Food allergies can make a visit to the cafeteria a harrowing experience for a child, but the staff of the Cumberland County Schools food and nutrition program are working to help make lunch a safer and more pleasant experience for children with food allergies.

"It takes a lot of forethought and planning, especially at the school level," said Kathy Hamby, school nutrition supervisor. "If students want to eat in the cafeteria, they'll [cafeteria managers] go out of their way so they can eat in the cafeteria."

The Centers for Disease Control states that even a tiny amount of allergy-causing food can cause severe reactions, including life-threatening anaphylaxis. Researchers estimate  up to 15 million Americans have food allergies, and about 1 in every 13 children under age 18 are affected. Numbers are rising, with a 2013 study released by the CDC finding food allergies among children increased about 50 percent from 1997 to 2011. Eight foods account for 90 percent of all food reaction. They are milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish.

There is no number of how many Cumberland County students have food allergies, but Hamby said there are 30 who have allergies severe enough to warrant meal modifications. These include students with severe peanut allergies to those who cannot ingest milk and dairy products, who are intolerant to gluten or who cannot properly digest proteins. 

"We're seeing more of the gluten allergies," Hamby said. "We also have those who cannot have even trace amounts of dairy."

For these students, cafeteria managers work with parents to develop menus that will be similar to what the student's peers are eating that day, but replace items that could be life-threatening for the student to eat. For example, many vendors offer gluten-free versions of foods, and a switch to whole-grain breading has made breaded chicken safe for those who are lactose intolerant. 

A form helps to determine dietary restrictions and the family and staff members work with physicians to determine food to be substituted. 

Hamby noted there were actually only 12 students the school system is required to provide alternative foods for, but the staff has taken on the special needs of the additional students, as well. The schools may make meal modifications for the other students, but it is not required.

When cooking, the cafeteria staff often has to plan ahead to accommodate the special dietary needs of students, putting aside a portion of taco filling, for example, before adding tomatoes to offer lunch to those with tomato allergies.

Each school has a book that lists the ingredients for each food item served. 

"Several people have the label books," Hamby said. The department has a four-week cycle for school lunch menus, and once that is developed, the food labels are placed in the book according to date. It even includes ingredient listings for condiments.

"It depends on the food allergies," Hamby said. "Sometimes we'll set up special meetings with parents and the school nurse to go through the foods. We've actually provided a label book to some parents who's children have severe food allergies."

The food and nutrition staff will also mark out items on the menu for common food allergies for easy reference. 

"We try to serve food that is as close as possible to what all the students are having for the day," Hamby said. "If they can't they'll try to pull something that is easy to substitute and keep everything else the same."

Food allergies have led to six schools in the county discontinuing use of peanuts or peanut butter. There may still be trace amounts of peanut as an ingredient in other items, Hamby said, but soy-based items have replaced peanut butter. The soybutter pockets were phased in at many of the schools.

"I don't want to say we're completely peanut free, but we've eliminated using anything with peanuts or peanut butter in it in the cafeteria," Hamby said. 

Schools who have tried to eliminate the use of peanuts and peanut butter are Crab Orchard Elementary, Brown Elementary, Martin Elementary, Homestead Elementary, North Cumberland Elementary and South Cumberland Elementary. 

Some of the alternative foods can increase costs for the nutrition program. So far, Hamby said the department has been able to absorb those costs without the need for additional funds. Vendors are beginning to offer more and more items that can help to meet these special dietary needs for students.

"We have to purchase from special vendors to meet some needs," Hamby said. "For some, there is not an alternate food. All the food is specially formulated. We also have access to a lot of gluten-free products, which is helping to meet these needs."

Many times, students with food allergies or sensitivities know what they can and cannot consume. Items that may be problematic are offered separately. For example, cheese is not on hamburgers, but provided with the fixings, and broccoli has the cheese sauce on the side. Those who would like cheese may request it as they go through the line. Free water is offered during breakfast and lunch, as well as juice, for those who cannot drink milk. 

"Many students just avoid certain foods and they're OK," Hamby said. "We try to help those students by just offering items."

Another option is vegetable juice daily. The sweet potato-based juice is blended with fruit juice to make it more appealing, Hamby said. 

With these options, Cumberland County Schools' cafeterias can better meet the nutritional needs of students with dietary restrictions.

Heather Mullinix is assistant editor of the Crossville Chronicle. She covers schools and education in Cumberland County. She may be reached at hmullinix@crossville-chronicle.com.

Assistant editor of the Crossville Chronicle.