HELP!
I don’t know
what to do about
ALLERGIES AND
ANAPHYLAXIS
d
A guide to
enrolling a child
with severe food
allergies in a
childcare service
Community
Child Care
Co-operative
Ltd. (NSW)
Food Allergies and Anaphylaxis
The number of children with food allergies enrolling in children’s services is
increasing. Management committees, owners and staff have to deal with many
delicate issues when considering enrolling a child with allergies in their service. When
a centre enrols their first child who has previously suffered a severe food allergy the
first reaction is often panic. Should we enrol this child? How will the centre cope with
this child? Will we have to ban certain foods? How do we develop a policy? And above
all…how will we ensure this child remains alive?
The reality of the situation is that there is every reason to provide safe care for the
child with a food allergy, and the reasons not to provide care may be based on fear or
ignorance of food allergies.
Many child care providers or report never questioning whether they should provide
care to a food-allergic child but how to do it safely.
They believe every child has the right to be cared for and every child brings into child
care some issue that needs to be addressed.
Food allergies happen to be the issue for some children.
Some caregivers view the situation as a learning experience and enthusiastically
become educated about food allergies and begin investigating how best to keep the
child safe.
Disclaimer
The information included in this booklet is intended to act as a guide only. While Community Child Care Co-operative has
attempted to ensure that the information provided is correct and up to date, it is not a substitute for specific medical advice. If
there are any concerns about the implications of a particular situation Community Child Care Co-operative recommends that
professional advice be sought.
FOOD ALLERGY AND ANAPHYLAXIS
Why are food allergies and anaphylaxis such an issue now?
Research indicates that about 6% of children under 2 years have food allergies although the majority
fade by age 10, with between one and two percent of children over 10 years remaining with allergies.
Allergies occur when an overactive immune system produces antibodies against substances in the
environment that are usually harmless. Anaphylaxis is the most severe, sometimes life threatening
form of allergic reaction to a specific food.
As more and more children attend child care centres and preschools and as foods such as peanuts
become more spread throughout food chains, more children will present at children’s services having
already experienced an allergic reaction. More children will also have their first allergic reaction at a
service. It is for these reasons that food allergies and anaphylaxis are becoming increasingly an issue
to children’s services.
Community Child Care Co-op’s own research shows that 87 per cent of services are caring for children
with food allergies or intolerances and of the approximately 32,500 children attending these services,
10 per cent of these children, or 3,250, suffer from food allergies. This is an increase of 50 per cent
over the past two years.
What are allergies and what is anaphylaxis?
•
Allergies occur when an overactive immune system produces antibodies against substances in
the environment that are normally harmless.
•
Anaphylaxis is a severe and sudden allergic reaction to the release of histamine and other
defensive chemicals. It occurs when a person is exposed to an allergen (such as a food or an
insect bite). Reactions usually begin within minutes of exposure and can progress rapidly at any
time over a period of up to two hours. Anaphylaxis is potentially life threatening and always
requires an emergency response. Fortunately anaphylactic reactions are uncommon and usually
preventable.
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Community Child Care Co-operative (NSW)
What causes anaphylaxis?
The most common causes of anaphylaxis are:
Food allergy – peanuts, other nuts, cows milk,Insect stings – bee, wasp, jumper ants Medicines –
penicillin, aspirin Latex
What are the signs and symptoms of anaphylaxis?
Anaphylaxis is the most severe allergic reaction, involving many organs of the body, including the:
Nose – sneezing, blocking, watering and runny nose
Upper airways – swelling of the throat and vocal cords leading to obstruction of breathing
Lungs – wheezing and asthma
Skin – itching hives (urticaria)
Circulatory system – a fall in blood pressure and collapse
How can anaphylaxis be treated?
