Serving students with food allergies or other special dietary needs in the cafeteria can be scary. Your top priority is keeping the student safe, and sometimes, staff get in the mindset that the safest option is to not prepare meals for these students at all.
There are a few reasons why this isn’t an option.
- You have to. Federal law requires students have equal access to an education, including supplementary programs offered by the school, such as meals.
- Families need it. Many families rely on free, reduced, or low-cost meals provided by the school
- Emergencies happen. Like forgetting their lunch or realizing the food they brought is spoiled, and the school needs to be prepared to provide safe meals in these situations
- School meals rock. We’re proud of our meals and want all students to participate in our program, regardless of what their needs are. Students deserve to experience school meals along with their peers!
Rather than avoid serving students with food allergies, focus on setting processes in place that will ensure you’re prepared to serve them safe meals. This article will outline tips for giving you the confidence to do so!
Understanding Special Diets
To effectively manage special diets, it is important to have a clear understanding of the various dietary restrictions students may have. Common special diets include:
Allergen-Free
Students with food allergies can be allergic to just about any food.
The nine most common are: peanuts, tree nuts, milk, eggs, wheat, fish, shellfish, soy, and sesame. We’ve also had students allergic to strawberries, kiwi, apples, green peas, food dye, ginger, tomato, and so many more.
Implementing allergen-free options and maintaining a clean and cross-contamination-free environment is crucial.
Gluten-Free
Students with celiac disease or gluten intolerance need to avoid gluten-containing grains such as wheat, barley, and rye.
Offering gluten-free alternatives and ensuring food preparation practices prevent cross-contamination are key.
In-Born Errors of Metabolism
While these are considered rare diseases, we’ve seen several students come through our district with one. Examples include PKU, galactosemia, and maple sugar urine disease.
Each of these are caused by a missing enzyme that would typically convert food into energy. If not properly managed, byproducts build up in the blood and can cause muscle spasms, developmental delays, brain injury, and other organ damage.
Strategies for managing in-born errors of metabolism include avoiding specific foods, purchasing therapeutic foods, and tracking specific nutrients of concern.
Texture Modifications
Students with dysphagia – a condition that makes it difficult to chew and swallow safely – may need texture modifications to their school meal. The doctor will prescribe a specific type of modification, which are outlined here.
You’ll need a blender or small food processor to get the right consistency. If beverages need to be thickened, you will also need to purchase a thickener, like Thick-It.
Have a Plan
Ideally before you ever get your first request, you should have a plan in place for how you will receive and process requests and implement accommodations.
Here are some questions you should ask yourself when developing this plan.
Will you be developing a specific form?
While doctors can submit a request on a prescription pad or on letterhead, the USDA requires specific information to be collected under certain circumstances, which doctors don’t automatically know to include. Therefore, many districts require a form to be completed.
Will all requests need to be signed by a medical authority?
If the meal pattern is unaffected by the meal modification, the USDA doesn’t require a medical statement; however, schools are allowed to require one to be completed.
Many schools choose to require a medical statement to ensure accuracy.
Who will receive the requests?
Many districts designate one person to receive and process the requests. Having one person manage this piece helps facilitate communication with parents, cafeteria staff, nursing, etc. It’s also good to have one person that becomes an expert on the topic!
How quickly will you process the request?
Give yourself a deadline for how quickly the request will be processed, such as within 24 hours or 3 business days. This is helpful to communicate to families so they know not to expect meal modifications the same day they submit it, which I’ve had happen!
What will you do if clarification is needed on the medical statement?
If you have follow-up questions about how to implement the doctor’s orders, the USDA states that you cannot delay providing a meal accommodation. I would lean on the side of caution and provide only foods you are certain are safe and relax those restrictions later if the doctor’s clarifications permit you to.
For example, with an egg allergy, some students only need to avoid eggs in their whole form (scrambled, hard boiled, omelets, etc.) and some need to avoid anything made with eggs (pancakes, breaded chicken patties, etc.). If we got a medical statement that said “no eggs” with no other instructions, we would restrict this child from getting anything made with eggs until we got further clarification.
What are the next steps after deciding how the request will be implemented?
You’ll want to outline what the next steps you’ll take to ensure everyone is informed and prepared.
Here are some steps I take:
- Notify the cafeteria manager of the need for an accommodation. Train if it’s a new modification for that school.
- Notify the parent of the modifications that will be made.
- Enter a flag on the student’s account with any instructions for the cashier
- Enter the student’s information into a spreadsheet to better track the accommodations
Communication and Collaboration
Establishing effective communication channels with parents, school staff, nurses, and students is crucial. Consider implementing the following practices:
Informing Parents How to Request a Modification
You must inform parents of their right to request meal modifications.
One way you can do this is at registration. For example, you could include information regarding meal modification requests in a printed packet or include a link to a webpage for online registration.
You can also include this information in student handbooks. `
Informing Parents of the Procedural Safeguards
USDA also requires you inform parents of their right to examine their records and file a grievance if a request is not granted.
