someone in the school district that may be more informed than the individual you’re dealing with.  If the person you’re facing is a school nurse, use data from the National Association of School Nurses.  They have a great guide about anaphylaxis here (aptly titled “Saving Lives at School“) and I’ve isolated the page about two doses of epinephrine below (click the image for a larger version).

Second Dose of Epinephrine Referenced in School Nurse Guidelines
Second Dose of Epinephrine Referenced in School Nurse Guidelines

7) Research Response Times

This may take some google searching on your part but some areas may have response times for emergency services (ie, 9-1-1) that exceed 5-10 minutes.  If you’ve ever been in a traffic jam near your child’s school, you probably won’t be surprised when you do find the stats you need.  You’ll see that this is even more important when you see my notes on biphasic reactions below.

8) Know Some of the Reasons Why Epinephrine Autoinjectors Come With Two Doses

Not only could the first injector malfunction, there may be user error (or inexperience) at play in addition to the risk of biphasic (subsequent) reactions from the same exposure or the epinephrine wearing off before help can arrive.  I’ve broken this final suggestion down with supporting information I was able to find – sometimes just knowing why a protocol is in place will help you if someone down the line challenges you.

Background Research

Here is some additional information (background research that I did) that could come in handy if someone tries to force split your two pack of injectors:

A second Dose of epinephrine is required For At Least 1 in 10 patients

While the percentages vary, a second dose is required for 10%-35% of patients experiencing an allergic emergency to deal with the symptoms of the reaction.  (EpiPen says 20%, Auvi-Q says 10%-20%, and Twinject says 35%)  Remember, of course, I am not a physician and none of this is a substitute for medical advice.  I just want to arm people with information that they could use if they find themselves in Pat’s shoes.  A study spanning 2001-2006 records for two hospitals in Boston found that 12% of children required two doses of epinephrine as opposed to one per Susan Rudders, MD, of Children’s Hospital Boston. (Source:  “Kids With Food Allergies May Need 2 EpiPens” – WebMD Health News, March 26, 2010)  The article goes on to quote Dr. Rudders as saying, “The problem is, we really don’t have good ways of identifying who will and will not need an extra dose.”

The effects of one dose of epinephrine may wear off after 10-20 minutes

Epinephrine suppresses the progression of a reaction. (Source)  It may wear off after 10-20 minutes, however, which may not be enough time for emergency help to have arrived.  (Source)  Remember, use epinephrine by injecting it into the outer thigh, call 911, also remembering to keep the patient lying down with their feet elevated and be prepared to use that second dose.

User Error And Device Malfunction

 Not that anyone wants to consider making a mistake when the situation calls for epinephrine, but in a high stress situation the person using the product may not know how or may make a mistake.  I found an interesting article from 2010 that compared four injectors (it was funded by the makers of the Intelliject, later called the Allerject in Canada or Auvi-Q in the United States) entitled: “A comparison of 4 epinephrine autoinjector delivery systems: usability and patient preference” from the Annals of Allergy, Asthma & Immunology (by Stephanie Guerlain, PhDemail, Akilah Hugine, MS, Lu Wang, MS, in Volume 104, Issue 2, Pages 172–177, February 2010 – the manuscript version is here).

The manuscript mentions that when a device malfunctioned, the likelihood of failing to follow instructions was higher.  What I was searching for were stats on malfunction but the reference here admits it is a possibility in a test setting at least:  “Studies have shown that patients and caregivers do not always correctly administer epinephrine autoinjector devices. […] There may also be a large time lapse (several years) between when a person is trained on an autoinjector and when it must be used during an allergic reaction. Finally, a patient or care provider may be under significant stress while attempting to provide the potentially life-saving dose of epinephrine when it is used.”  Id.

As an aside, I was surprised that the most common error for use of an epinephrine injector was not holding it for the correct amount of time.  In the study I looked at,  versions of what would become the Auvi-Q (INT02 and INT01 in the study)  were used as well as the EpiPen and the TwinJect.  “The INT02 device resulted in participants committing this [(not holding long enough)] error 11 times compared with 27 (INT01), 40 (EpiPen), and 42 (TwinJect) times.”  Training across devices was held to be crucial, with the manuscript indicating that “[t]he fact that less than 50% of participants across all devices could follow the labeled instructions without committing a single error provides confirmation that the need for training on the use of epinephrine autoinjectors is still important.”

