I recently came across an an open letter, published in the Journal of the American Medical Association, in which a doctor expresses dismay over the glut of junk food his first grader is offered at school.
As someone who’s written a 40-page free guide devoted to precisely this topic, “The Lunch Tray’s Guide to Getting Junk Food Out of Your Child’s Classroom,” as well as a widely-shared “Food-in-the-Classroom Manifesto,” I was of course quite sympathetic to the views of this father, Dr. Sean Lucan, a family physician in the Bronx. Indeed, many of Lucan’s sentiments – such as wondering why other parents are allowed to feed his kid without his consent, or that “treats” cease to be treats if they’re routinely offered – could have been taken straight out of past Lunch Tray posts. (See, e.g., “The Birthday Cupcake Debate Heats Up,” “Sarah Palin and Birthday Sweets Redux” and the many, many other posts in the Related Posts section below.)
But despite being totally sympathetic to Lucan’s distress and supportive of his efforts to clean up his child’s school food environment, two things about Lucan’s open letter took me aback a little bit.
First, I couldn’t help but feel that Lucan was bringing a whole lot of negative judgment to the other parents at his child’s school. For example, in discussing the snacks that parents were sending in as part of the school’s “Healthy Snack” program, two items particularly aroused his ire – Mott’s applesauce and Go-Gurt yogurt – which he describes this way: “It would hardly be a stretch to characterize Mott’s Apple Sauce as a fruit-added corn syrup or Go-Gurt as a sugary blend of suspicious synthetics with a modicum of milk to connote actual fermented dairy.” Similarly, he describes the Goldfish crackers offered in the after-school snack program as “an industrial amalgam of artificial ingredients and refined starch.”
He then scratches his head in confusion over why on earth parents and school personnel would feed his child these foods. He writes:
I gleaned from orientation events at the school that other parents were well educated and quite comfortable financially. Certainly other parents were invested— and had invested—in their children’s futures. Likewise the school seemed dedicated to healthy child development, and teachers and administrators seemed committed to an overall goal of building healthy minds and bodies. Perhaps these well-intended, informed, and well-resourced people just didn’t see the connection between food, education, and broader child wellness?
It’s not that I quibble with Lucan’s description of these highly processed foods, but his confusion struck me as a bit tone deaf or myopic. Because while I don’t want my kid eating Go-Gurt either, I do have a lot of sympathy for school personnel and for parents – even these more affluent, private school parents – who believe they are providing healthy snacks when they select applesauce, yogurt and crackers over the many other options out there.
Forgive me for obnoxiously quoting myself here, but as I tell readers in my free guide (in the section on Best Practices for Advocacy), parents are always better served if they start these discussions by remembering that:
. . . your definition of “healthy” food may differ dramatically from someone else’s. We all have varying levels of nutrition education and our own particular set of nutrition concerns: some parents worry about artificial ingredients or GMOs, for example, while others trust that anything in the food supply must be safe. Every day we read about some new and supposedly better way of eating, whether vegan or Paleo or low-carb or gluten-free, and even the nation’s leading experts can’t seem to agree on the ideal American diet. All of this confusion is compounded by the processed food industry, which is heavily invested in making health claims for its products. It’s no wonder, then, that one parent might pick up a 100-calorie bag of “100% whole grain” Baked Doritos and think it’s an excellent choice for her children, while another might regard it as Satan’s own snack food.
Lucan tells us that he held a “coffee talk” to educate the school population about healthy choices, and perhaps he did approach the group with the requisite sensitivity and empathy when he explained why Go-Gurt isn’t actually a great snack choice. Obviously, I wasn’t there, so I can’t know.
But then there was a second aspect of Lucan’s letter that also took me aback. Because he wants the snacks at his child’s school to be only whole-foods-based, he’s not happy that the school’s “no-nut” policy rules out one possible category of healthy snacks. Therefore he and some like-minded parents:
argued [with the school administration] that the “nut-free” policy has only a small chance of benefiting a tiny minority of students, although science does not clearly support the strategy and experts do not espouse it. Moreover, the cost is an inconvenience to all families and possible nutritional compromise for unaffected students (ie, through vastly inferior chips, crackers, and cookies officially recommended as alternatives and by removing nutritious staples from options available to possibly picky eaters). By comparison, our proposed new policy could benefit nearly all students. . . .
Lucan subsequently wrote a piece for U.S. News & World Report, again urging schools to drop their nut bans in order to allow healthy nut snacks on campus: “When School Food Policies Are Just Nuts.”
I’m certainly no expert regarding the best way to manage food allergies in the school setting, but it seems to me that there’s a categorical difference between removing a nut ban (if that’s indeed recommended by experts, as Lucan asserts) versus the school affirmatively offering all children nut-based foods – even when some of those children are known to be nut-allergic, and when some of them could be as young as five or six years old. Moreover, while Lucan may be correct in stating that exposing kids to nuts more often could eventually reduce nut allergies across the board, doesn’t that justification rather cavalierly dismiss the concerns of kids who already have life-threatening nut sensitivities?
I don’t know the answers to these questions, but I did run Lucan’s argument past Lianne Mandelbaum, the mother of a highly nut-allergic child and an outspoken advocate for families with food-allergic kids. Predictably, she wasn’t too happy with Lucan’s proposal, telling me:
Food allergic parents are well aware that nut free classrooms cannot guarantee 100% safety from all possible forms of cross-contamination. However, a reasonable goal for food allergic children is to reduce their daily risk of a life threatening allergic reaction. Peanut protein is particularly robust and can last up to 110 days. Due to this nature of peanut/nut products, it can be more challenging for staff as well as other children to prevent the contamination of common surfaces in the classrooms, cafeteria, bathrooms, keyboards, etc. Let us remember that children, especially when they are young, often cannot protect themselves. Other children simply may not truly understand the potential dangers of exposing an allergen on another child. Therefore, the responsibility lies with the adults to protect the children that have not developed an adequate capacity yet to protect themselves.
At any rate, I really don’t mean to rake Lucan over the coals here. As I said at the outset, he and I couldn’t be more aligned in our views about classroom and school junk food. I applaud him for taking an active role in trying to improve his own child’s school food environment, and I wish him every success in that effort. And the fact that his child is in an affluent private school, in which the administration has already allowed him to express his concerns with other parents, signals to me that he’s likely to make great strides.
