504 Plan Roadmap for the Accommodation of a
Student with Celiac Disease

A resource created by the National Foundation for Celiac Awareness (NFCA)

This roadmap is not meant to be legal advice nor definitive resource. Rather, it is insight into this process and should be adjusted for individual circumstances.

Section 504 is part of the Rehabilitation Act of 1973, and applies to all institutions receiving federal financial assistance, such as public schools. Under this law, public schools must provide a free appropriate public education and not discriminate against disabled students.

This law acknowledges that the disability may not require special education services but a plan is needed to ensure the student receives an appropriate education accommodating the disability within the classroom. This law must accommodate a special diet, including a gluten-free diet, the only known treatment for celiac disease.

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STUDENT INFORMATION

• Name of the Student
• Name of Student’s Parents
• Date of Birth of the Student
• Grade of the Student
• School Child Attends
• Name of the School District
• Date of the Current 504 Meeting
• Date of the Next 504 Meeting

504 TEAM INFORMATION

• Child’s Parents and contact information
• Primary Classroom Teacher
• School Nurse
• 504 Coordinator
• School Counselor or Psychologist
• Director of Foodservices or Cafeteria

BACKGROUND INFORMATION

What is celiac disease?

Celiac disease is a hereditary autoimmune disease that damages the villi of the small intestine and interferes with absorption of nutrients from food. What does this mean? Put simply, the body is attacking itself! Celiac disease is triggered by consumption of the protein called gluten, which is found in wheat, barley and rye. When people with celiac disease eat foods containing gluten, their immune system responds by damaging the fingerlike villi of the small intestine. When the villi become damaged, the body is unable to absorb nutrients into the bloodstream.

What is the treatment?

The only treatment for celiac disease is a 100%, life-long gluten-free diet, which means avoiding all forms of wheat, barley and rye. A special caution must be given to oats, which in their natural form do not contain the gluten protein. However, most fields where oats are grown and mills that produce and store oats also manufacture wheat, barley or rye, resulting in crosscontamination. Current research shows that the majority of patients with celiac disease can tolerate oats in their pure, uncontaminated form. It is important that oat consumption be limited to oats with one of the following labels: “pure, uncontaminated oats, ” “gluten-free, ” or “certified gluten-free oats.” It is recommended that oats be introduced under medical supervision and slowly.

Despite these restrictions, people with celiac disease can eat a well-balanced diet that consists of healthy and delicious foods. Even though it may seem impossible to maintain the diet at school, these simple guidelines will ensure that your child has the best possible experience throughout their school years.

OVERVIEW OF THE CHILD’S CONDITION

• History of celiac disease of child:
  • Year of diagnosis
  • Amount of time on a gluten-free diet
• Basis for the determination of the disability:
  • Refer to letter from doctor/physician initiating 504 plan
• Disability that affects a major life activity:
  • Restricted diet, gluten-free
• Child’s developmental level and needs:
  • Self-reliance for the student in managing their diet and disease. This fluctuates individually and developmentally. Some indicators of a child’s readiness: The student is always able to visually recognize the allergen in all its hidden forms or part of another food (starch, malt, play dough, etc.). __________Yes _____________No
  • The student is always able to read labels for gluten.
    __________Yes _____________No
  • The student is always able to verbally communicate body discomfort associated with a reaction.
    __________Yes _____________No
  • The student always knows to wash his/her hands well with an approved soap and warm water before eating
    . __________Yes _____________No
  • The student always knows to eat only food brought from home. (If arranged)
    __________Yes _____________No
  • The student always knows not to trade food with classmates and adults.
    __________Yes _____________No o
  • The student always understands how a safe food may become cross-contaminated with gluten.
    __________Yes _____________No

GOALS OF THE 504 PLAN -examples

1. Adhering to all aspects of the 504 Plan to avoid gluten.

2. Assisting the child to maintain a stable physiological state void of gluten reactions through preventative measures.

3. Recognizing the signs of a reaction and treating it promptly in all school contexts.

4. Striking a balance between safety and social normalcy, providing the same opportunities and conditions as the child’s peers, and offering encouragement to the child.

