Special dietary requirements for medical reasons are becoming more commonplace, so it’s essential school kitchens are up to the challenge.
Catering for special dietary requirements for health reasons can be a minefield for school caterers and something that must be navigated with caution. And so it is vital that schools invest in training to ensure that all members of staff understand exactly what they are dealing with, whether it’s an allergy, intolerance or a disease which dictates a child’s diet.
Food allergies have the potential to be fatal, so its essential schools have a strict protocol in place. According to the National Institute for Health and Clinical Excellence, 5-8 % of children have a proven food allergy, with up to one in 55 children having a peanut allergy. This means that every school is likely to have at least one child who has a severe allergy requiring an adrenaline auto-injector.
An allergy is the response of the immune system to foods and other substances that are usually harmless. In the case of people with allergies to foods, their immune system identifies them as a threat and produces an inappropriate response such as a rash, wheezing and itching, even to the smallest trace of the food.
Anaphylaxis is a severe and potentially life-threatening allergic reaction affecting more than one body system such as the airways, heart, circulation, gut and skin. Symptoms can start within seconds or minutes of exposure to the food or substance and usually will progress rapidly. On rare occasions there may be a delay in the onset of a few hours.
Although unpleasant, food intolerances are completely different from food allergies. Food intolerances are more common than food allergies and the symptoms tend to emerge hours after eating the problem food.
The NHS describes a food intolerance as difficulty digesting certain foods and having an unpleasant physical reaction to them. Symptoms include bloating and stomach pain. This doesn’t involve the immune system and is never life threatening like an allergy.
Coeliac disease is a lifelong autoimmune disease caused by an abnormal reaction when gluten (a protein found in wheat, barley and rye) is eaten by individuals predisposed to the disease; it is not an allergy or a food intolerance.
“The gluten causes damage to the lining of the small bowel and also results in production of IgA antibodies to tissue transglutaminase in the blood,” explains Norma McGough, Coeliac UK director of policy, research and campaigns. “Detection of these antibodies and damage to the lining of the small bowel which can be detected by endoscopy with biopsy are both used to diagnose coeliac disease.”
Coeliac disease is common with a prevalence of one in 100, however, only 24% of the one in 100 are currently diagnosed in the UK. A gluten-free diet is the only medical treatment for coeliac disease.
School can be the first time that children with special dietary requirements are eating without their parents present, which can be an anxious time for all involved, including the ones giving them food, the school caterers. With children starting school at the tender age of four it’s essential that caterers clearly flag up all foods that they know pupils need to avoid.
“A close relationship between schools, their catering staff and parents is paramount,” says Julia Kitchenham, allergy aware scheme officer at Allergy UK. “A conversation needs to take place prior to the beginning of term and the child’s dietary needs shared with the school catering manager. This could be via a face to face meeting, email conversation or a phone call, but should be followed up in writing for future reference by the parent and caterer alike.”
A food matrix is a great way to collate information and should be updated regularly with any change of supplier or recipes. This document should be readily available to all staff in paper and electronic format. The Food Standards Agency (FSA) has a free template that schools can download for convenience.
“Clear communication about free-from or gluten-free choices to consumers is key at any age,” says McGough. “Caterers need to have accurate information about the gluten status of food from the ingredients, the preparation and through to the serving of the food. For children in school, Coeliac UK provides information for both caterers and parents about gluten-free provision.”
Schools have a duty of care to ensure the wellbeing of every child which means following the care plan of a child with a medical issue to the letter. Safety measures include regular dialogue between catering staff and teachers as well as parents and carers about each child’s specific dietary requirements.
“Appropriate measures should be followed every day to check their meals and the area in which they eat,” says Lynne Regent, chief executive of the Anaphylaxis Campaign. “We also encourage schools to adopt a culture of awareness to help children know how to keep their friends safe; for example, by being discouraged from sharing food and encouraged to wash their hands.”
Ensuring that each child is catered for safely means that school catering teams need to be diligent in their approach. This usually takes the form of a highly visible list of children and their individual food requirements.
“We have pictures of all the children with special dietary requirements printed up next to the serving hatch,” explains Jenny Wright, catering manager at Grove Park School. “There are four members of staff serving so there are essentially four checkpoints. We always check deliveries carefully, particularly if they substitute anything.”
When it comes to catering for children with special dietary requirements it’s not just the ingredients within the dishes that school caterers need to careful about, but the preparation of them too.
“Having a dedicated preparation space and equipment is an important precaution that will help to minimise the risk of cross-contamination,” says Marie Medhurst, director of Bannisters Yorkshire Family Farm. “It’s sensible to go even further, creating separate sections in store rooms and freezers.”
In an ideal world, segregated preparation areas would be perfect, but in reality school kitchens are limited on space so caterers need to ensure their hygiene standards are impeccable when it comes to catering for pupils with medical conditions. Composing documented procedures of processes to ensure the safety of children is essential.
“There are several areas that are important to consider for successful gluten-free production,” says McGough. “These include making sure caterers know the right ingredients to use and that they are using reputable suppliers, ensuring ingredients and finished dishes are stored correctly to avoid cross-contamination and cross-contamination risk controlled at all stages of preparation, for example using clean oil for frying, clean water for boiling, and clean surfaces.”
It’s entirely possible to produce a range of gluten-free meals with few changes to menus. Many dishes will already be gluten-free, but if they aren’t, there are simple swaps such as corn flour instead of wheat flour that can easily be made.