Adrenaline given as an injection into the muscle is the most effective first aid treatment for
anaphylaxis. Where a child is at risk of recurrent anaphylaxis the centre should have an auto injector
of adrenaline (eg, Epipen) for administration in an emergency. A child treated with adrenaline for
anaphylaxis should be taken immediately to a hospital or other emergency facility preferably in an
ambulance.
Providing support to children at risk of anaphylaxis
It is the responsibility of parents to notify the child care centre that their child is at risk of an
anaphylactic reaction, either at the time of enrolment, or if the child is already enrolled, as soon after
diagnosis is made.
As with other health conditions, children’s services provide support to assist parents in the
management of their children’s health.
The most important aspect of the management of children with anaphylaxis is avoidance of any known
triggers. If a child is affected the parents may ask that the food be totally excluded from their child’s
environment.
Food Allergies and Anaphylaxis
3
SO WHAT DO WE HAVE TO DO?
There are six steps you need to undertake before enrolling a child with severe food allergies or
anaphylaxis at a children’s service.
1.
Develop a policy. The process of developing a policy will ensure that your service thinks
through all the issues surrounding the enrolment of a child with severe food allergies into
the service. It is unlikely that the centre's current policies are adequate for dealing with a
child with severe allergies.
2.
Communicate with the parents. The parents of the child will have understandable
concerns about sending their child to a child care centre. They can often work in
partnership with the centre to ensure that the centre will be able to ensure their child’s
safety.
3.
Minimise allergens. The service will need to minimise the foods at the centre that are the
most common causes of severe allergies in young children and in particular the substances
the child you are enrolling is allergic to. The service must ensure that all attempts are
made to ensure that the allergic child will not come in contact with the allergen.
4.
Develop an individual management plan. This management plan must be developed in
consultation with the child’s parents and doctor/s.
5.
Train your staff. All staff at a centre must have training in food allergies and anaphylaxis
as well as on administering an EpiPen™(An EpiPen™Adrenalin Auto-injector is an
intramuscular injection of adrenalin designed for use in the treatment of anaphylactic
reactions. It is available over the counter in both child and adult doses.) Ensure that staff
will recognise symptoms of a child having an anaphylactic reaction and are capable of
instituting an emergency response plan.
6.
Educate everyone in the centre. Centre-wide education measures need to be
implemented including procedures for dealing with concerns or complaints from staff or
parents as a direct result of environment modification.
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Community Child Care Co-operative (NSW)
1. POLICY DEVELOPMENT
The aim of your policy should be to ensure any child with allergies, is provided with an environment
that is safe and allows them to participate in the daily routine of the service without risk or fear of
being exposed to traces of their allergen.
Areas that need to be covered in your policy include:
•
The aim of the policy.
•
Procedures for developing a system of identifying allergic children and those who are at risk of
anaphylaxis.
•
Procedures for the minimising of certain foods/ingredients at your centre. Procedures for the
implementation of avoidance measures and eliminating the allergen from the allergic child's
environment.
•
Procedures for collecting information from parents. These need to be developed to ensure
communication between parents and staff is clear and will not need further interpretation.
•
Procedures for developing individual management plans. These need to include an avoidance of
triggers action plan, emergency response plans in the event that an allergic child has symptoms
that suggest they are having an allergic reaction, and an administration of medication (including
storage and labelling) plan.
•
Procedures for the collection of information from doctors. These need to ensure that the centre
has medical advice on the nature of the allergy and the doctors' recommended emergency
action plan.
•
Procedures for staff training. All staff need to be educated about food allergies in general and
anaphylaxis. They require first aid training for food allergy reactions including the
administration of an EpiPen™.
•
Procedures for centre-wide education measures including procedures for dealing with concerns
or complaints from staff or parents as a direct result of environment modification.
Food Allergies and Anaphylaxis
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2. COMMUNICATE WITH THE PARENTS.
When a child begins childcare for the first time, parents often have many questions & queries about
how the staff will cater for their child’s individual needs. This is heightened when the child starting
child care has more specifics needs, such as those with food allergies or intolerances.