I didn’t mean to get sidetracked but I found it interesting.  At any rate, someone administering the medicine could not hold it long enough, the device itself could malfunction, the person may not be adequately trained, or the stress of the situation could cause errors as well.  With these things in mind, a second device is a very important thing to have.

Biphasic Reactions

The first time I heard of biphasic reactions I was fairly shaken.  It isn’t enough to worry about accidental exposure to an allergen without now thinking that you could have the reaction, be stabilized, only to have it return like an aftershock even hours later.  A biphasic reaction is defined as “a worsening of symptoms requiring new therapy after resolution of anaphylaxis.”  (Source)  (This Post Updated 12/1/14 to include this post by Dr. Anne Ellis about Biphasic Reactions: “Biphasic Anaphylaxis: What You Should Know“)

Final Notes

I hope some or all of the above is useful!  I also hope you don’t run into push back when you work with your school.  Pat was able to get the school to retain both EpiPens and I really appreciate the talking point the story provided (thank you!).

As I stated in my post regarding EpiPen and Auvi-Q expiration dates (people are reporting in the comments that they’re receiving their $400 Auvi-Q savings cards in the mail in about 2 weeks after reporting short dated injectors, check out Amazing & Atopic and Food Allergy Pharmacist for even more if you’re following the issue), I have connections at both Mylan and Sanofi (I am the co-founder of the Food Allergy Bloggers Conference and they are both sponsors and my travel, hotel, and some food was covered for my attendance at the Mylan Summit earlier this year) – see my disclosures page as always for more.

The opinions herein are my own, do not constitute legal advice or medical advice, and are provided merely as discussion points.  I am an attorney and parent of a child with food allergies living in Southern Nevada. 

A Brief in (Semi) Brief – Understanding the Amicus Brief of FARE and COPAA in T.F. vs. Fox Chapel Area School District

I was excited to see that FARE (Food Allergy Research and Education) posted their Amicus Brief recently filed in TF and DF and TSF v. Fox Chapel Area School District for download on their blog.  Speaking with other allergy advocates, many had seen the brief go up but had not had time to read through.  I found it to be a great overview of food allergy accommodations in federally funded schools and had the idea to try to distill the brief into a post in honor of Food Allergy Awareness Week (starting tomorrow, May 11, 2014) here in the United States.  I tried to also cover some questions people may have, like what an Amicus Brief is, and why there are citations to cases as well as parts of the US Code in the brief.

Remember that briefs and settlements are not binding precedent (I see some people cite the Lesley University settlement as binding in other cases) and analysis of food allergies as a disability are a very individualized thing even if we can all agree that food allergies are a disability.  For example, in a private daycare, you could use the Americans With Disabilities Act to seek accommodations for your child but the factors and balancing at play could very well leave you having to look elsewhere for services.  With federal money involved, however, your chances get significantly better.

Generic policy does not meet the requirements for a free, appropriate public education under the law. The major theme is individualized planning, from inputs to process, to outcome. As an aside, for most lawyers there are three answers to any question: Yes, No, and It Depends – individualized case by case planning falls in the third category. As a parent of a child with multiple food allergies and also one aware of the co-existence of other issues unique to each child, I think the brief is a great resource.

Amicus Brief re: TF and DF and TSF v. Fox Chapel Area School District (download the original brief here)

From the caption we can tell the case was initiated by a minor and his parents against a school district. It is on appeal by the parents & child so we can guess that there was an unfavorable aspect of the decision below.  From the FARE Blog:

A federal judge previously ruled that the school district did not discriminate against the child in violation of Section 504 of the Rehabilitation Act, and that the school offered reasonable accommodations, and had not retaliated against the student’s parents when it filed a truancy petition after the parents withdrew their child from school. Among the accommodations that the school offered was special lunch seating at a nut-free table that was actually a single desk in the cafeteria. 

