After their classmates finished laboring over a list of math problems, they sang a few verses of Happy Birthday. But there was no slicing of a sheet cake, no huffing to blow out candles.
Instead, the newly minted 10-year-olds pulled out wrapped packages and ripped them open, as friends gasped with excitement, to reveal their birthday gifts to the class: a biography of Paul Revere, a book about vampires, and a 2004 almanac.
As the number of children diagnosed with life-threatening food allergies has ballooned in recent years, more schools are starting to look like Belmont's Mary Lee Burbank School, which bans birthday cupcakes and other treats that could trigger allergic reactions. Across the state, educators and parents are learning to navigate a new world, where candy can be deadly and townspeople clash over whether their schools should allow peanut butter sandwiches.
"We want people to understand that this is not just sneezing and a running nose," said Theresa Normile, a registered nurse and the parent of a Belmont second-grader severely allergic to peanuts and nuts. "Children can die."
Last year, the Massachusetts Department of Education became the first in the country to release suggested guidelines -- not requirements, so schools can adopt their own policies based on the number and severity of student allergies -- for protecting children with life-threatening allergies in schools. The 76-page guide alerts schools to the need to accommodate students, some with allergies so severe that eating 1/5,000 of a teaspoon of an offending substance could cause death.
It was the allergy deaths of three young people in Massachusetts within two years that spurred Michele Abu Carrick, the Reading mother of a high school sophomore with food allergies, to take action. "When the last child died, I just thought this is so unacceptable because these [deaths] are so preventable," she said.
The first death came in the summer of 1999, when a lacrosse player from Winchester and recent high school graduate died after eating nuts. In 2000, an Acton cheerleader, 13, was stricken after eating a snack containing cream.
And in May 2001, an Amesbury middle school student died after eating nuts in a home economics class. In February, the parents of the boy, William J. Gallagher, filed a $10 million lawsuit against the city and school district.
Carrick, well aware from her own experiences that schools vary in their approach to food allergies, argued that a statewide effort was necessary to prevent more children from dying. She eventually served on the Department of Education task force that released the guidelines last year.
No one knows exactly why severe allergies are increasing in children -- some researchers speculate that pregnant women are eating more peanuts -- but the numbers have soared. Nationally, the number of children with known food allergies jumped 55 percent between 1995 and 2000.
Now, an estimated 6 to 8 percent of school-age children have food allergies -- and about half of those children are believed to have a high risk of anaphylaxis, the life-threatening reaction that can kill within minutes of exposure.
While public schools cannot reject students, some private schools have refused to enroll children with serious allergies, arguing that they cannot adequately protect them. This fall, the parents of a 4-year-old girl filed a complaint with the US Office of Civil Rights, charging that St. Edward Elementary School in Brockton illegally rejected their daughter because she has a severe peanut allergy.
Ellie Goldberg, an educational consultant from Newton, has seen resistance in schools run by other denominations, as well as charter schools: "Peanut butter just goes with kids. They have a hard time making that adjustment."
North Andover first confronted the issue in the 1990s when officials created a peanut-free classroom after enrolling a kindergartner with a severe allergy to peanuts.
"There were parents who were upset about this because their children only eat peanut butter and jelly," said Diane Huster, former chairwoman of the school committee. As the mother of a girl who once ate little besides peanut butter and crackers, she, too, was conflicted.
But once she understood the severity of the allergy, she said, she supported the ban. And in time, the school's policy -- which included a daily washing-down of the school-bus seat where the allergic child sat -- became routine.
Still, Huster said, "I was surprised that we had to do so much convincing."
Public schools vary so widely in their approach to students with food allergies that some parents move into school districts for their allergy policies, officials say. "There is a huge trend for families to seek communities that have active programs," said Jane Franks, coordinator of school health services in Lexington, where 140 of about 6,000 students have life-threatening allergies.
The new state guidelines urge banning the tradition of trading lunches. They also recommend peanut-free tables in the cafeteria. "In most cases, it wouldn't need to be the whole school," said Katie Millett, who oversees the Department of Education's school nutrition safety program.
And they suggest that all schools maintain a supply of epinephrine for students who may have their first allergic reaction at school. About one-third of students who have severe allergy attacks at school and are injected with epinephrine did not previously know that they had life-threatening allergies, according to Anne Sheetz, the director of school health services for the state Department of Public Health.
In Belmont this year, the school system adopted a new protocol for protecting students with severe allergies. Parents of elementary school children are asked not to pack snacks containing ingredients -- such as peanuts and nuts -- that cause allergic reactions in their classmates.
The school district has hired extra school nurses so every school has full-time coverage. Bus drivers and coaches are alerted to children's allergies, and every field trip has a trained staffer designated to administer life-saving epinephrine.
Some educators didn't have to be sold on limiting sugary treats in school. "The kids don't need that much sugar during the day," said Dr. Rose Feinberg, principal of the Burbank School.
Normile, who started the parents' support group that eventually helped establish Belmont's new guidelines, said her son's friends didn't minding giving up sweets.
"Typically, you had your birthday and in went 24 cupcakes into the classroom," she said. "The teachers are very creative. Now they find other ways to celebrate the children's birthdays."
Kathleen Burge can be reached at firstname.lastname@example.org.
© Copyright 2003 Globe Newspaper Company.