Families are looking for a willing and cooperative person who will see that their child is treated like
every other child in almost every way, and who will take the necessary steps to ensure their child's
safety, just as you would for a child without food allergies.
Parents want to know that you will learn how to practice food avoidance, recognise if a reaction is
occurring, and respond by providing emergency treatment if necessary.
When you care for children, any one of them could experience an unexpected emergency, and
caregivers would be responsible for responding.
The difference is that with a food-allergic child you can prepare yourself for a possible anaphylactic
reaction.
Understanding the parents of a food-allergic child can be puzzling for some caregivers. Once a
caregiver becomes fully educated about severe food allergies, it is more evident where the parents'
concern is coming from. Parents are sometimes perceived to be overprotective. This protectiveness is
understandable when you consider that their child's life is at stake.
Parents must do whatever they feel is necessary to help ensure their child's safety. Your centre will
need to take this into consideration when dealing with parents of food-allergic children.
Become a partner with the concerned parent. Join in doing what the parent asks of you and come up
with additional ways to minimise risks. If you react in a way that is unconcerned or uncooperative, the
parent is likely to behave in a way that seems more unreasonable. When you react and follow through
in a way that shows the parent that you understand what the parent has said about anaphylaxis, the
parent will naturally de-escalate.
Taking food allergies seriously and doing everything you can to keep the child safe will benefit everyone involved.
Occasionally after learning about serious food allergies, you may encounter a parent that you perceive
to be under reacting. He or she may not carry an Epipen™, despite previous serious allergic reactions.
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Community Child Care Co-operative (NSW)
The parent may not possess a full and accurate understanding of food allergies, or may not know how
to communicate the child's needs.
A parent should not leave a food-allergic child without available treatment. Simply avoiding the
offending foods has proven to be unreliable and has led to tragic results.
Every reaction is different, and the fact that the child "only" developed hives or vomited during past
allergic reactions does not mean that the next reaction, or the next, could not progress to a full-blown
anaphylactic reaction. In this case you may want to recommend that the child see an allergist to
determine whether previous reactions were due to a true food allergy, which involves the immune
system. This can usually be determined through skin and blood tests, in addition to a complete medical
evaluation. If a true food allergy exists, it is in the child's, as well as your best interest to have an
EpiPen™on site.
Parents may be very anxious about their child beginning care. They will want to ensure that the centre
is aware of all of the risks or issues that may arise through caring for their child with severe food
allergies.
Because children with severe food allergies can have fatal reactions from contact with their allergen,
there are specific questions that parents will possibly ask, for example:
–
Will the child care centre be able to adequately supervise my child?
–
Does the Centre understand food allergies?
–
Will the Child Care Centre cooperate with substance avoidance strategies?
–
Will someone recognise that my child is having an allergic reaction?
–
Does the Centre staff know what an anaphylactic reaction is?
–
Who will administer medication?
–
If necessary can the staff administer the EpiPen™ in time to save my child’s life?
Food Allergies and Anaphylaxis
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3.MINIMISING ALLERGENS
Avoidance of a specific trigger is the cornerstone of management in preventing food allergy and
anaphylaxis. Appropriate avoidance depends on the elimination of certain foods from the centre.
As a consequence of enrolling a child with severe food allergies into the centre, most centres will
decide to make their centre a nut and shellfish free centre. Some centre’s will also ban egg and egg
products where a child enrolled at the centre is allergic to egg.
The aim of eliminating specific foods is to ensure that any child with severe food allergies who attends
the centre is provided with an environment that is as safe as possible and which allows them to
participate in the daily routine without risk or fear of being exposed to traces of their allergen. This
acknowledges that the centre has a role in the prevention, recognition and management of food allergy
and anaphylaxis in all children under its care.