Amici Curiae

An “Amicus Brief” is one filed in a case not by anyone that is a party to the dispute but usually by organizations that have a vested interest in the outcome of the case. They can highlight unique impacts on their organization depending on the outcome of the case or just show support. Here, we have FARE (Food Allergy Research and Education) joining with the Council of Parent Attorneys and Advocates to support TF, DF, and TSF.

Table of Contents and Other Introductory Material

If you’ve had experience with your local court system, you may notice the greater formality in a federal brief. Ideally, we should all be well organized in our writing (headings, etc.) but you simply don’t always have time to draft the perfect document in regular motion practice. In other words, don’t hold your divorce attorney to the standard you see when you’re reading a brief like this.

Relevant Statutes and Regulations

They start off with 29 USC (s) 794. This citation tells you the title of the United States Code and the section where the provision quoted is located. The ellipses let you know portions that were perhaps not relevant have been removed. This provision of the US Code states that if you otherwise qualify (so subject to any exceptions that may apply from other laws), if you have a disability in the US, you can’t only because of your disability be excluded from, denied benefits of, or be discriminated against by/through a program or activity that receives federal financial assistance. It goes on to define what a program or activity would be, including educational agencies or a school system. Note that it specifically says in this provision that they have to receive Federal financial assistance. If you’re looking at this brief to apply broadly then you’re out of luck because a private school system would require you to find a different provision, if one exists, to apply to your circumstances.

Many times, the key here is knowing how the court gets jurisdiction on an issue, that is, how do they have the “right to speak” on the topic and bind the parties that come before them. For things to hit Federal Court, one great way is for an issue to be one of Federal Law.

Next up is 34 CFR (s) 104.33. We see that under Title 34 of the Code of Federal Regulations, Section 104.33 we can find the provision cited. Title 34 of the CFR is titled “Education” so that would also clue you in that you could look under that title for related subjects.

When laws are passed, they often set into motion a framework to make rules to apply those laws. So these are rules that are also binding under the law. This particular portion of the CFR states that a recipient of federal assistance operating an education program has to provide “free appropriate public education to each qualified handicapped person” in their area, “regardless of the nature or severity of the person’s handicap.” So we see from this that a school getting federal money can’t turn away a student even if they are handicapped and the accommodation for that handicap may be great. This is different than the American’s With Disabilities Act provision that a private entity that is classed as a “public accommodation,” such as a daycare, won’t have to accommodate a disabled individual if, among other things, it would be unduly burdensome or change the nature of the service they offer. Here, if you’ve got a school that is getting federal assistance they have to take a student on and figure out how to make it work so that their education is still free to the family and appropriate.

A subsection goes on to point out that “appropriate education” is defined to include any special services and aids to meet the person’s needs “as adequately as…” the needs of people non-handicapped person. There are more provisions about how to determine the placement procedures for a handicapped individual.

Title 34 of the Code of Federal Regulations, section 104.36 is an additional rule that provides for procedural safeguards, notice, opportunity for parents to examine records, a review procedure, and an impartial hearing with participation of the child’s parents.

Statements of Interest

This section details the resume of FARE and their focus on research and allergy education and is interested in the case because of a belief that “students with the disability of a severe food allergy have the right to individualized plans that ensures their access to education and safety while in schools.”

The Council of Parent Attorneys and Advocates is described as a nonprofit organization for parents of children with disability and those that advocate for them. They assist counsel for families on disability law.

Argument

The Importance of Protecting Students with the Hidden Disability of a Severe Food Allergy

Pretty much general statistics here, ones advocates are all too familiar with. Some that were new to me:
– Over 160 foods can cause severe food allergy reactions
– The Food Allergen Labeling and Consumer Protection Act also requires federal agencies like the CDC to monitor and research “the growing prevalence of food allergy.”
– Peanuts and Tree Nuts account for 50-62% of reactions and 15-30% of the fatal/near fatal reactions in emergency rooms.