“If you are preparing meals in advance, it is a good idea to make the free-from meal first,” advises Kitchenham. “Bear in mind the risk of contamination if you are using toasters, dishwashers, deep fryers etc. If possible, have a separate toaster for gluten-free, make sure dishes are rinsed before going in the dishwasher and consider not only the oil you are using, but what you are frying in the oil.”
Also, your freezer is your friend. Individually portioning meals for people with special diets means that you always have something to hand. Manufacturers are catching onto this need too. Central Foods has recently launched individual portions of cooked, gluten-free penne pasta, which are also dairy free and suitable for vegans and vegetarians.
“Cross-contamination within the kitchen is reduced because each portion is individually wrapped, with zero wastage,” explains Gordon Lauder, MD for Central Foods.
“Food producers have really risen to the challenge and created a range of tasty products that are suitable for those with allergies and intolerances. This makes it so much easier for busy caterers to serve up nutritious meals for youngsters with specific diets, as well as removing some of the worry providing such dishes can naturally cause.”
Spreading the word
Educating all staff on the importance of food safety in school kitchens is of paramount importance, so thorough training is essential for every member of the catering team from checking the ingredient supply right through to preparation and serving.
“At least one member of staff in a kitchen should have received training, they can then become the ‘go to’ person for any related issues as well as being able to supervise the preparation of any free-from dishes that need to be made,” says Matt Cull, development chef at Brakes. “The FSA offers free online courses, so there is no excuse.”
With school numbers swelling there could be multiples of children whose special dietary requirements need to be catered for, so to help ensure all staff in the kitchen are confident when it comes to trigger foods it’s a good idea to create visual aids as a back up.
“These can include large wall posters or menu cards,” suggests Aine Melichar, senior brand manager for Kerrymaid. “School caterers could also consider creating a reference guide for individual pupils. This guide can be completed by parents or carers and should detail the foods children need to avoid, their full name, class and a photo. The reference tool can then be made easily accessible to teachers, cooks and the dining room attendants.”
It’s important that members of staff are not only aware of each child’s individual medial needs, but provide foods they want, too. Making children feel included in the decision making around their food will avoid the feeling of exclusion and ensure there’s always something on the menu they will like. This has never been more important than since the introduction of Universal Infant Free School Meals, as every child in Reception, Year 1 and Year 2 is entitled to a free school meal no matter what their circumstance.
“Schools should make sure staff are aware of which pupils have any medical issues in relation to food and also speak to them to find out their likes and dislikes so they are well catered for,” says Sarah Robb, channel marketing manager at Premier Foods. “Staff must understand the importance of being positive, empathetic and patient when speaking to pupils about their requirements.”
In fact, the best way to make all children feel included is to give them all the same thing. There’s no reason why children with certain food allergies need to eat something different to their peers when a dish could be made allergen-free for all to eat. Thanks to the 2014 European legislation on food allergen labelling, the issue of food allergies has been brought to the attention of every food manufacturer and there are now thousands of products that have been made specifically free from certain allergens.
For example, Tideford Organics has created a new Tomato + Basil Soup with Red Peppers + Miso, the first organic FODMAP-friendly accredited soup in the UK.
FODMAPs are certain carbohydrates and sugars found in some popular foods (onions, cow’s milk and honey are common examples) that researchers now believe are responsible for many of the uncomfortable and often debilitating symptoms of IBS. It is packed with Vitamin C, and like the rest of Tideford’s range, it’s organic, vegan and gluten-free, with no added sugar.
There’s no denying that catering to a range of special dietary requirements in schools has its challenges, but as long as caterers are well informed, expertly trained and diligent in their approach there’s no reason why all children with allergies, intolerances and coeliac disease can’t enjoy a healthy school lunch with their peers.
Allergy Awareness Week
Allergy Awareness Week, which runs from 23rd April to 29th April, aims to raise awareness of people living with allergies. The Allergy UK website has a schools section, which contains information for schools as well as for parents/carers of pupils. It also has developed downloadable tools to take schools through a seven-stage process to facilitate whole school allergy awareness, management of allergy, as well as what needs to be included in policy and procedures.
Allergy UK has an extensive collection of free-to-download factsheets on various allergens including the ‘Guide to Food Allergy for Caterers’ on their website allergyuk.org. Advice and guidance is also available via the Allergy UK helpline on 01322 619898.
Coeliac UK Awareness Week
Coeliac UK Awareness Week, which runs from 14th to 20th May, will be celebrating the charity’s 50th anniversary – which surprises many as they think gluten-free has only been around for a few years!
Coeliac UK has developed a framework for gluten free accreditation in the catering sector and online training on gluten free catering, which can be found on its website www.glutenfreetraining.org. For further information and advice call the helpline on 0333 332 2033.
Coeliac disease – the facts
• Coeliac disease is not a food allergy or an intolerance but an autoimmune disease caused by a reaction to gluten.
• Gluten is a protein found in the grains wheat, rye and barley. Some people with coeliac disease are also sensitive to oats.
• Gluten is also found in many favourite foods such as fish fingers, sausages, gravies, sauces, stock cubes, soy sauce and even in some chocolate.
• Gluten-free food can be contaminated by food that contains gluten during preparation. Sources of contamination include breadcrumbs in toasters and on bread boards, utensils used for spreading and spooning jam, butter, chutney etc onto bread and from cooking oil and water.
• Coeliac disease is a genetic condition and runs in families. Studies show that if someone in a family has the condition, there is a one in 10 chance of a close relative developing the disease.
Courtesy of Coeliac UK coeliac.org.uk.