Tuesday, April 15, 2008

Who is responsible?

Recently a group of parents, in an attempt to make their children feel better, have decided the best course of action is to ban foods from the schools and classrooms. I have written a response (below). I would love an email from each of you with respect to how you feel on this issue (even if you don't agree with me). Especially you Dr. Mintz!

Best Regards,

Alex

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Dear AFN Members,

With a Petition entitled: "Petition to Revise Acton Public Schools' Wellness Policy" you might think it harmless to endorse such a petition. I do not. The people who have endorsed this letter do not.

The petition asserts in the first two paragraphs:

In order to protect our children with life-threatening food allergies, juvenile diabetes, celiac disease and to address the overall health of all students, we ask the administration and Acton School Committee to make changes to the current Wellness Policy.

As it stands, policies regarding the use of food in classrooms are determined by individual principals, teachers and PTO’s. In addition, the culture of food in the Acton schools excludes many children, while putting their health at serious risk.


I appreciate the earnest efforts of these committed parents who are doing what they think is best. Unfortunately, I think their efforts also constitute an unreasonable intrusion into the lives of children who are not their own. From the tone of these paragraphs it would seem the petitioners are under the impression that many of us in the community are either (a) uninformed; or (b) not able to help our children make good food choices when they are outside of our direct supervision.

On the issue of protection of children with life-threatening food allergies. I am very sympathetic to the issue. I had asthma and allergies as a child and that put me at the highest risk for death from anaphylaxis.

Not being able to breath is, from my own experience, one of the most terrifying experiences you can have. It is scary when it is happening to you, and from the looks in my parent's eyes, it was just as scary for them when they realize they could do very little for me other than seek medical attention. It is also scary for the other children around you.

That being said, outside of the youngest grades (daycare and preschool) where children are prone to put things in their mouths unexpectedly, eliminating the source of anaphylaxis does not make sense. Education as opposed to elimination is the best defense for children against death from anaphylaxis. From my earliest memories, I always knew I was allergic to eggs and milk. I also always knew I should not eat things that could not be guaranteed to be free of eggs and milk.

My parents helped me take responsibility for my own safety no matter what environment I happened to be in. It is the same reason that my wife and I taught our children to swim at a very early age. We will not be able to control where they go in life, but we can make sure that it is very unlikely they will drown in a pool.

The story of the last child to die in Massachusetts of an anaphylactic reaction to food is especially sad. As reported on CNN, Brenton Schivley was always very careful about what he ate -- until September 1, 2007. On that day he was at a friend's house and took a cookie from a bowl on the kitchen table.

He took a bite of the cookie and he said to his friend, 'I shouldn't have eaten that.'
Severely allergic to peanuts, the 16-year-old from western Massachusetts made the dire mistake of not asking about the ingredients. Within minutes he developed a severe allergic reaction to the cookie, which contained peanuts. Within an hour, he was dead.

"He should have asked [about the ingredients] but he didn't," his mother Caryl Schivley reported.

Experts say people with severe food allergies should always carry self-injectable epinephrine, a form of adrenaline usually carried in a small device called an Epipen, in case of accidental ingestion of an offending food. However, the study found that the majority of those who died did not have epinephrine administered in a timely manner.

After eating the cookie, Brenton took an over-the-counter antihistamine but that didn't help. His mother said the Epipen that Brenton normally carried in his backpack was not with him.

Knowing he was in danger, Brenton called his mom. She raced to him with his injectable epinephrine within four minutes, but she estimates at least half an hour had elapsed since he had eaten the cookie. He had collapsed on the sidewalk by the time she was able to administer the epinephrine. "We called the ambulance and they could never revive him," his mom said.

The "sooner these reactions can be treated with epinephrine, the more likely you are to have a good outcome," said Dr. Hugh Sampson, director of the Jaffe Food Allergy Institute at New York's Mount Sinai School of Medicine, and a study co-author. Sampson likens an allergic reaction to a "snowball coming down a mountain." At the top of mountain it's small "but by the time it gets to the bottom of the mountain it becomes huge."

For those with food allergies, vigilance about food preparation is essential to staying safe.

The last child to die in Acton (1997) was a teenager who was allergic to milk and ate something she shouldn't in her own home and then went to practice without her epipen.
In my opinion people urge us to make accommodations around food, only because it seems like something we can actually accomplish. What about the Acton children who have anaphylaxis when stung by bees? I don't see this mentioned anywhere in the proposed wellness policy changes. Is animal induced anaphylaxis any less deadly? Why not simply get rid of bees and wasps in and around the school zones.

The bottom line is that you can't control what your child will be exposed to over their lifetime. You can start early and often to reinforce how they should deal with their own allergy. The good news about Anaphylaxis is that it is highly treatable - [ see http://alexhorovitz.com/Anaphylaxis.pdf ]. The risk that a parent looses a child to allergy induced anaphylaxis approaches zero as long as we as a community know how to spot the symptoms and provide prompt medical care.

The Food Allergy & Anaphylaxis Network - the most vocal advocacy group for food allergy sufferers - actually recommends against food bans because they lead to a false sense of security. If eating a particular food can kill you, you should simply be taught that you shouldn't eat anything given to you by others until you are old enough to sort these things out yourself.

As for the supposed "Culture of food" you cite as exclusionary, what evidence do you have that this is actually causing children to feel excluded? I know, from first hand experience growing up, at events where food was involved I could not eat foods that contained eggs or milk. As it turns out, if you've never had cake (or insert any food here) you don't actually miss it. How could you? Could it be that you are projecting your own feelings of exclusion onto your children unnecessarily?

Wouldn't it be better to help your child cope with these feelings of exclusion? Afterall, there is a high likelihood they will be stuck with their allergy for the rest of their life. In my opinion, as a parent of an allergic child, you should be encouraging your child not to place a great deal of emotion in not being able to eat something they are allergic to.

Why do you want to deprive other children of their ability to enjoy something they are not allergic to? Put another way, why shouldn't we assign the lowest grade on a test to every student? In this way, no child would feel excluded simply because they could not do something (say math or english) as well as the other children in the class.

I think your proposal is a slap in the face to all of the School personnel who work tirelessly to provide the best educational environment for our children. Trusting our schools and teachers to make good decisions about the day to day education of our children, even when we might not personally agree with every individual action, is something we as parents who choose the public schooling option must learn to live with.

Life is about choices. There is no such thing as a universally bad food. For different people different foods can lead to different outcomes. AND, as you might recall, what we learn about food is constantly changing. Do you remember how surprised researchers were to find out that transfats were a much bigger problem than the actual fats they were engineered to replace (again because we felt those fats were harmful).

In so much as we are all trying to raise healthy children, I think that your petition is unnecessary. In so much as allergic children need to take responsibility as early as practicable for the implications of their particular allergy, your petition is counter productive. Perhaps a greater level of trust in our children's natural ability to do the right things is all that is needed.

I think most parents in this town are responsible enough to handle their own children's dietary needs without additional rules foisted upon them. If you are someone who still feels that your child needs this type of monitoring with respect to food and nutrition, I would highly encourage you to consider the excellent home schooling options available here in Acton ( http://www.voyagersinc.org ).

I would ask AFN members not to sign onto this seriously flawed petition to revise our wellness policy.

Best regards,
Alex Horovitz
7 Jefferson Drive
Acton, MA 01720

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