Friday, August 20, 2010

Ainsley's 504 Plan

I met with the nurse, counselor, and all three kindergarten teachers today to go over the final version of the 504 Plan/IHP we hammered out in the Spring. I was extremely pleased with the way the meeting went - they were all warm and friendly and wanted to see a picture of Ainsley, know what typically happens when she has an allergic reaction, and what we usually do when it happens (they know to give her Benadryl and, in some cases, the Epi-Pen, but it was wonderful to have an opportunity to explain how an allergic reaction usually manifests in Ainsley and precisely what I do in those situations). Ainsley's teacher was happy to receive my bag full of 12 weeks' worth of individually-packaged snacks for her. They also liked the bright red insulated bag I bought to keep Ainsley's Epi-Pen and Benadryl in for the classroom (the nurse will have a set of Epi-Pens and some more Benadryl in her office too).

So here are the important parts of the 504 plan that I wanted to share with everyone. I am not pasting the entire thing because it is very long and some parts simply describe Ainsley and her health history, etc. Here are the important parts:

SCHOOL ACTIONS

-Perfect Measure Children’s Benadryl x 2 will be in the insulated bag in the classroom and in the clinic.

-Epi-Pen Jr. Dual Pack x 2 will be in the insulated bag in the classroom and in the clinic.

-Home supplied safe snacks will be kept in the classroom and in a freezer in the cafeteria (e.g., cupcakes in case a child's parent sends birthday treats for the class).

-Home supplied lunch box will be kept separate from other children's in the classroom.

-The school will send out a district letter to the entire class informing of student’s allergy including recommended snacks.

-The school will provide a safe environment in the classroom through education of food allergies and its effect [the first week, the nurse will show the Alexander the Elephant movie to the class and talk to the kids about food allergies, no sharing food, etc.].

-The school will provide a designated table adjacent to a regular table that will be cleaned by assigned staff prior to schedule lunch time. Cleaning will be with “Break Up” a high level cleaner that breaks up protein, animal fat and grease.

-The child will sit in a designated seat at the end of the table with students peanut/nut-free sitting around her.

-Student or teacher will carry the insulated bag with Epi-Pen and Benadryl so that it will remain with her at all times.

-HVAC in the clinic will maintain constant temperature year around from 68°-78°.

-Nurse or teacher will provide hand washing education to the class at the beginning of the school year.

-Student will wear a medical alert bracelet.

-Procedure to follow for field trips: (a) Teachers will notify the school nurse in advance of all field trips. (b) Arrangements will be made with parent, nurse, and anaphylactic trained staff to ensure student’s supplies accompanies the student to the event. (c) A copy of the student’s Quick Reference Emergency Plan will accompany the trained staff.

-Training for school personnel: Student’s teachers and other staff employees will receive annual education regarding the student’s allergy. This includes general information, signs and symptoms of anaphylaxis, administration of Benadryl and administration of epinephrine, Universal Precautions, resources available when questions/problems arise, and emergency measures. All staff members who will have direct contact with the student will receive a copy of the Quick Reference Emergency Plan. In addition, the student’s teachers will receive a copy of the IHP. This training will include substitutes/ IHP in the substitute folder when assigned to the classroom.

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As you can see, the plan is pretty detailed and I am very happy with it. I take no credit for it - it is pretty much word-for-word the same as that of a peanut-allergic child going into the second grade whose mom revolutionized the school in terms of making it food-allergy friendly.

A couple of things about the plan: (1) It states that Ainsley will eat a separate snack from the other kids. The school has one child bring in snacks for the whole class each week. The school is sending out a "safe snack list" to parents of her classmates that lists only snacks that are safe for Ainsley. I thought about allowing her to eat the snack another kid brings in as long as it's on the safe snack list, but then I got nervous about it and decided that, for now, Ainsley will eat her own snack regardless of whether the class snack is also safe for her. Right now I'm too antsy about the possibility about ingredients changing/teacher accidentally giving her something that's not on the list/etc. Nevertheless, I am thrilled the school is sending out the safe snack list I sent them because that means that, at least most of the time, the class snack will likely not contain anything Ainsley's allergic to and therefore her allergens won't be spread around her classroom (they eat snacks in class).