Schools are Required to Develop Individualized (s) 504 Plans to Ensure a FAPE for Students with Disabilities

Before section 504 of the Rehabilitation Act of 1973, discrimination regarding disability was viewed by Congress as careless, not intentional. Now, under a section 504 claim, a student has to prove:

“(1) he is ‘disabled’ under the meaning of this Act;
(2) he is ‘otherwise qualified’ to participate in school activities;
(3) the school or the board of education receives federal financial assistance; and
(4) he was excluded from participation in, denied the benefits of, or subject to discrimination at, the school.”

Ridgewood Bd. Of Educ. v. N.E. ex rel., 172 F.3d 238, 253 (3rd Cir. 1999).

FAPE, or “free appropriate public education” (and individualized needs) to students with a disability so that they can participate in education. The protections of section 504 are procedural and include extracurricular activities as well with a mind to meaningfulness for the student with a disability.

The two procedural safeguards are that a person that is “knowledgeable about the child” to be part of the group evaluating their placement and that guardians have notice and opportunity to see the records informing decisions about placement.

An IEP may be needed, or a 504 plan, depending on the circumstances and even if other provisions are in place for the student.

The Court Should Require Schools to Develop Individualized 504 Plans for Students With the Hidden Disability of a Severe Food Allergy

A school can’t simply decide on a policy for all students with food allergy, they have to adjust to each unique circumstance with parental and expert involvement.

In 2011 the Food Allergy & Anaphylaxis Management Act (FAAMA) was passed by Congress to require national guidelines to assist implementation of plans for individuals to manage food allergy and anaphylaxis risks in schools. The individualized mandate appears again and again.

The brief is requesting that the court rule that 504 and IEP plans be individualized based on the regulations, case law, and United States Code. Schools can’t bypass families and administer a generalized policy if the court rules that individualization is the “minimal bright line rule.”

Components would include individualized accommodation for meaningful participation at school as well as an emergency care plan specific to the student. The factors requested for consideration are (1) medical history, (2) type and severity of allergy, (3) number of allergies, (4) atopic conditions, (5) mental health, age, and maturity, (6) any developmental or learning disabilities, (7) past bullying and harassment, (8) school nurse presence or absence, and (9) transportation needs.

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Special thanks to Laurel Francoeur and Kim Pebley for the encouragement to drive this post forward.  I hope it is of use.  Special thanks also to my daughter’s teacher and her school, she is wrapping up her kindergarten year in the next month and we are truly lucky for the support and compassion of the staff, students, and other families when it comes to keeping her safe.

Also, check out our latest post over at FABlogCon.com, our Mother’s Day gift/Food Allergy Awareness Week contribution of a video session from last year’s conference entitled “Facing Adversity With a Smile.”  I make a teary appearance but to those that know me that isn’t a surprise.  I can argue cases just fine but when it comes to food allergies I get very emotional!   

“An Emerging Epidemic: Food Allergies in America” and Nevada SB 453

If you follow food allergy topics online, it is likely you’re already aware of a television special funded by FARE and Mylan Specialty (makers of the “Epi-pen”) that aired this morning.  I watched the special, narrated by father of a food allergic child, actor Steve Carell, online (click here to stream the entire program, thank you to Selena of Amazing & Atopic for sharing the link).  It is called “An Emerging Epidemic – Food Allergies in America” which is very fitting.

I’ll admit to crying a few times.  When you identify so keenly with something it is hard to escape reliving scenes from your own life.  I wonder how the program will impact people that don’t live with food allergies.  I wasn’t sure what to expect when I pressed “play” – it certainly is not something you want to watch with little ones because it comes right out and talks about fatalities with images of hospitals and a child in peril.

I think the program put faces to the issue but the questions I get as a parent of a child with food allergies were glossed over a bit.  For example, I’d say people ask me why there is an increase in the incidence food allergy and what causes food allergy.

The special mentions the hygiene hypothesis, which is one our pediatrician brought up most recently at the children’s 3 and 5 year well visit.  I brought up a lot of the other theories that I’ve been reading about and she hadn’t heard of them.  So to not present any of the other theories might perpetuate the implication of parental fault (which may be my “mommy guilt” talking).