But I’d love to hear your thoughts, too. What do you think about ending nut bans at school to allow these healthy foods in? And have you ever encountered the issue I describe above, in which another parent’s “healthy” snack offering isn’t so healthy at all – but they have no idea this is the case? How did you handle that tricky discussion? Let me know in a comment below.
[Hat tip to Marion Nestle for alerting me to Dr. Lucan’s letter via her Twitter feed.]
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LW says
The CDC has actual guidelines for managing food allergies in schools. They call for allergen-free classrooms. Children with food allergies can be considered disabled (b/c a major life function is affected, i.e. respiration, breathing, circulation), which means they have certain rights including equal access to their education and the right to fully participate. There is no right to send in anything in school to be served to students–not cupcakes (well, except in texas), not nuts. I sure do wish we’d stick to eating in the cafeteria and learning in the classroom. Thanks for your advocacy.
http://www.foodallergy.org/CDC
Bettina Elias Siegel says
Ah, thanks for this info, Lenore.
Yael from "The Anaphylactic Allergy Podcast" says
Perfectly put. Not only that but 504’s dictate many of these restrictions (or bans). Our school district simply doesn’t have enough adults to run around with epipens so they know it protects them too. There is no ban but they do nit sell or serve and keep nuts and other allergens upon need with 504’s out of classrooms for parties and projects. Too many kids, too many possible bullets and not enough adults to protect in case of contact. My daughter is airborne and lives in the real world knowing that although there are signs she is still very much aware that kids bring peanut and nut projects to school so she protects herself. PTSD is also a very real thing. Teachers don’t want to live in fear of having to save lives and no one needs that added anxiety. Schools are too big and risky which is also why many parents home school when the accommodations fail. If the school can not accommodate then the school district could also be found responsible to pay for home schooling for that child or children $$$$$$. Bans allow the kids to go to school, save the teachers and administration close calls, ER runs, potential liability and money. It’s up to the school. Unless this DR. wants to look at the cost of full time nurses and the risks of airborne and contact anaphylaxis he has no business trying to tell anyone how to run a school and protect kids. He’s a Doctor not our Doctor. I trust our school district more than him to keep my kid alive just with this stupid dangerous path he has chosen which is none of his business.
Caroline says
Very good piece. Thank you for taking on this topic. Here is the problem: Lucan nor any of us can make the call regarding nuts. Anaphylaxis is serious life threatening medical condition that is managed by nursing or student health services. Lucan is asking for the equivalent of saying we are wasting our funds on elevators in schools for students with physical disabilities.
I’m saddened that a physician does not comprehend anaphylaxis and the need for schools to reduce risk. Are we becoming so entitled that medical need is not a priority?
I hope he does not have any patients with life threatening food allergies. I fear his lack of understanding could place them in danger.
Thanks again for bringing up this topic. The more we talk, the more we have the opportunity to raise awareness and educate!
Bettina Elias Siegel says
I guess Dr. Lucan would say that bans aren’t effective at preventing anaphylaxis – I couldn’t read his citation for that proposition because it was behind a paywall. But as I say in the piece, removing a ban is one thing (and I surmise you think that’s a very bad idea) while affirmatively passing out nuts seems to be taking risk to another, greater level. Perhaps Dr. Lucan will come by and share his thoughts, but thank you, at any rate, for your comment here.
Lorna says
Let’s keep food out of the classroom. Problem solved.
Bettina Elias Siegel says
You know I agree! (My manifesto advocates for NO food in classrooms.)
Miss Allergic Reactor (Allie Bahn) says
I agree, too! As an elementary teacher and someone who has grown up with anaphylactic food allergies, I try to do my best to leave food out of classroom everything.
Jennifer Haubrich says
I think there’s a danger in thinking that if you know something, everyone else does and that’s what Dr. Lucan has fallen for when he can’t understand how other parents think things like go-gurts are healthy. In reality, busy parents can fall prey to the marketing of “kids’ foods” just as easily as kids can. In this case, I think it is possible to educate without insulting them. It’s unlikely these parents are trying to purposely harm their children with their food choices!
As for the nuts issue, as the parent of vegan elementary school children, I have to admit it would be nice to be able to send nuts in for snack (we are allowed to at lunch), but even if I couldn’t, there are many other times during the day I can find an opportunity to give them an ounce or two of nuts — like breakfast, after school snack, dinner and dessert! I’d never want to put another child at risk for the sake of my own convenience.
By the way, I love your term “Satan’s own snack food”. Hilarious!
Bettina Elias Siegel says
I think you put your finger on exactly what was bothering me, Jennifer: “there’s a danger in thinking that if you know something, everyone else does.” That’s what was coming through to me in Dr. Lucan’s letter (rightly or wrongly) and it just kept niggling at me for days, until I finally decided to write this post even though I really hate to be at all critical of anyone out there fighting the good fight.
And thank you for the kind words! Glad I made you laugh. 🙂
Kim T says
Thank you for understanding that. I’m a vegetarian and know that nuts are a great choice for protein for vegan and vegetarian people – but equally know that kids spend only 6 -8 hours per day at school and have many other opportunities to consume nuts. (Though, like your school, our school did not ban peanuts or tree nuts for lunch – nor did we ever ask them to – we only asked them not to be in the classroom.