5. Encouraging open and on-going communication among adults about food intolerance issues and doing so discretely and in the appropriate forum.

PART F: FOOD ALLERGY EDUCATION, AWARENESS & REACTION PREVENTION

The basic question to be answered and discussed in this section: What kind of training needs to take place to promote education, awareness and reaction prevention in the school context? Types of Education, Awareness and Reaction Prevention:

• Label reading.
• Proper hand washing.
• What is cross contamination and how can it be avoided?
• Effective table and desk washing with appropriate chemicals and materials
• Positive role modeling (Example: A positive role model would not make statements to parents and students such as, “We cannot have a holiday party because of “Suzy” Celiac and her food allergies.” A positive role model would say, “We are going to have a holiday party and we will make it fun and safe for everyone.”)
• Promotion of positive self-esteem for child with celiac disease .
• Promotion of peer support for child with celiac disease.

COMMUNICATION MANAGEMENT

A plan should be made for communication amongst those on the team and possibly include a provision for parents to be included in all communication about this subject. The most important conduits in the communication management plan will between the parents and the school cafeteria or food provider and the parents and the homeroom or primary teacher. A communication plan should be available in the event a substitute is covering a class.

CLASSROOM MANAGEMENT

• Parent and teacher will work together to monitor classroom events that may include the use of food.
• An alternative to using food treats for students’ birthdays can be selected.
• Class activities using envelopes will be minimized and child reminded not to lick any envelope/stickers in class.
• Student should be allowed bathroom privileges when necessary.
• Student must be careful with use of the following materials for classroom projects or completely avoid their use: play dough, paper mache, fruit loops and cheerios and other gluten containing food, pasta, flour, paste, envelope and stamp adhesives. Hands and surfaces must be completely washed after the use of these materials. Parents will provide a list of alternative materials if the class plans to use any of these materials.
• The teacher will communicate with parents about upcoming projects that may require alternative foods or materials.

Nurse or Medical Department

• Faculty and staff training regarding the plan.
• Provide presentation and or information to staff and class on celiac disease and the gluten-free diet.

Art Room

• Food will not be distributed in the art classroom.
• Products commonly used in the art room will be reviewed to determine that they are gluten-free. Any changes in art products will be communicated prior to instituting the change. (e.g. paper mache and play dough)
• Student must be careful with use of the following materials for classroom projects or completely avoid their use: play dough, paper mache, fruit loops and cheerios and other gluten containing food, pasta, flour, paste, envelope and stamp adhesives. Hands and surfaces must be completely washed after the use of these materials. Parents will provide a list of alternative materials if the class plans to use any of these materials.

Food Services

• Food handling procedures that introduce gluten-free foods and prevent cross contamination are essential. The National Foundation for Celiac Awareness has a training program in place for schools called GREAT Schools. More information can be found by visiting: www.CeliacLearning.com.
• Assimilation: A goal of this is to assimilate the child into the regular structures of the school.
• Separate is often unequal and kitchens are encouraged to have students on a gluten-free diet have the same choices as other students, just gluten-free • It is the parent’s responsibility to review food and approve items
• The kitchen then is responsible to appraise parent of changes
• Some options tried by other schools:
• All side items are gluten-free
• One day a week one entrée is gluten-free but available for everyone.
• Bring in quick items to substitute: hamburger buns or pizza crust.
• Parent and Food Services will work together to arrange procedures when student is ordering school lunch or bringing food from home that will require heating in the cafeteria. (e.g. warming in the oven on a separate foiled cookie sheet).

Field Trips

Teachers will communicate to parent if food will be provided as part of field trip. Parent will determine whether food is gluten-free and/or provide student with a safe alternative. Parents will have the option of keeping a child home if no provisions can be made without penalty to the student.

Some other topics to be considered in this section:

• Safety snack box provided by the family to be kept in classroom
• Birthdays
• After school events such as pizza night consider utilizing one of the many companies now providing gluten-free options: Zpizza, Godfather’s Pizza, Garlic Jims.
• Holiday parties
• In case of reaction: access to bathroom.
• Emergency kits: If your school has kits for emergencies or evacuation, then what supplies will be provided for those on a gluten-free diet and by whom?