The coverage given to oral immunotherapy is promising and exciting but there are already reports that the gains in treatment may not be lasting.  I know I love disclaimers but ending on the note of one treatment may diminish the impact of the program’s message.  Then again, as a food allergy mom I want to feel hopeful, I want to feel like people are working to help further research and awareness.

I have been feeling unsure of whether it is the best thing to keep this blog going but there is a part of the program where Dr. Ruchi Gupta mentions her mission to achieve safety for her child and others and it captured why we share and reach out.

As I wrote previously, I gave a presentation at my daughter’s school about food allergies.  I was then asked to write something for our school newsletter recently on the subject of food allergies and I decided to cover the new epinephrine law passed this summer in Nevada (using some of my notes from last year).  I want to be sure I thank my husband, my mother in law, my sister in law, Jenny (Multiple Food Allergy Help & FABlogCon), Missy (Marketing Mama), Elizabeth (Onespot Allergy & EpiCenter Medical), Tiffany (Food Allergy Fun), Caroline (Grateful Foodie), and Dana (The Las Vegas FARE Walk).  Each of them reviewed drafts of the following at various stages and provided valuable feedback.  I love this community, I know I say it often but I really and truly appreciate the support!  

I don’t know if this will be included in the newsletter in its entirety but I wanted to share it here in case it is of use to any of you out there in trying to raise awareness and impact the safety of all in the face of “an emerging epidemic.”  If you need my citations/references to feel free to leave a comment and I’ll get them to you.

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IMG_0242

New Epinephrine Law Could Save Lives at School

During this summer’s 2013 legislative session, Nevada unanimously passed Senate Bill 453. The bill mandates that public schools obtain and have authorization to use injectable epinephrine (private schools are authorized but not mandated to obtain epinephrine). This allows them to save lives in the face of the rising risk of food allergies among children and anaphylaxis deaths nationwide. The New England Journal of Medicine has said that four of six deaths from food allergy occur in schools and are associated with delay in treating reactions with epinephrine

Anaphylaxis is associated with symptoms that may include hives, swelling, rapidly closing airways, and more. While not completely understood, anaphylaxis is essentially an overreaction by the immune system to any number of external triggers, including food. Estimates currently are that one in thirteen children suffers from food allergies. The most common food allergens are peanuts, tree nuts, milk, eggs, soy, shellfish, fish, and wheat. While some children might outgrow food allergies, they need protection at home, school, and play while their immune systems are so affected.

What does this development mean for students as they begin another school year in Nevada? Much like any person would obtain a prescription from their pharmacy, Nevada schools are now able and required to obtain and fill prescriptions for injectable epinephrine. Currently there is a program for schools so that each school can keep epinephrine injectors on hand without cost (the “Epi-pen” brand in this program). Discovery Charter School is making arrangements to obtain these free injectors to protect students and staff alike from known or undiagnosed food allergies. The Center for Disease Control reports that 25% of anaphylactic reactions in schools occur without a prior food allergy diagnosis.

During the legislative process, some wondered if epinephrine could cause more harm than good if used when it wasn’t needed but this is not the case. The side effects of mistaken use are mild and are greatly outweighed by the benefit of immediate use when needed. The only time giving epinephrine could be a problem is if a student has a heart disease but even so, physicians still feel that in a life and death situation, the epinephrine is worth the risk. So adverse reactions are rare and epinephrine is easy to administer to the thigh and even through clothing.

How does SB 453 help? In the case of an allergic anaphylactic reaction, epinephrine is most effective when used quickly. That means that a child who does not have their own prescription for injectable epinephrine would not even have the medicine at hand. The stock epinephrine could save that student during the delay in time for emergency services to arrive. Minutes make all the difference.

In Virginia, where a similar bill was passed, children have already had their lives saved because of stock epinephrine. A fifteen year old boy in Virginia was stung by a bee and two injections (the injectors are always provided in two-packs) stabilized him so that emergency personnel could assist him further.

I appreciate [my daughter’s school’s] embrace of training associated with food allergies and recognizing the signs of anaphylaxis. If you have any questions please feel free to get in touch with the school nurse. You are also welcome to contact me at [email]. Learn more about supporting the cause of awareness and a cure at http://www.foodallergywalk.org/lasvegas (the food allergy walk on November 2, 2013 at Green Valley Ranch’s The District is great for families — there will be a face painter, game truck, and more!).  I also encourage you to seek the assistance of a physician if you suspect your child has food allergies.