Michi Sakurai says
My son is severely allergic to peanuts and tree nuts. His condition is considered a disability and he has a 504 in place at his public school to protect him. Simple procedures are in place like hand washing and no nuts in party foods and definitely no sharing. I think it’s very difficult for people to wrap their heads around a life threatening condition that revolves around something so innocent as a peanut or a healthy almond. I say that bc I too didn’t truly understand until I had my son. He’s young and for young children it’s especially difficult to navigate and understand. It’s sometimes easy for adults to speak for children (like hey, they just don’t have to eat the nuts! easy peasy) but keep in mind they don’t have fully developed minds and not mature enough to handle certain issues and self advocate. And we shouldn’t ask the teacher who is over taxed to keep an eye on all 20 kids and what they’re doing at all times. Luckily my sons class only has 20 kids. I know other people who have 35 kids in one classroom and no paras. But enough about my thoughts. In our school district in Boulder, CO we are blessed to have Chef Ann Cooper, who is a BIG advocate for healthy foods and also a huge change maker in school lunches with her Chef Ann Foundation. She is for whole foods and just about every school in our district has a learning garden. She sources local foods when we can and every school has a salad bar. They also publish an allergen chart for every food served in the lunches. There is so much transparency with the meals that our kids eat in our district. Please take a look at what Chef Ann is up to here in her blog. http://www.thelunchbox.org/ I guess my point is bring back nuts for everyone in the classroom isn’t the only answer to healthy food at schools. It’s easy but not very creative. Nuts alone isn’t going to solve the problems either.
Bettina Elias Siegel says
Thank you for sharing your experiences here, Michi. As a parent of two kids who are free of food allergies, I really appreciate getting the perspective of families who are dealing with this condition. And what a great shout-out to Chef Ann, who’s a good friend of TLT! I’m going to make sure she sees your comment. 🙂
Trish Gavanakar says
Hi!
Thank you for involving a parent of a child with food allergies in your write up! The reality is, food allergies are not going away and the incidence continues to increase. Food allergic children will continue to be in classrooms and they also require a well thought out solution. We can all go back and forth about what the best solution is OUTSIDE of the classroom, but why do we need food INSIDE the classroom?
Kids come home with hours of homework and so much time is wasted on non-educational activities. How about the “treat” be RECESS?? A big factor in approaching this question, has to involve age appropriate restrictions. When kids are yonger, they really do get food everywhere (not just peanuts either, milk/wheat/soy are in most foods). Younger classrrooms really should be striving for food free, at minimum allergen free as suggested by the CDC’s voluntary guidelines for managing food allergies in school.
The doctor was concerned about overall nutrition. Health is heavily reliant on proper nutrition, but I do not think any child’s overall health/nutrition status would be determined by access to a single snack during a school day. Consideration of another’s well being provides children with the framework to become compassionate adults. The deameanor of the “rights of the masses” versus the “safety of a few,” really doesn’t contribute to a long term path of thinking outside of one’s own wishes. As a registered nurse, I challenge myself to consider all points and feel it is imperative that medical providers refrain from using their education to slot disorders that they may or may not even treat.
I think you have written a good piece and have illustrated important points, kids do not need to be plied with sugary, processed food. But children with medical conditions should not be discounted in the pursuit or suggested pursuit of improving the nutrition of the student population.
Jean says
I am both a teacher and a parent of a nut allergic child. I don’t necessarily take issue with the idea of eating in the classroom and having treats. I personally enjoy treating my students once in a while and I know that my students enjoy getting to share a birthday treat with their classmates. But I do find it disturbing that a Dr. would basicslly advocate nuts for all and be so ignorant about the consequences. My child’s right to life does not get trumped by another’s desire to feed their child a food that they can easily eat at another point in their day. And isn’t there an oath that Drs. take that includes “first do no harm”. It seems that advocating for a food that kills others is pretty harmful to me.
MB says
Hi Jean:
I am totally in agreement that nuts are such a dangerous allergen for the few that are allergic that I am fine with a nut ban–even though, nuts are a mainstay of my picky child’s diet and I count on them to give him nutrients I suspect he doesn’t get elsewhere.
However, I ask you as a teacher, to respect that I and many other parents, want to reserve the right to treat our kids. The occassional treat you provide, plus the birthday treats that get brought in approx 3 times a month during the school year, plus the well meaning parents who supply gogurts to the soccer team, plus the after school program that gives out lollipops as bingo prizes, plus the pizza class celebration for being “good,” plus the innumerable other childrens activities that include some sort of “treat”—–IT HAS TO STOP. I can’t keep up. I am a nutrition educator. I run a tight ship at home, nutritionally speaking. Yet I am stymied by all the well-meaning adults who offer kids treats because it makes them (the adults) feel good. And in the end, I often skip out on making homemade cookies with my kids because chances are they were just given a chocolate chip granola bar or juice box.
I am not trying to call you out or flame you. It is just a plea. Think of better ways to “treat” kids.
April Ashby says
There should be NO food in the classroom. Keep it in the cafeteria only. I also think that the potential loss of even one childs life due to anaphylaxis far out weighs the benefit of an entire school getting another healthy snack choice. This physician seems extrely uncompassionate.
Sean C. Lucan says
I am Lucan. Sean Lucan to be precise. Thanks for the thoughts and your passion and work in this area. I suspect we agree more than we disagree. The same is true of experts despite the contention above from your blog. The appearance of uncertainty and disagreement about what is “healthy” is largely an illusion (perpetuated in no small part by the media and food industry). There is actually broad consensus among experts about what is “healthy” (e.g., buff.ly/1SGltef) and I have spoken about “healthy” eating elsewhere if interested (bit.ly/1Ua7CLf).
Regardless, parents have every right to provide their own children with whatever foods they feel are best (no matter what the reasoning). But should *other* parents have the right to provide *my* child with whatever foods they feel are best? (e.g., Go-gurt, etc.) Should the school have the right? (e.g., Goldfish, etc.) This is the issue.
As for nuts, nuts allergies are very serious. And nut bans are the wrong approach to the problem (not supported by evidence or experts — see JAMA or US News pieces mentioned in the blog entry above for references). Bans are harmful for both children with and without allergies:
1. A nut-free policy does *not* protect children with allergy from exposure. For instance, other children may eat peanut butter for breakfast or on the way to school; that persistent allergen may linger on their hands, mouths, and clothing, which can then be transferred to doorknobs, desks, playground equipment, and other school surfaces (and then to other children, if not to other children directly). A nut ban may create the impression that such exposure would not occur and may result in both children and adults being lax in otherwise protective measures.
2. A nut-free policy may harm children with allergy by providing a false sense of security and by not fostering independence in learning how to avoid allergen exposure, or manage it should it occur — life skills that will be vital beyond the protective walls of the school.
3. A nut-free policy is a missed opportunity for children without allergy to learn courtesy, consideration, cooperation, and compassion for those with allergy (e.g., by being responsible about no food sharing, by cleaning surfaces, etc.).
