When do you Need a Care Plan for Food Allergies?

When do you Need a Care Plan for Food Allergies?

If you have a child with life threatening food allergies (LTFA) the answer to the question when do you need a care plan, is “yesterday”. All too many people fail to realize that a written plan, be it an Emergency Care Plan, Individualized Health Care Plan (IHCP), 504 Plan, or Individualized Education Plan (IEP), is crucial in maintaining the safety, emergency response, and educational needs of a child with LTFA. So what are each of these plans and which does your child need?

At minimum all individuals with life threatening food allergies should have an Emergency Care Plan, Food Allergy Action Plan, or something similar. Children in schools or day care settings should also have an IHCP. However all children with LTFA in schools that receive money from the federal government are entitled to a section 504 plan, and may qualify for an IEP. We’ll discuss each of these plans in detail below.

Emergency Care Plan, Food Allergy Action Plan, etc.
This is a written plan that you may have received from your allergist. It should be a single sheet of paper (sometimes two sheets) that lists the patients allergies, which ones are life threatening, what the symptoms of an allergic reaction are, and what medications the patient should receive, how much, and when. There is also a space for emergency contact numbers. There may be a space for a picture of the patient and there may be illustrations on how to use the epi-pen. A sample Food Allergy Action Plan can be found by clicking here.

Individualized Health Care Plan (IHCP)
An IHCP is a written plan that many LTFA children have in school. It usually includes the Emergency Care Plan but also goes a step further. This plan should be developed with the help of the school nurse and can also include input from the classroom teacher, school principal, etc. Many things can be listed in an IHCP and it is up to the parents and child’s needs as to what is appropriate.

Some suggestions are separating the IHCP into sections such as: classroom, cafeteria, field trips, recess, specials (ie: art, music, etc.), and so on. Within these sections, the IHCP should list the accommodations agreed upon between the parent of the food allergic child and the nurse/school. Examples might be cleaning protocols for the classroom, specials rooms, and cafeteria, and/or food protocols as well. Will the classroom be free of your child’s allergens? Will your child sit at an allergen free table? These are just some of the questions you need to think about.

The completed plan should be kept in the nurse’s office as well as the main classroom, and in a substitute teacher folder in the event of a substitute. Click here for a sample of an IHCP, but keep in mind it can be formatted in numerous ways.

Section 504 Plan
Section 504 is a civil rights law that prohibits discrimination on the basis of disability. It applies to all institutions, including public schools, which receive financial assistance from the federal government.

“The ED [U.S. Department of Education] Section 504 regulation defines an ‘individual with handicaps’ as any person who (i) has a physical or mental impairment which substantially limits one or more major life activities, (ii) has a record of such an impairment, or (iii) is regarded as having such an impairment.”

Individuals with LTFA often qualify for 504 as the major life activity that is limited is breathing, but there are also other major life activities considered such as eating. A section 504 plan by law does not have to be in writing, however it clearly makes sense to do so and can be formated much like an IHCP. An outline and more information on section 504 for food allergies can be found by clicking here.

Your school district should have a section 504 coordinator. This is the person you would contact to start the process of determining eligibility.

Individualized Education Plan (IEP)
An IEP falls under the Individuals with Disabilities Education Act (IDEA). To qualify for an IEP, the disability must affect learning.

There are thirteen disabilities covered under IDEA in its current form:

  1. Autism
  2. Deaf-blindness
  3. Deafness
  4. Emotional disturbance
  5. Hearing impairment
  6. Mental retardation
  7. Multiple disabilities
  8. Orthopedic impairment
  9. Other health impairment
  10. Specific learning disability
  11. Speech or language impairment
  12. Traumatic brain injury
  13. Visual impairment including blindness

Life threatening food allergies and asthma are typically covered under other health impairment (OHI). Though to qualify for an IEP can be difficult at times as the disability needs to affect learning. Your school district should have a Special Education Director. This is the person you would need to contact to start the process of determining eligibility.

We’ve now covered the care plans. How do you know which is right for you and your child? This depends largely on your child, his/her allergies, how severe they are, and whether your child has any other disabilities.

Remember that at minimum; all individuals with LTFA should have an Emergency Care Plan, or Food Allery Action Plan. This plan will tell parents, relatives, babysitters, daycare providers, etc. what to do in the event of an emergency or severe reaction.

I believe it’s also helpful for adults with food allergies as well, as we sometimes need to be reminded as to what symptoms require an epi-pen. It also helps others in the event that you are unconsious and unable to speak for yourself.

If you feel that your child has no other disabilities, the school has a good sense of how to handle food allergies ie: a set of policies and procedures pertaining to food allergies, and you have a good working relationship with the school; an IHCP may be all that you need. Keep in mind that while it is a written plan, there is a possibility that the school will not agree to all requested accommodations. If that ends up happening, there are very few recourse options. You can possibly file a grievance with the school, but the Office of Civil Rights (OCR) typically does not get involved with IHCP’s. When all parties agree, an IHCP can be put together fairly quickly.

If you find the school resistant to your requests for accommodations or you feel it necessary or comforting for the school to have more “legal” accountability, you may need a 504 plan. Again, while the law states that it does not have to be in writing-it certainly should be. The school still may not agree to all requested accommodations, but at this point you have recourse options through state and federal offices such as OCR. A 504 plan will usually take longer to draft than an IHCP as you first need to submit for eligibility. This is a process and the school typically has so many days to review and respond.

If your child has other disabilities, already has an IEP, or has allergies and asthma so severe that you feel it affects his/her learning; you should be looking at an IEP. Like a 504, there is an eligibility determination process and it can take up to several months from beginning to end. However, an IEP offers children with disabilities the most protection.

Whichever plan is right for your child, keep in mind that it can be a process. Not all schools are created equal and not all individuals truly understand the needs of a food allergic child. What might seem like a perfectly reasonable accommodation to you (like a peanut free Kindergarten class) the school may not agree to. You need to determine exactly what it is you want for your child and how far you are willing to push to get it.

Some schools are very understanding and very willing, while other schools seem to want nothing to do with helping to care for children with LTFA. If you find yourself in that position remember that Life Threatening Food Allergies ARE a disability and covered under disability laws.

Some things you may need:
A detailed letter from your allergist stating your child’s allergies, that they are life threatening (if they are), and any medication requirements. It is best to leave any school accommodations out of the letter as this can sometimes backfire. The school may then require “all” the accommodations you requested be signed off by your allergist. Some allergists are more willing than others to get involved with stating which accommodations are appropriate. Just as with anything in life, not all allergists are created equal. If you have an allergist who is unwilling to work with you on keeping your child safe in school; it may be time to search for a new allergist.

The only exception to this is your allergist recommending a classroom free of your child’s allergens. Some schools will not agree to this unless it is recommended by a medical professional. You’ll want to negotiate other accommodations with the school.

You may also want to print out sample plans for those with LTFA, as well as legal documentation stating LTFA are covered under disability law. While all schools should be on top of this, there are many schools that are just not educated on the subject.

Start the process of developing a school plan on a positive note and know the laws and what you want beforehand. If you find yourself in a difficult position with your school the following websites and information might be of help.

504 plan or IEP: Which is Best

Best Allergy Sites Resources List Links

Managing Life Threatening Food Allergies in Schools
(Massachusetts Guidelines. Other states are also developing their own similar Guidelines)

Office of Civil Rights
(504 plan information)

USDA-Accommodating Children with Special Dietary Needs in the School Nutrition Programs