Child nutrition program practices and self-efficacy of menu planners associated with meals for children with food allergy in California schools

Child Nutrition Programs in schools in the United States provide healthy, safe, affordable meals for a diverse population of children every school day. The USDA requires the menu for children with food allergies to be modified with no additional meal reimbursement. Food allergies affect up to 8% of children in the U.S.; eight allergens (milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat) account for over 90% of allergic reactions in susceptible individuals. The purpose of the study was to assess self-efficacy of child nutrition program menu planners in California schools who design and implement menus for children with food allergies. Also identified were menu planning protocols used in the accommodation process, self-reported menu modification frequency, and cost perceptions to produce meals modified for children with food allergies. A two phase data collection included an electronic Delphi panel (n=16) and general survey (n=212) to menu planners for children with food allergies at California public schools. Based on food and labor costs, results indicated child nutrition program menu planners perceived modified meals cost more than non-modified meals planned to accommodate children with wheat, soy, milk products, and multiple allergens. This study estimated that 0.96% of lunch meals served in California were modified to eliminate food allergens. Ready availability and ease of sourcing substitute foods reduced perceptions of negative labor impacts on operations. Self-efficacy was measured using factors of perceived skill, perceived knowledge, frequency of training, perceived cost of menu modifications, district enrollment, years of work experience in child nutrition programs, education level, sex, and age of respondent, in providing meal accommodations for students with food allergies. Knowledge was the sole predictor of self-efficacy for menu planners of allergen modified menus for children. Findings from this study regarding perceived cost of accommodations and benchmarks of frequency of accommodations for children with specific food allergies can be utilized to calculate impact of additional food and labor costs. Child nutrition program menu planners were found to have high self-efficacy in planning modified meals; knowledge and adequate funding are keys to success