4. A nut-free policy may harm children without allergy when what is recommended instead are ultraprocessed chips, crackers, cookies, etc. (http://snacksafely.com/safe-snack-guide/)
Solutions will vary by grade level and school.
Suffice it to say, the other parents and I are making progress at my son’s school with regard to food more generally. I’d like to thank you for the helpful resources you’ve shared which I will pass on to the administration and shcool’s newly formed committee on food and nutrition.
Very best,
Sean C. Lucan, MD, MPH, MS
Bettina Elias Siegel says
Hi Dr. Lucan, and thanks for coming by.
I agree that you and I are pretty much on the same page when it comes to school junk food, which is why I hesitated for many days before even writing this post. I don’t want to be critical of anyone who’s out there fighting the good fight.
I’m going to let those better informed about food allergies respond to much of your comment here, but I’d like to explore this one statement further: “There is actually broad consensus among experts about what is ‘healthy.'”
I agree completely, but the operative qualifier here is “among experts.”
Precisely because the food industry has sown such confusion (and btw, I used to be a lawyer for a major food and consumer products conglomerate who, among other things, approved front label health claims, so I know how that game is played), there is very little consensus among parents about what is “healthy.” And it’s that lack of consensus which can create difficulties in both addressing and improving the problem of junk food snacks at school. My sense from your open letter – perhaps unfounded – was that because you are an expert, you might have trouble understanding or empathizing with regular parents who lack your particular knowledge about food. That’s what sent up a red flag for me.
But I’m glad you’re making progress at your son’s school and that the resources I’ve created might further your success.
Thanks again for coming by, and I hope we can stay in touch.
Kind regards,
Bettina
Sean C. Lucan says
I have deep empathy for those struggling to understand what “healthy” means. I do not blame other parents who are trying to do their best. I do blame the food industry and the media (beyond the scope here) for confusing some simple truths, and also a system that allows patently unhealthy provision to occur at school. Nobody thinks cupcakes, cookies, candy, and sugar drinks are healthy and yet these items have been and continue to be provided by other parents and the school on various occasions.
Education is key. Policy guidance will be important. In the interim, a good simple rule: “choose food from plants” (the living botanical kind not the industrial processing kind).
One parting point of clarification: I never advocated nuts for everyone. I advocated doing away with nut bans. Schools should allow nuts, not provide nuts (or really any other food for many of the occasions that they currently do).
Bettina Elias Siegel says
Re: nuts – You mentioned the school’s Healthy Snack program, which I understood to be a program though which parents bring snacks for an entire class or grade. So if a nut ban is lifted, couldn’t nuts be given out to all children that way?
And yes, I agree, apart from the considerable confusion over “healthy” snacks, there is just a lot of unequivocally junk-y food that makes its way into our kids’ lives via classroom rewards, parties, etc. No question.
Connie Green says
Dr Lucan,
Nut bans are just one tool to reduce the incidence of avoidable anaphylaxis while at school. Awareness, good hygiene and compassion are also key tools.
I beg to differ on many of your points:
Nut bans significantly reduce the frequency nuts are brought to school, which logically, reduces the risk of accidental exposure, especially in younger children.
Nut bans alone will not keep children allergic to nuts safe. However, combined with other safety measures such as hand washing (before entering classroom, before/after lunch) etc., bans can be very effective in reducing risk.
The “false sense of security” is an old argument against bans, and not particularly valid. Some parents will have a false-sense of security if nuts are banned, however these are the parents that are in dire need of food allergy education (education that is not as yet available when an adult, or child is first diagnosed). And until that education is available, it’s important for school staff and school nurses to be educated on food allergies and to ensure the allergic children have epinephrine at school, and that the parents are directed to nationally recognized food allergy organizations for information and facts.
In this Generation Allergy, teachers are a vital part of keeping allergic students safe, and it is essential they are regularly trained on basic allergy facts. They must be aware that it is possible for an allergic child (or in fact any child or even fellow teacher) to have an allergic reaction at school (whether to nuts, or to milk, or to soy, or even bananas!), and to know how to initiate the school’s emergency response procedures.
Some objectors to food bans also believe that children should learn to navigate food allergies right from Kindergarten, because otherwise they are living in a bubble, because the real world has nuts everywhere. An analogy is saying lets remove school crossing monitors at schools, because having adults monitoring the crossings doesn’t allow children the opportunity to learn how to safely cross the road on their own. This is illogical. In the same way that young children are not capable of crossing roads safely, young children with food allergies are not capable to manage their food allergies independently.
Unfortunately, we are still in the infancy of community-wide food allergy awareness. The true “false sense of security” I have seen in schools is related to a school staffs’ lack of factual understanding on the prevalence, severity and unpredictability of food allergies. This unfortunately often includes school nurses and district medical personnel. For example, nurses often are not aware expert recommendations on anaphylaxis treatment was updated in 2010 to specify earlier administration of epinephrine during allergic reactions, that may, if untreated, result in severe anaphylaxis symptoms.
Many schools truly believe that they are prepared to prevent, recognize and respond to allergic emergencies. Unfortunately, many of these schools only realize this is not the case when the worst situation happens. Parent advocates such as myself are trying hard to educate the community on these changes – but we often come up against people who believe they already know all of the information needed to make an informed decision.
Until our community (school staff, parents, yes, even medical doctors) are brought up to date on the severity of food allergies, the reality of food allergies will not be understood, putting all allergic children at risk. You can find a lot of research regarding the huge gap in food allergy knowledge community wide on pubmed.
Regarding junk food. Parents should always have the final say on whether a food is appropriate or safe for their child (whether allergic or not). Guides such as snack safely are not prescribing these foods be eaten, rather offering allergy-safe alternatives. Allergic parents often prefer having natural, healthy snacks and treats (such as clementine pumpkins for Halloween, vegetables, etc), but there is a *lot* of kick back from non-allergic parents and school staff who believe they should be able to bring high-fat, high-sugar foods to school. Infact, you’ll see that many parent of kids with food allergies want food out of the classroom, and prefer having non-food rewards (such as time with the teacher, etc, etc).