We put this information in a few places:
- Within information distributed at registration (along with how to make a request)
- On the form we use for meal modification requests
- Within the letter sent to the parent communicating the decision
This notice must explain to the parent their right to:
- File a grievance if they believe a violation has occurred regarding the request for a reasonable modification
- Receive a prompt and equitable resolution of the grievance
- Request and participate in an impartial hearing to resolve their grievances
- Be represented by counsel at the hearing
- Examine the record
- Receive notice of the final decision and a procedure for review, i.e., right to appeal the hearing’s decision.
Sample language: Parents/guardians have the right to file a grievance if they do not agree with the accommodations provided or believe a violation has occurred. The parent/guardian also has the right to a prompt and equitable solution of the grievance. The parent/guardian should contact the School Nutrition Central Office at [phone #] to discuss the matter. If after contacting the School Nutrition Central Office the concerns are not addressed, please contact the district’s 504 Coordinator at [phone #] to request an impartial hearing, where you have the option to be represented by counsel. Parents/guardians have the right to examine records pertaining to the request. To do so, contact the School Nutrition Central Office at [phone #]. Upon conclusion of the hearing, you will receive a notice of the final decision and will have the right to appeal the hearing’s decision.
Communicating with Nursing
Nursing often receives information from parents at registration regarding students with food allergies and other special diets.
Get with the nursing department to arrange how information will be shared between the two departments.
In my district, the nurses at each school consult with the cafeteria manager to see who is missing on each other’s lists. Then, the nurses reach out to families to explain the documentation needed.
Meal Planning and Preparation
With a well-thought-out approach to meal planning and preparation, you can create an inclusive cafeteria environment for students with food allergies and other special dietary needs.
Identifying Allergens
When you have a student with a known allergen, you’ll need to read through all the food labels to identify which foods contain the allergens.
Even if you don’t have a student with a food allergen, it can be helpful to know which foods contain which major allergens so that you’re prepared to provide meal accommodations quickly.
Sound like a daunting task? Hire a dietitian to do this for you.
Menu Labeling
One approach to assisting families is labeling menu items with information about common allergens and dietary restrictions. For example, some menu planning software programs will allow you to mark items that contain allergens and students and parents can then filter by allergen.
You can also label items on the line with their name and which allergens they contain.
This will help students make informed choices and prevent accidental consumption of restricted ingredients.
Allergen Separation
Depending on the allergen, it may be easier to isolate foods that contain the allergen, or it might make more sense to isolate a specific child’s food.
For example, if you make peanut butter sandwiches, you would want to isolate the peanut butter.
- First, don’t allow the jars of peanut butter to touch any other food in the stock room.
- Then, only use peanut butter in one designated prep area in the kitchen.
- Also, have designated utensils that are used only for peanut butter.
- Next, clean and sanitize those utensils and work surfaces separately from all other dishes. Wash them last!
- Lastly, keep those designated utensils in a designated area (we put them in a zip top bag) labeled and separate from other utensils.
However, if the child’s allergy is to wheat, it would be very difficult to follow this approach and isolate all wheat-containing foods. Instead, isolate that child’s food. Prepare that child’s food separately and use clean, designated tools just for that child.
Ingredient Substitutions
Finding alternative ingredients for students with food allergies or other diets is key to inclusivity.
While the federal law doesn’t require the school to match the menu exactly for students with special diets, it’s important to have a handful of special ingredients you can substitute for those students.
For example, for our students with Celiac’s disease, we carry a few gluten-free items, such as bread/buns, chicken tenders, corn tortillas and penne pasta. Then we try to create a dish for the student with those ingredients that is similar to what the other students are having.
- When the menu lists spaghetti and meat sauce, we substitute gluten-free penne with meat sauce.
- When the menu lists tacos or fajitas with wheat tortillas, we make theirs with corn tortillas.
- If the menu lists a cripsy chicken sandwich, we will make a chicken tender sub using GF tenders and GF hoagie buns.
You don’t need to find a substitute for every allergen-containing item, but having some versatile ingredients on hand is important for ensuring they feel included and don’t burn out on the same foods.
Training and Education
Conduct regular training sessions for cafeteria staff to enhance their knowledge of special diets, food allergies, and safe food handling practices.
Topics should include:
- Processes for families requesting a special diet
- What to do while a request is being processed
- Types of dietary requests and how to accommodate
- Cross-contamination prevention
- The importance of following recipes
Collaboration with Food Suppliers
Partnering with reliable food suppliers is essential to meet the diverse dietary needs of students.
Supplier Communication
Communicate your school’s requirements and ensure that suppliers understand the importance of allergen-free, gluten-free options.
Also be sure to write into contracts that you reserve the right to buy off contract. This allows you to run to the grocery store for supplies if the vendor is out of stock or the kitchen forgot to place an order.
Ingredient Verification
Manufacturer’s often change product formulations with little notice to its customers.
Therefore, you need to regularly review ingredient lists and nutrition labels provided by suppliers to ensure compliance with dietary restrictions.
Whoever your designated person is for handling special diets should make it a habit to regularly read nutrition labels in storerooms to ensure your allergen lists are accurate.
Summary
Equipped with this knowledge and a solid plan, you can ensure that students with food allergies and other special dietary needs are safely included in school meal programs.