(2) I also contemplated allowing her to sit next to anyone, not just kids who don't have peanuts/tree nuts in their lunch. But then I got nervous again and decided to play it really safe this semester and see how things go. Thankfully, Ainsley's best friend is in the same class as she is, and I bet they will want to sit together every day, so there's one kid I can count on who won't have peanuts/tree nuts in her lunch. Note that Ainsley is NOT sitting at a peanut/tree-nut free table. Her table will be cleaned with a special cleaner that breaks up food proteins, but she will be sitting at the same table as kids eating peanuts/tree-nuts (and eggs and milk). But she will be sitting at the end of the table so she will only be sitting next to one child and across from one child. The teacher will check the lunches of those two children to ensure they are peanut/tree-nut free.

(3) You might also notice that the plan specifically provides that the nurse's clinic will be temperature-controlled at all times. Unfortunately, the classroom won't be. That is why I bought an insulated container for the medication we'll keep in the classroom.

(4) Another important part of the plan is the provision for the training of substitute teachers. My greatest fear is that a substitute will accidentally give something to Ainsley that she's allergic to (like a snack, birthday treat, etc.) Thankfully, Ainsley is very aware of her allergies and I feel confident she wouldn't accept anything like that from a substitute. Still, I wanted to ensure that the substitute knows about Ainsley's allergies. So, under the plan, the staff is to notify the nurse before the start of school that a substitute is in Ainsley's classroom. The nurse will then make sure the substitute knows there's a child with food allergies in the classroom and will train him/her on how to administer emergency medication, including the Epi-Pen.

Any questions/concerns/suggestions? Please let me know! This has been a real learning experience for me, but so far I'm thrilled about how it's turned out.

Monday, August 16, 2010

Getting ready for Kindergarten!

Just wanted to post a quick note to let you know that allergy planning for Ainsley's first day of Kindergarten is well under way. She starts on Monday, 8/23, so right now I'm busy finalizing a letter to the parents of kids in her class complete with a safe snack list, confirming with the nurse how many Epi-Pens/how much Benadryl I need to bring to school, thinking about what sort of safe snacks I will buy to stock in Ainsley's classroom in case the class snack isn't safe for her, etc. We will have our second 504 meeting to finalize the plan this week (not sure when yet). I feel so much calmer about this than I thought I would. I think it's because Ainsley really is ready for Kindergarten, and is mature enough to take on some responsibility for keeping herself safe. I am very excited about how she'll like Kindergarten and about all of the new friends she'll make!

Monday, August 2, 2010

Loosening up

For about three years, we have been in "lock-down" mode in terms of allowing Ainsley to eat food outside of our house. Ever since her last severe allergic reaction in a restaurant (Mothers' Day 2007, when she was 2.5 yrs old) I have refused to let her eat anything at any restaurant except for the cheese-free pizza at my favorite local pizza place, the smoked meat at one of our favorite bbq joints, and a few select things at McDonald's (plain hamburger or chicken selects and apple dippers w/o the sauce), Wendy's (hamburger or kid's chicken sandwich and fries), and Burger King (fish patty or chicken fries and onion rings/french fries/apple fries). The one exception to our ban on other restaurant food is if a restaurant has fresh fruit or corn chips (we live in Texas so at least once every couple of weeks we'll go to a Mexican restaurant and have never had a problem with the corn chips).

Now that Ainsley is 5 and is very good at telling me as soon as she thinks she's having an allergic reaction (usually itchy mouth is the first indicator), I have begun loosening up a little. When we were on vacation in Michigan, I allowed her to eat a cheese-free pizza from a place that assured us their crust was safe for her - thankfully, she loved the pizza and had no problem. I am also allowing her to eat McDonald's chicken nuggets now because even though they contain a slight bit of milk, they don't cause any allergic reaction (this is per my allergist's recent advice that we can start introducing certain cooked/baked things containing very small amounts of milk or egg).

This weekend we introduced a new restaurant to her - Papa John's Pizza. Dave has a love of Papa John's that goes back to his college years, when he discovered he could get bacon (not Canadian bacon - real bacon) on a Papa John's pizza. He introduced me to it in law school, and for years our favorite road-trip food was bacon and pepperoni Papa John's (delivered to whatever cheap motel room we were staying in).

Now that I'm feeling braver about trying new things with Ainsley, I had him check to see if Papa John's crust was safe for her, and low and behold, it is - the thin crust contains milk but the regular crust does not. We ordered a small cheese-free pizza for her with bacon and mushrooms and she went to town on it.

I can't express how liberating it is to be able to give Ainsley new kinds of restaurant foods. These good experiences have encouraged me to talk to other restaurants to see if there are things at other restaurants that are safe for her. She loves trying new things and we love seeing her life is get a little bit more normal.