I hope my perspective has given you something to think about. I do ask that you take time to consider promoting healthy food at school from a perspective that also includes kids with food allergies, keeping all students healthy and safe at school.
p.s. In public schools, children at risk of anaphylaxis are often afforded the protection of a section 504 plan, which allows them to have equal access to all school experiences and activities. Sometimes, keeping a child safe and included at school may require restricting foods, especially when children are smaller.
Best regards,
Connie
Susan Kelly says
Dr. Lucan,
I am a mom of a child with multiple life threatening food allergies, as well as an RN. I agree, wholeheartedly, with Connie Green’s outstanding response.
Dr Lucan, regarding your concern that food bans do not help children with food allergies learn life skills such as independence, I once read an allergic teen’s blog who clarified this misconception so well:
School is not the real world. In the real world, kids with food allergies can walk away- they cannot walk away from their classrooms.
Let’s encourage accurate food allergy education & communities of support in our schools- we have a long way to go.
Let’s recognize both of these growing public health concerns- the abundance of unhealthy foods in schools AND the alarming increase of life threatening food allergies.
Let’s find strategies to improve our children’s overall health and well being, while also reducing the risk of anaphylaxis in our schools- we all know nut bans may be a *very* necessary accommodation in certain settings, such as classrooms and early childhood education.
Above all, let’s not add fuel to the fire when it comes to the management of food allergies on the school setting.
These are responsibilities given to us as health care professionals.
– Susan Kelly BSN, RN
Susanne Stark says
Dear Dr. Lucan,
As a parent of a food allergic child, I feel the need to point out that you are not making a fair comparison. Your child wouldn’t have to be rushed to the ER from mistakenly thinking the Go-gurt was a healthy choice or being exposed to go-gurt residue on a desk surface. Let us look at your points one by one.
1. A nut-free policy DOES protect children with allergy. It goes without saying that a nut ban at school greatly diminishes the risk of inadvertent nut exposure. No law, rule or policy will ever bring a risk down to zero. Nut allergy families and teachers will take a nut-free policy any day, rather than guaranteed have to worry, wipe and clean all the time and babysit e-ve-ry snack, treat.
2. A nut-free policy will NOT harm children with allergy by providing a false sense of security. It will make them feel MUCH SAFER and included when not constantly surrounded by allergens that may physically harm them. Please, do not think for those afflicted by food allergy. Really. Do not worry for us. We are not sleeping at the helm with our nut bans. You might imagine that we are but that speaks to your imaginings, not ours. We will STILL foster independence in learning how to avoid allergen exposure and manage it should it occur. We will remind teachers to stay alert and compliant should we detect any false sense of security. We expect others to forget, trust us. We have seen it in action. Meanwhile, we all breathe a little easier with a nut-free policy at school and an epipen in our child’s pocket.
3. A nut-free policy is NOT A MISSED OPPORTUNITY for children without allergy to learn courtesy, consideration, cooperation, and compassion for those with allergy. Any policy is only as good as taught, retaught, followed, policed and sanctioned. The school will have to constantly remind students and families of the policies. I would in fact argue that a nut policy is in fact a PRIME opportunity to teach food allergy awareness, cooperation and compassion. Being made familiar with the policy is the first moment this even gets on the radar of those who didn’t have to think about it. With a nut ban in place, classmates will keep being reminded about the prevalence of severe food allergies, and hopefully compassion, each time their mom couldn’t pack a certain snack.
4. A nut-free policy does NOT HARM children without allergy. Honestly, this is such an unfair argument. If a school chooses chips over fruit, that has nothing to do with nut allergies. Maybe you could join hands with the nut-allergy community and advocate for more non-packaged choices. We are all for it. No label reading, no hidden ingredients or cross contamination concerns. Better yet, join us in asking for snack-free classroom so that children with allergies, diabetes, obesity, Feingold/ADHD diets, religious diets, etc. can all feel safe, honored and included.
In the meantime, if your school isn’t ready to go without snacks and keeps offering the packaged stuff, perhaps YOU could teach your child greater independence — JUST SAY NO to the Go-Gurt and send in an apple in case it is Go-Gurt time again. But still skip the nuts, please. It is the compassionate thing to do.
Your child doesn’t need acute medical care from Go-Gurt exposure. Therein lies the simple difference. This is why nut allergic children are protected under the Americans with Disabilities Act, while your child isn’t safe from Go-Gurt.
Please don’t feel miffed that “these food allergy kids” get their way with the menu. I can assure you that every birthday party, airplane flight, Disney trip, grandparent visit, vacation, sleep over, camp trip, food allergies are a huge headache. Food allergic children have to pass the food all the time, excluded from celebrating the holiday food du jour, eat a lame alternative or nothing, be different, eat alone at the allergy table. What we wouldn’t give for our kid to be able to take a big fat bite of GMO supermarket cake iced with Red 40 and Yellow 5, unworried.
You know that if you had to choose for your child, you would pick a life without food allergies any day. Please, some compassion Dr. Lucan.
Bettina Elias Siegel says
Suzanne – We’re fortunate in that neither of our two children has any food allergies, but if we were parents of severely allergic kids, I think I’d nominate you to be our advocate. Your argument here is extremely well stated.
Kim T says
I agree wholeheartedly with this response. There can be little question that reducing or eliminating allergens in the schools, particularly in the classroom, reduces the risk to the children with anaphylactic allergies. I personally only requested no nuts in the actual classroom (and we made no requests about what students brought in their lunches from home which were eaten in the cafeteria.) But I cannot imagine how any adult, let along an M.D. would think it would be possible for students with allergies to focus on learning when students all around them are consuming foods which could send them to the ER or worse. (For the record, had there ever been students with other allergies in my son’s class, I would have advocated just as strongly that their allergens not be brought into the classroom either.)
The arguments that nut bans limit the food allergic children from learning to advocate for themselves or that they need to live in the real world which will not accommodate them are also very tired ones indeed. These kids learn from very, very early ages how to read labels, ask questions and advocate for themselves – whether they are in schools with nut bans or not! Can you possibly imagine what it is like for a 3 year old to learn to read “nut” on packaging as one of his first words because it literally could save his life? Or what it must be like by age 6 or 8 to come to terms with the fact that a bite of food could kill you? Most of us have the luxury of not thinking much about our own mortality until we are much older – these kids live it every single minute of every single day.
