Of course, sometimes it is best to find sugar free alternatives, especially if you have a student with a restricted diet. The balloon bouquets can be made with curly straws, pens, or special pencils as an alternative. If you are interested in sugar free birthday celebration ideas, you should check out the No More Cupcakes post at Minds in Bloom.
The Schroeder Page has a great post on her birthday box and special bithday chair cover.
Another source for Some ideas and resources to help celebrate birthdays in your classroom with a great literature connection is Carolyn Wilhelm's post at Wise Owl Factory.
For even more ideas, check out the birthday linky party going on at Sunny Days in Second Grade. I'm linking up because I can always use more ideas.