The most common foods associated with allergic problems in children are milk, soy, egg, wheat, fish,
shellfish, peanut and tree nuts. For a small but significant number of children with food allergy, minute
amounts of certain foods (eg peanuts) when ingested can be life threatening. Opening containers of the
food and releasing vapours of the food in the presence of the child, are all potential causes of severe
allergic reactions.
Nuts, seeds and shellfish are distinguished from other potential allergens in the decision to remove
foods from a Centre because of the quantities that can cause an anaphylactic reaction. Minute
quantities of nuts, shellfish and seeds can cause extreme reactions. With allergens such as milk or egg
large amounts need to be ingested to cause an anaphylactic reaction.
The banning of these foods may seem extreme. The following factors show why many centres have
taken this step.:
•
Not all children who will be diagnosed as allergic to these products will have been diagnosed by
the time they start child care
•
For some children their first exposure to these products could occur at the child care centre
•
The prevalence of food allergy is increasing rapidly
•
Centres need to ensure the safety of all children who attend the centre. As minute quantities of
the nuts and shellfish are potentially fatal (as opposed to other foods children are allergic to
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Community Child Care Co-operative (NSW)
where large quantities need to be ingested) the banning of these will ensure the centre is safe
for all,
The removal of these foods from child care centres is a sensible risk mangagement strategy comparable
to ensuring there is softfall under play equipment.
Once these foods have been eliminated from the centre the policy should apply even when there is no
known allergic children enrolled at the centre at the time. This is because for some children their first
exposure to nut products could occur at the centre.
Food Allergies and Anaphylaxis
9
4.DEVELOPING AN INDIVIDUAL MANAGEMENT PLAN.
All children with anaphylaxis should have an individual management plan including an emergency response plan
All children attending the centre must have clear documentation, from a medical practitioner, as to
the trigger, expected symptoms and recommended action in the case of accidental exposure to a
trigger. If medication for emergency first aid use is prescribed instructions should be clear on when and
how to use the medication.
The plan should be practical and be adapted to the routines etc of the child care centre. The plan
should be reviewed annually and following any anaphylactic events.
The emergency response plan should be used if the child is exposed to a trigger
If a child is suspected of ingesting a food or to which they are known to have had an allergy or
anaphylactic reaction the action plan should be instituted. Emergency medical help should be sought
for those children who have had a previous anaphylactic reaction regardless of the presence or absence
of symptoms. This may involve calling an ambulance or taking the child to a medical service such as a
hospital or general practitioner. The child should remain under close and constant supervision until
medical review.
Check List for enrolling a child with identified food allergies
N.B. sample forms are included later in this booklet.
1.
Notification from the parent of a previous allergic or anaphylactic reaction. Get any parent
who has indicated that their child suffers from a food allergy to complete a “children with
allergies form”. (Sample Form A)
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2.
Inform the parents/carers of what steps the centre will now undertake. (Sample Letter B)
3.
Documentation from a medical practitioner including;
•
Triggers, if known
•
How to recognise that the child is having an allergic or anaphylactic reaction
•
First aid steps to be followed if the child is inadvertently exposed to the trigger.
Community Child Care Co-operative (NSW)
Parents should complete an authorisation to allow the centre to contact the child’s medical
practitioner (Form C) and should be given a letter (Form D) to explain to the Doctor what
information the centre requires. Form E can be completed by the doctor or they can provide
the information in their own format.
4.
Complete individual management plan and allergy alert posters with parents (Forms F,G,I)
5.
Develop food substitution plans with centre cook and parents for allergies that are nonanaphylactic
6.
Develop room action plan detailing preventative measures, recognition of anaphylaxis and
who will institute medical action plan.
7.
Ensure medication has not expired and is correctly stored
8.
Implement action plan if inadvertent exposure to trigger occurs
9.
Review action plans annually or after any reaction.
Adrenalin and anaphylaxis
There are no contraindications to the use of adrenalin for life-threatening allergic reactions and the
risk of not giving adrenalin is almost always greater than any potential risk of giving adrenalin.