They have to grow up much faster and they already have to miss out on many, many things. What they should not have to ever do is be unsafe at school. What being safe at school looks like is different for all kids because kids mature at different rates and allergies are different. A 3 to 5 year old would probably need many more accommodations than an 11 or 12 year old (we currently have none for our 6th grader.)
I believe we can and do all agree on two points: 1) really, no one – not teachers, not other parents, and not school staff should be feeding our kids things we don’t want them to eat or which could harm them (particularly at younger ages) and 2) that there is much too much unhealthy food being served way too often in schools. An occasional treat is certainly fine (though we might all disagree on both what is an acceptable treat and how often occasional is!).
Perhaps we should all work together to minimize the barrage of cakes, cookies, candy and other so-called treats overall, and to reduce or eliminate food within classrooms. I believe there is much common ground on those points.
But I also would equally beseech you, doctor, to understand that if your school has a nut ban, your family is still welcome to eat them at home and in all of the non school hours.
Sean C. Lucan says
With sincere compassion, I wish you, your child, all children with allergy, all children without allergy, and all their parents nothing but the best.
Dr. Dave Stukus weighed in on Twitter. I think his blog post is superb and says it all: http://bit.ly/1WQn2pe
Best wishes.
Sean C. Lucan, MD, MPH, MS
Harriet75 says
Dear Susan Stark,
I would like to address some issues in your letter.
In your opening you said his child wouldn’t be rushed to the ER from mistakenly thinking go-gurt was a healthy choice or being exposed to Go-Gurt residue on a desk. Guess what many kids with a dairy allergy would. TheGo-Gurt. Gold fish, pirate booty, pizza, etc all pose the exact same risk. Same goes for the kid who is allergic to soy and seeds. We like to replace peanut butter with soy or sunflower butter. That poses the exact same risk to a child who is allergic. So please don’t think this is only about nuts.
1) Your argument that a nut free policy protects kids because “ nut allergy families and teachers will take a nut-free policy any day. Rather than guaranteed have to worry, wipe and clean all the time and baby sit e-ve-ry snack. Treat” REALLY?? With the rates of food allergies being 1 in 13 in the US that means 2 kids in a class can have a food allergy. NOT ALL anaphylaxis food allergies are to nuts, many kids have multiple food allergies. To protect all kids we should be demanding the hygiene more! Not the ban. What you describe is the easy way out and is only thinking about the child with only a nut allergy.
2) A nut free policy DOES hurt kids. Once children are older than kindergarten they need to develop skills. These self-advocacy skills need to be learned early; by 6th grade it’s too late. Children and parents need to take responsibility in their own management. We food allergy parents cannot expect that the world will bend for our needs. Children need to learn that early on, the better adjusted they will be.
3) Why are we running to accommodate only “nut allergy kids” what about all food allergy kids, what about the diabetics? Do you see those parents up in a storm? Do you see them making all kinds of demands? Many kids have issues, sometimes it’s best not to draw so much attention to it and make the child feel as normal as possible.
4) Finally A nut free policy DOES HARM children without nut allergies. Many diabetics have doctor’s notes and requirements. Nuts help regulate blood sugar. Also, for children with other allergies, like milk or egg lunches are hard enough. If the child is able to eat peanut butter, it is a great protein and an easy option. Why should a child with an egg, milk, or wheat allergy have their diet further limited for an allergen that is not their own. They in reality are much more limited than a nut allergy child. Also a side not even fruit is not safe; I manage a case load of 40 kids with food allergies at camp and many kids have anaphylaxis to fruit. Again don’t assume because it’s not a nut its safe!
Again, my child carries his epi pen because something like Go-Gurt would require acute medical care, and while my children have multiple food allergies. I know I can’t take dairy, or their other allergens out of school or the world.
Rose says
I have to agree. That Go-Gurt mistake would likely kill my child who has a contact and airborne dairy allergy. I don’t agree with nut bans unless there is a very good reason for it. If we’re banning nuts because of allergies then we should also ban for other allergens. Eventually, though, you will ban another child’s safe food, or cause an influx of another child’s allergen into the environment. The fruit that people love to talk about as a “safe” food was unsafe for my child for years. I think teaching your child to exist safely in an environment that contains their allergens is the best choice
Meaghan says
My children are in a small, private school because of their allergies. I feel they are better accommodated. I am able to have a voice. Our recommendations, as a family, are welcomed by The nurse and put into place. Not everyone can attend the school of their choice. Everyone should be able to feel safe at school.
I am in shock that a doctor would consider put a child’s life at risk?! Some schools have a part-time nurse. Some schools don’t have a nurse at all. Most children are not capable of handling their allergies. Most children without allergies, are not capable of getting allergens off of their hands, cross contamination issues, etc. Do you have a plan in place for that? We need a nationwide awareness program. Allergies are not going away, they are only growing.
What school hands out food? I would never allow a school to give my child food. There are certain foods that are not allowed in our diets. A lot of them are processed and packaged. Just a choice we made.
Malinda says
Just let him have a year with a kid with food allergies. Where everyday you wonder if they will come home or end up in a hospital because of the lack of caring from the staff. Most of the world today doesn’t have a sympathetic bone in their bodies. All you hear is I want my peanuts/nuts. I feel for my child’s future.
Tisa Monticelli-Fritz says
How unfortunate that a physician with good intentions for healthy lunches completely misses major safety issues with his nut propaganda. Nutrition is one thing but anaphylaxis is scary and very prevalent. Im sure if his child had a life threatening food allergy, he would be singing a different tune. Dr. Lucan’s mentality infuriates me. One of President Obama’s daughters has a life threatening peanut allergy. I wonder if he would express his “nut” opinion in the White House or to the President directly?
mommm!!! says
As harsh as he comes off on his position of nut bans, he’s right in that kids are likely to spread around products like peanut butter products via sticky hands much like they do snot.
