Tuesday, April 27, 2010

Does Your Food--Allergic Child Qualify for a 504 Plan?

A parent of 2 food-allergic kiddo's shared an interesting tidbit with me the other day, of which I was not previously aware.

If your child has a history of anaphylaxis to a food allergen, he/she may be a candidate for a 504 plan, which creates a specific plan outlining the accommodations that may be needed in the school setting to ensure that the student with a disability (in this case, severe food allergy) is not excluded from the full educational resources available to other children due to his/her disability.

From the Department of Education website: Section 504 is a federal law designed to protect the rights of individuals with disabilities in programs and activities that receive Federal financial assistance from the U.S. Department of Education (ED). Section 504 provides: "No otherwise qualified individual with a disability in the United States . . . shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance . . . ."

Many parents of food-allergic children already meet informally with teachers and school administrators to discuss their child's food allergy, and how best to ensure safety in the learning environment. For the most part, especially for children with milder food allergies, this is sufficient.

However, for those children with a history of anaphylaxis to commonly encountered foods (especially those for which the risk of cross-contamination is high, and which cannot be easily excluded from the school environment), parental anxiety about proper precautions and procedures in the event of a reaction is understandably higher. Even when the relationship with school staff is cooperative and non-adversarial, having a detailed 504 plan in place can be beneficial for all involved, as it puts into writing a legal document which details appropriate educational measures for all individuals involved in the affected child's education. This document can provide guidance regarding everything from bus transportation issues to the provision of a "peanut-free" computer keyboard.

Obviously, creating a 504 plan is an involved process, and is not appropriate for every food-allergic child. But, if after discussion with your child's physician, you determine that your child needs the accommodations provided by a 504 plan, it can be helpful to approach the school with some of the "homework" already completed. As a parent, you are an integral member of the 504 plan team.

To that end, I've discovered an excellent resource created by a mother of a child with severe food allergy, based on research of 504 plans compiled from around the country. This is an outline of a 504 plan which addresses many of the issues facing food-allergic children in the school setting. It is, of course, not intended to replace medical advice, nor does the author claim that is is fully comprehensive. However, it is a formidable effort, and is likely to be very useful to you as you work with your school to ensure that your severely food-allergic child has a safe and healthy learning environment. Here's the link (on the allergysupport.org website): http://allergysupport.org/index.php?option=com_content&task=view&id=16&Itemid=1

Saturday, April 24, 2010

Thursday, April 22, 2010

Warnings About Volcano-Related Respiratory Problems May Have Been Premature

Eyjafjallajokull (ay-yah-FYAH-lah-yer-kuhl). Say that five times fast!

No matter how you pronounce it, this volcano has been in the news and in water-cooler conversations around the world. It has affected travelers, governments, and reportedly, even a rhinoceros who got stuck en route!

On Friday, the World Health Organization issued a warning for patients in Europe with asthma and other respiratory problems, claiming that the ash cloud released by the volcano could be "very dangerous" for them due to the abrasive and corrosive nature of volcanic dust particles.

However, they have since toned down this warning. The tiny particles of volcanic ash which are most likely to cause these issues are still very high up in the atmosphere- too high to cause significant problems for individuals on the ground (except in the immediate vicinity of the volcano). A low-pressure weather system expected over Iceland later this week may push the ash cloud towards the Arctic and prompt rain which may further "wash out" the ash. With any luck, the fine particles of volcanic ash capable of causing severe respiratory issues will never make it to the ground in highly populated areas.

In the meantime, it is important to keep in mind that volcanic ash particles are probably less toxic to our lungs than the small particles from traffic pollution and HVAC systems. So, in honor of Earth day... less fretting about what Mother Nature has done to us, and more fretting about what we have done to Mother Earth!

Thursday, April 8, 2010

Should Smoking in Passenger Vehicles be Banned?

The dangers of environmental tobacco smoke (ETS) have been well-documented. Environmental tobacco smoke has been associated with increased risk for not only asthma and ear infections, but also with meningitis and sudden infant death syndrome. Young children are particularly susceptible to these ill-effects. The risk is not limited to second-hand smoke, however. Third-hand smoking occurs when an individual is exposed to an environment in which someone has been, but is not currently, smoking.

Quoting from the Pediatrics article "Beliefs About the Health Effects of 'Thirdhand' Smoke and Home Smoking Bans" by Jonathan P. Winickoff, MD, MPH et al: "Research has documented the association between smoking in the home and persistently high levels of tobacco toxins well beyond the period of active smoking. These toxins take the form of particulate matter deposited in a layer onto every surface within the home; in loose household dust; and as volatile toxic compounds that 'gas' into the air over days, weeks, and months."

Knowing this, the Royal College of Physicians in the United Kingdom has called for a smoking ban in vehicles. The goal is to protect children, who are unable to advocate for themselves when riding in cars in which adults choose to smoke. I couldn't agree more! As parents and physicians, we have a responsibility to advocate for the health of all children, who don't have a say in whether they are exposed to the damaging effects of ETS. They are completely dependent upon the decisions we make, and permit others to make.

Without an outright ban on smoking, we cannot legislate what happens within the home. However, there are municipalities within the U.S. that have proposed classifying smoking in a vehicle carrying minors as a secondary offense, meaning that although a police officer cannot stop you for smoking, they can cite you for smoking if you are pulled over for another reason. It's a start, but this only addresses the risks of second-hand, and not third-hand smoke. (Anyone who's stepped into a taxi where the cabbie had been recently smoking knows where I'm coming from.)

Perhaps I am in the minority, but I view ETS as a child-endangerment issue. Given the documented risks of third-hand smoke and the exquisite susceptibility of young children to it, why should we tolerate anything less than a ban on smoking in vehicles altogether? Of course, there are those who argue that such a ban would be an affront to personal liberty.

My argument: why should your "right" to smoke trump your child's right to breathe clean air?

What do you think? In the United States, could a ban on smoking in vehicles ever be enforecable?