My 7-year-old son has confirmed peanut a

Answer

I'll load the family-allergies skill file first to make sure my answer follows the right playbook for school planning.

Let me pull the school card and the action-plan template, That file was not generated this turn — the draft above is what I have.

The clinician-signed Allergy Action Plan (AAP), not the school's general intake form, is the document that drives the response — so bring a current AAP from his allergist or pediatrician to the meeting and ask the school to file it as the operating plan, with their form only carrying the roster information.

Below are answers to your five questions, with the hard limits stated up front.

**What I won't do here**
The AAP itself is a medical document filled and signed by the prescriber — drug name, dose, timing, second-dose trigger, and trigger signs all stay in his doctor's handwriting. The same goes for any device dose box (his weight and brand settle the dose exactly, not me). State-by-state US school-stock-epinephrine law varies; I won't recite any.

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## 1. What a school food allergy EAP should containMost standard school forms cover the roster side (name, allergens, parent contact). The clinical side usually needs to be added as the doctor's AAP. A complete plan covers:

| Section | What it should say | Why it matters |
|---|---|---|
| Identifying info | Name, DOB, current photo, weight, grade, classroom | Photo lets a substitute teacher recognize him in seconds |
| Confirmed allergens | Peanut + tree nuts (specific nuts if known — almond, cashew, walnut are common; coconut is usually not a tree nut for this purpose but the allergist decides) | Cafeteria and party-food decisions hinge on this |
| **Mild vs. anaphylaxis signs** | Skin-only (hives, flushing) vs. multi-system (throat, breathing, vomiting, pale, dizzy) | The plan must distinguish so a school nurse doesn't "wait and see" through a real reaction |
| **First-line treatment** | Epinephrine auto-injector, brand, dose, when to give (per the AAP) | Antihistamines do not replace epi |
| **Second dose rule** | When to give a second device (typically around 5 minutes if no improvement) | Schools sometimes leave this off |
| **Position** | Lie flat with legs raised; sitting on the floor if breathing is hard; never stand or walk | Standing/walking during anaphylaxis has killed kids |
| **Call local emergency services** | "Immediately after epi, before parent" — every plan, no exceptions | This is the #1 thing schools sometimes omit |
| **Asthma co-management** | If he has asthma, epi first, reliever inhaler second | A child with food allergy + asthma is higher risk |
| **Hospital observation** | At least ~4 hours after epi | Biphasic reactions can recur |
| **Field trips, recess, PE, parties, food crafts, bus** | Same rules apply off-site | Substitute teachers and bus drivers must be looped in |

When the school form comes back, check that each row above is filled or attached. If the school's form is missing the **second-dose / "call emergency immediately" / position** rows, ask the nurse to attach the clinician's AAP instead of leaving those blanks.

## 2. Who needs to know

Anyone who is alone with him — and anyone who feeds him. Practically:

- **Homeroom teacher and every specialist who teaches his class** (PE, art, music, librarian)
- **Substitute folder** — the folder a sub grabs on a sick day must include his photo, allergens, epi location, and the AAP
- **School nurse / health office**
- **Cafeteria staff and the lunch-period monitor** — peanut-free table decisions live here
- **ecess and before/after-care staff**
- **Front office** — they often cover the health office and they field parents and deliveries
- **Bus driver** (especially for field trips)
- **Field-trip chaperones** — written copy, not just a verbal mention

One person at the school should be the **named point of contact** (often the nurse) — ask for that name and write it on your copy.

## 3. Where the two epinephrine auto-injectors live

This is the most-leveraged decision. Two patterns work; **a single pair locked in the nurse's office is the weak option** — the child is often across the building when a reaction starts.

- **With him, immediately accessible** (in his backpack in a pocket the teacher knows, or on his person if the school and he are comfortable) — the carrying pattern that current US guidance favors, because most reactions happen outside the health office (cafeteria, PE, recess, parties).
- **One backup in the unlocked health office** as the second device, in-date and logged.

The plan must live **with the device**: every AAP should be stored next to the epi it describes, not in a separate binder. Storage conditions matter too — epinephrine auto-injectors are kept at roughly room temperature (15–25 °C); don't let the school store one in a hot bus, a freezing car, or a staff fridge.