I feel for this guy. I remember the rude awakening I went through when I encountered what I considered to be a food atrocity upon being faced with the constant barrage of crap that my child was exposed to at school on a daily basis and looking down the line and realizing that I was in for a life long battle over something as simple as food. Food, up this point in my kid’s life, had been a large source of joy. In one day…the first day of first grade…it instantly became a source of contention that lasted years. I became the mom who was forced to say “no” every five minutes in grocery store now. I get where this guy is coming from.
Fortunately, my kid preferred the taste of actual food over the hyper flavored stuff. I did goldfish sometimes. But when my kid was into those they were a different product. As I watched them start producing gimmicky “flavor blasted” products we wandered away. Which wasnt hard because I didn’t buy them often to begin with. The point is, exposure to these kinds of products isn’t the end of the world. I used those exposures to really teach my child about food, food politics, and giving my kid the opportunity to learn how to self regulate.
Which is exactly what the good doctor thinks children with nut allergies should be learning. So I find his position on both issues hypocritical to be blunt. Somehow, kids with possible life threatening allergens are the only ones that should be held responsible for learning all those life coping skills. Which is something I agree all children should be learning, not just allergic kids.
allison says
Will a nut ban prevent a child with a life threatening nut allergy from having a reaction while at school? No…HOWEVER, it will mitigate the likelihood of a reaction and it’s potential severity. The benefit of mitigation should always outweigh the potential inconveniences that come along with keeping your nuts at home and out of schools. Nut bans reduce nut residue. As the Dr. should be well aware, nut residue (or dust) can cause a reaction if it comes in contact with a mucous membrane (e.g., a child could touch a contaminated surface then rub her nose and have a reaction). Will nut residue coming in contact with a child with a nut allergy always lead to an anaphylactic reaction? Not always (although it could) but it could trigger asthma, hives, itchy eyes, etc….all of which impairs a child’s ability to learn. How is the inclusion of a food product in school ever more important than a child’s right to learn without medical impairment caused by such food??? Alas, while all of the above seems to be so common sense to me, after years of being involved with food allergy discussions, I realize that common sense is not a trait enjoyed by all. Neither is compassion. The good doctor seems to be lacking both when it comes to nut allergies.
Richard says
I find it appalling that a doctor, who is supposed to be a humanitarian, values the inconvenience of most children of not having peanuts for a few hours a day as more important than the lives of the few children than can have a potentially fatal allergic reaction. As a parent who has had to use the epi-pen on his son, I can only imagine that the good doctor must have slept thru all his classes on empathy in medical school.
Harriet75 says
I am the mother of 2 food allergic children; I am also someone who see’s things daily as a teacher, a food allergy coordinator and as a certified asthma educator and food allergy educator. I have been advocating for my kids since they were little. They are now 12 and 9. I am 100% against nut bans, Yup you heard me, I have spoken out very loudly about this and I get lots of flack on the on line community, but the medical and educational community has always supported my views.
While I am sure I won’t reach many of you, please at least read what I have to say before you attack.
Over 150 foods have been identified to cause anaphylaxis. But the top 8 plus sesame are the most common ones to cause reactions. Many think only peanut is the “deadly” one. This is simply not true. Talk to a parent of a kid with a dairy allergy. Dairy is proven to be airborne by steaming, cooking, and powered cheese products. Milk is in every single lunch and snack at schools. Dairy allergy kids, yes even those with contact allergies are forced to survive school every day knowing 100% that their allergen will be present. These children and their parents learn very early on how to adapt in a world surrounded by their life threatening allergen. By USDA law milk must be present in school. What about the child who is allergic to seeds or soy? That lovely replacement for peanut butter could be just as deadly to them. Why is it okay to limit one class of allergens? One out of 8.
Many people think by elimination nuts they greatly reduce the risk of anaphylaxis. The issue is given the fact many people are allergic to many foods elimination of one food does nothing in prevention of anaphylaxis. You are only protecting on group! Schools need plans to deal with all people with food allergies. Nut bans let people let their guard down assuming things won’t have nuts because nuts are not allowed. Nuts still come in, not maliciously but because people don’t know better, nothing can ever be nut free EVER!!
What we need is not bans. We need good hygiene practices, hand washing before and after eating, we need tables to be cleaned. We also need staff to be trained in what an allergic reaction looks like and how to respond. We also need to make sure EPI is always available. Doing what I listed helps protect ALL with food allergies, a blanket nut ban is just the easy way out and doesn’t take the needs of all kids in to account.
Lianne Mandelbaum says
Thank you Bettina for writing this piece. It is rare to find an article about nuts in schools that is kind to food allergy parents, many of whom also care about feeding their children healthy food. While it is my belief Dr. Lucan did not intend to “lock horns” so to speak with food allergy parents, he must realize that this is a direct consequence of his statements.
I don’t need an MD after my name or the citation of a clinical study to argue the obvious fact that a nut free classroom mitigates my son’s risk of having a life threatening reaction in school. Science is fluid and ever changing. I took a workshop on Nutrition and Longevity today for my NJ Physical Therapy license and so many of the guidelines have changed over the years. Sometimes in the absence of good and replicated science, we have to make the right decision, one that is both morally and ethically correct. To quote myself- “To the naysayers, your child is as precious as mine, but food choice is never more precious than a child’s life.
When my Joshua was 4, he had a classmate who had a severe dairy allergy. At the time, Josh was allergic to tree nuts, peanuts, eggs, and was a very picky eater. One of the only healthy lunch foods he ate was organic vanilla yogurt. I never sent this in, nor his favorite dairy snacks, as nothing was worth harming his friend. We talked about his allergy and he actually learned about empathy and tried some new foods.
We not only want to feed our children good healthy fresh foods to fertilize their growing brains, but we also need to teach them compassion and empathy and how to be good citizens. I find this is best taught by example.
Lacy Willey says
Hi Bettina,
http://cspinet.org/nutritionpolicy/healthy_school_snacks.html
This resource from CSPI is a prime example of your quote “. . . your definition of “healthy” food may differ dramatically from someone else’s.” It lists gogurt and Motts applesauce as recommended snacks for kids, two items of his concern that were referenced in the article. I use this excellent list to make suggestions when educating parents and classroom teachers about healthy snacks. I agree that no snacks should be allowed in schools so until that day comes I will continue to do my best educating about “healthy” snacks. We all want to do what’s best for our kids and parents have to start somewhere so remember to keep judgment out.