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School has been going wonderfully so far and it is the support of a caring community of staff, families, and friends that make all the difference.  Thank you for reading and being a part of that community.

Local Advocacy Opportunity: Clark County School District Wellness Regulation 5157 (Proposed Changes)

fapelogo

I wanted to share this even though it is aimed more to folks here in Clark County, Nevada than the general internet.  An e-mail from FAPE (our local Food Allergy Parent Education Group, click here for upcoming events on their website) alerted that some promising changes have been proposed (spearheaded by Food Services) to rules in the district that involve treats in classrooms and food rewards.  The proposed changes might not pass, however.  Here’s a run-down of some of the changes the district is looking at making (I’m most excited about the fifth one on my list):

  1. Adding a requirement that there be no trans fats in food and beverage choices offered to students.
  2. Specifying that foods offered by student stores, sports teams, the PTA, kiosks, and vending machines must be approved if they are offered an hour before school starts through half hour after the end of the school day.  The approved list is provided by the district’s Registered Dietician.  Also, outside vendors can’t sell things during the school day – student run events selling food items essentially would have to be run by students and any vending contracts would have to be approved by the district’s legal counsel.
  3. Furthermore specifying that: “All food sold or given away must be commercially prepared.  NO homemade food may be sold or given away to students from one-half hour before school starts until one-half hour after the end of the regular school day.”
  4. A provision exempting the following activities from the nutrition guidelines but not from the “no homemade food” requirement: Halloween, Thanksgiving, Christmas, and Valentine’s Day activities as well as school wide recognition parties (limited to no more than four occurrences per school year).
  5. A mandate that: “Teachers should not use foods or beverages, especially those that do not meet specified nutrition standards, as rewards for academic performance or good behavior.”
  6. Though “FAAN” is now “FARE,” an explanation in the text of the Wellness Regulation that states: “The Food and Anaphylaxis Network supports the restrictions on homemade food due to the great threat of anaphylaxis when exposed to allergens.  The School Nurses have worked to promote this policy within our Clark County School District.”
  7. Fines will result from violation of the State of Nevada Wellness Policy and USDA Wellness Regulation (through the Healthy Hunger Free Kids Act of 2010) and will be the liability of the violating school.

I uploaded a highlighted version of the provisions provided by FAPE in case you’re like me and prefer to read rules in context but the list above is promising.  I’d love to see provisions moving classrooms away from food incentives not just for children with food allergies but for the health of all children.

A friend of mine has been wrangling with some backlash (at skittlegate.blogspot.com, you can also read about it here) from advocating against food rewards in classrooms (in an area in Virginia where the rules already provide that the incentives are discouraged) in case you want to get a preview of the arguments people are likely to make here in Clark County against such a provision.  If you’ll recall, Virginia is at the forefront of the stock epinephrine movement so if people are resisting changes over there I think it would be prudent for those of us in Southern Nevada to front load support of these wellness provisions.

Remember that the homemade food points cover food sold or given away at school but kids would still be able to bring their own food from home which I totally support.  (The school my daughter goes to right now for preschool doesn’t allow outside food even as snacks and that means she can’t go to class more than a few hours before I bring her home to eat so I wouldn’t be advocating anything like that for the district.)  This is really about giving clear guidance to schools.

So, here’s the call to action: contact the district deputy superintendent and associate superintendent to voice support for the changes if you would like to see them adopted in the Clark County School District.  The District has been really working hard to address food allergy concerns but the community has to support them.  I know we’re all busy but how about a post card (or two)?

Pat Skorkowsky
Deputy Superintendent
5100 W. Sahara Ave., 4th floor
Las Vegas, Nevada   89146
(799-5475)

Jeremy Hauser
Associate Superintendent
2298 Vegas Valley Dr.
Las Vegas, Nevada  89169
(799-1222)

If you do send a note over or make a call, please share what you did in the comments.  Thank you!