> **Two expirations to write down before day one:** the expiration on each device, and the date the AAP was last reviewed by his doctor. A device expiring mid-semester with no replacement lined up is the gap that closes silently.

## 4. What to actually say at the first meeting

Bring one of each epinephrine auto-injector (or the trainer), the AAP, and a one-page summary. Then walk the staff through these, not "in case something happens":

- **What a reaction looks like in him specifically.** His prior reaction at age 5 is the script — fast onset, what started, what came next. Every child presents differently; the plan should reflect his pattern.
- **The4-hour clock.** After epi, he goes by ambulance to the ED and stays roughly four hours. This isn't optional.
- **Demonstrate the device.** Many school staff have never practiced on a trainer. Ask each person who will be alone with him to do one practice injection on the trainer in front of you. This is the single highest-leverage ten minutes of the meeting.
- **Show the steps out loud, in order.** Epi → call emergency → lie flat, legs up (sitting only if breathing is hard) → stay with him → second device at 5 min if no improvement → parent. No standing or walking to the office.
- **Antihistamines do not replace epinephrine.** A common school reflex is Benadryl first. State this out loud.
- **If he has asthma: epi first, reliever inhaler second.** Another reflex to head off.
- **Who calls emergency.** The school, not you, because you may not be reachable. The nurse's office dials; the office staff dials; the teacher dials — somebody dials in the first sixty seconds, every time, no "let's see how he does."
- **Biphasic reaction.** Symptoms can come back hours later even after he seems fine — that's why the ED keeps him.

## 5. ed lines — the things to insist on in writing

These are the items school forms most often leave off. Ask for each in writing:

1. **Epinephrine is the first-line treatment, not antihistamines.** No "give Benadryl and watch" step in place of epi for breathing or multi-system signs.
2. **Call local emergency services immediately after epinephrine, before calling the parent.** Don't wait to see if symptoms resolve.
3. **Second dose at roughly 5 minutes if no improvement or symptoms worsen**, per the AAP.
4. **Position: lie flat, legs raised; sitting on the floor if breathing hard; never stand or walk.** In writing.
5. **If he has asthma: epi first, reliever second.** In writing.
6. **Auto-injector travels with him** to PE, recess, cafeteria, field trips, and the bus — not left in the nurse's office while he is elsewhere.
7. **The AAP is filed with each epinephrine device**, and a copy goes in the substitute folder.
8. **Every adult supervising him can name his allergens, the epi location, and the four-step sequence** (epi → emergency call → position → stay). The school attests in writing that training happened.
9. **Substitute teachers are held to the same standard**, not handed a folder they can ignore.
10. **Field-trip and party-food policy:** shared food and unlabeled bake-sale items are not allowed in his classroom or at his table. Birthday treats, food crafts (play dough with peanut oil, wheat paste), and cultural-food lessons go through you first.
11. **No "may contain peanut / peanut-free facility" marketing language as a substitute for reading the actual label** on packaged items. Voluntary "may contain" is not a safety verdict — your son's signed AAP governs.
12. **Post-seizure, biphasic, or two-device event: hospital observation for ~4 hours**, per the AAP.

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## Before the first day, a short checklist

- Two in-date epinephrine auto-injectors; one with him, one in the unlocked health office
- Current AAP, signed by his allergist/pediatrician, with his photo and current weight
- Expiration dates written on a single page for the nurse
- A 1-page summary the sub folder can hold (photo, allergens, epi location, four-step sequence)
- A practice injection on the trainer with each adult who supervises him
- A named point of contact at the school and a backup
- Cafeteria and recess staff briefed; bus driver briefed; field-trip policy in writing

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**Honest limits of what I just gave you.** I described the contents of an EAP from published guidance; his AAP is the document the school actually follows, and his prescriber is the one who fills the dose, timing, and trigger columns. US state laws on stock epinephrine, unlicensed assistive personnel administration, and 504/IHP accommodations vary by state and district — the school nurse and the district's allergy policy are the doors for those questions.