Keep up the good fight Bettina!
School Foodservice RD
Heather McKenna says
I’m the parent of a child with a severe peanut/tree-nut allergy, and I’ve always been comfortable with our (public) school district’s balanced and rational approach to keeping all kids safe, healthy, and included. Each day parents are to send a fresh fruit or vegetable of their choice for the morning snack, and the parent/child’s choice of lunch. At lunch my food allergic son sits at the allergy free table, which happens to be where he met his best friend (who has many more allergies to navigate than my son). All students wash their hands immediately after lunch before entering the classroom. There are no snacks provided at birthday parties. Instead, parents may choose to send small, non-food treats. I’ve never heard anyone complain.
With this approach the child who wants to eat peanut butter for lunch gets to do so, but away from my child in the contained environment of the cafeteria. That child then gains allergy safety awareness through the routine of hand washing. All of my son’s non-food allergy friends are compassionate and respectful regarding his allergy.
I realize this approach doesn’t remove risk of all possible allergen exposure. Of course it doesn’t. Every time we leave the house there’s a risk for exposure. Every trip to the grocery store, park, even our backyard (where squirrels are constantly scattering walnut shells from some neighbor’s tree) presents possible opportunities for exposure. My job as a parent is to teach my son how to best navigate the dangers.
Brad Aronson says
Hi,
Well written article.
Our son doesn’t have food allergies, but there are friends of his and kids who have been in his classes who could die if they eat nuts. Given that, I think it’s reasonable to avoid nuts in his classroom and lunchroom. Our kid is in first grade, and I could see children accidentally sharing lunches or creating other risks for allergic children. We find plenty of healthy snacks without having to send nuts, which could endanger another child. I appreciate not having nuts in the school, because I’d rather reduce risks to allergic children.
I also think having nuts creates extra stress for parents of allergic kids. If my kid could die from eating nuts, I’d be extremely nervous about him at school lunch time where nuts were served or eaten by others. Kids make mistakes. If we can reduce the chance of a life threatening mistake, I’m all for it.
Thanks for writing your post.
Brad
Sally at Real Mom Nutrition says
I completely agree that one parent’s version of “healthy” isn’t the same as another’s. Case in point: Snack lists requesting only organic fruit. I found the tone of his letter patronizing. To imply that parents who are “educated” and “quite comfortable financially” would somehow be better equipped at knowing what a healthy snack is rubs me the wrong way too.
Gina Mennett Lee says
I don’t want to be repetitive as there are many wonderful responses already from food allergy advocates that I respect. I have written about this topic at length and have posted several blogs about the topic including: “Why Our Classrooms Must Be A Sanctuary for All Children” which can be accessed here: http://bit.ly/1ln1xz4
There are a couple of points that I would like to add to the discussion:
One point is that there is a big difference between a school-wide nut “ban” and allergen-free classrooms. Research demonstrates, consistently, that the vast majority of allergic reactions requiring epinephrine begin in the classroom (not the cafeteria as many would assume). Therefore, if our goal is to reduce reactions, it is logical that if one eliminates allergens (in addition to implementing hand washing and other appropriate measures) we will reduce the number of severe allergic reactions in our schools. Allergen-free classrooms are a common sense measure recommended by the CDC.
Secondly, school-wide nuts bans may be appropriate depending on the needs of the students, and the unique setting of the school. However, a broader, more comprehensive approach is needed to address the needs of all students with food allergies. This approach is what is recommended in the aforementioned CDC guidelines through the development of a district-wide Food Allergy Management and Prevention Plan.
Lastly, I think the doctor makes many excellent, valid points regarding the fact that we should be concerned that children are being fed unhealthy food (frequently), and many times without the consent of their parents or guardians. It is important for Dr. Lucan to understand that the issue of keeping children with food allergy safe at school is not just about the well-publicized nut bans. It is much more complex and requires an open and sophisticated conversation. I think that through discussions such as this, we can find common ground and provide an environment that is healthy and safe for all children, not just some children or even the majority of children, but ALL children. Now, that would really be “Thinking Outside the (Lunch) Box.”
Respectfully,
Gina Mennett Lee, M.Ed.
lindtfree says
One doesn’t need an advanced or professional degree or a six-figure (or higher) income to know about good nutrition: for example, I have read on more than one occasion that recent immigrants to the United States from relatively unindustrialized nations generally have better nutritional habits than USA natives. . .but only until they become acclimated to North American food marketing and eating habits.
There is sometimes correlation between education/income and diet, but it can depend on one’s area of specialization: for example, is an advertising account manager whose agency represents several Big Junk Food accounts going to deny her children snacks that fund their family’s lifestyle? Most likely only by limiting quantities. Is a vegan naturopath going to give his children access to salt/sugar/fat processed foods? Perhaps only at friends’ birthday parties.
I began learning about nutrition at age 13, when my father developed heart disease and my mother, with whom I usually shopped for groceries, started label-reading in earnest. I knew most adolescents didn’t read labels (and still consumed chips, bakery products, and candy myself), but I think I honestly believed everyone acquired label-reading as a skill by age 25, certainly before 30. Becoming a vegetarian at age 20 only increased my label-reading habits, and also forced me to relearn many cooking skills.
Perhaps the easiest lesson for everyone to learn is this: if an edible item is marketed to aggressively or exclusively to children, it’s probably processed junk: therefore, don’t buy it for them.
When I was a child, HFCS “fruit snacks” and processed chicken “nuggets” didn’t exist (the latter were introduced by McDonald’s when I was 15; having experienced significant gastric distress after eating a McChicken sandwich when these were introduced a few years earlier, I wasn’t even tempted!). Fast-food hamburgers, pizza, boxed macaronic and cheese, and frozen dinners were absent from my parents’ early years. For my grandparents, hypersugared breakfast cereal had yet to be invented.
Once they are weaned from breast or bottle, feed your children mashed versions of whatever you’re having for dinner, which is apparently the tradition in many other countries. Avoid “children’s” foods, and chances are you’ll avoid many nutritional problems.