Any adrenalin prescribed for centre use should be correctly stored and not expired. Adrenalin should be
kept at room temperature away from bright light in locations which are easily accessible. If stored in a
cupboard or drawer this should not be locked and the location should be known to all staff members.
For all children the adrenalin device should be labelled with the name of the child and recommended
dosage. The adrenalin device should be carried on all excursions. Parents of the allergic child will
normally be responsible for supplying the adrenalin devices and ensuring that the medication has not
expired.
ALL CHILDREN SHOULD HAVE APPROPRIATE CONSENT AND RELEASE DOCUMENTATION COMPLETED
REGARDING THE ADMINISTRATION OF ADRENALIN BY CENTRE STAFF.
Food Allergies and Anaphylaxis
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FORM A: - CHILDREN WITH ALLERGIES
This form is to be completed by the parent of a child with an allergy and returned to the
director. The purpose of collecting this information is to identify children whose parent will
need to provide further medical information.
Childcare centre to complete:
Dear .....................................................
you have identified ..........................................................................................
as having an allergy/allergies to: ...................................................................... .
Please complete the questions below and return to the centre Director.
1. My child has an allergy to:
peanuts
Y/N
other nuts
Y/N
fish
Y/N
shellfish
Y/N
other
Yes
No
2. My child has been hospitalised with a severe allergy.
3. My child has been prescribed an EpiPen.
Completed by ............................................................... on ..........................
Parent
Thank you for your co-operation
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Community Child Care Co-operative (NSW)
FORM B: - INFORMATION FOR PARENTS AND CARERS
You have identified your child of being at risk of a severe allergic reaction. Our Centre will work with
you to ensure that to the best of our ability your child will be safe at all times. To do this we require
your assistance on completing the below steps.
STEP 1 — Preparation of an individual management plan
This plan will include:
•
details of your child's allergy/allergies*
•
a photo of your child
•
actions the centre will take to minimise the risk of contact with known allergens
•
arrangements for child care staff to support your child
•
an emergency response plan
•
your contact details in case of an emergency and those of another person in the event you are
unavailable
•
posters (including a photo) to be displayed around the centre
* Your medical practitioner will need to provide information about the history, signs and symptoms and
treatment of your child's allergy.
STEP 2 — Documentation and supply of prescribed treatment
Any treatment required by your child will require a written request to the Director including
instructions for administration. You will need to provide the appropriately labelled medication(s) to the
school (e.g. EpiPen, antihistamine).
STEP 3 — Communication with your medical practitioner
The centre would like your permission to contact your medical practitioner if necessary.
Food Allergies and Anaphylaxis
13
FORM C: - AUTHORISATION TO CONTACT MEDICA L PRACTITIONER
This form is to be completed by the parent.
My child ______________________________________________________
Will shortly be attending ______________________________ child care centre/preschool.
I understand that they may need to discuss the implications of my son’s/daughter’s medical
condition so that the centre can support him/her.
I hereby give my permission for the centre to contact my son’s/daughter’s medical practitioner to
obtain necessary information.
Medical practitioner information:
Name: ___________________________________________________________________
Address: _________________________________________________________________
Phone: __________________________________________________________________
Mobile (if known): _________________________________________________________
Email (if known): __________________________________________________________
Fax (if known): ___________________________________________________________
I understand the information given may be discussed by the Director of the centre with
other members of the centre staff, as is necessary, enabling staff to care for my child.
Signed: ____________________________________________ Date: _______________
(Parent)
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Community Child Care Co-operative (NSW)
FORM D: - LETTER AND FORM FOR THE PARENT(S) TO TAKE TO THE MEDICAL PRACTITIONER
Dear medical practitioner,
The bearer of this letter has advised our child care centre that your patient
___________________
___________________________ is at risk of a severe allergic or anaphylactic reaction
when exposed to certain allergens.
To assist us in providing a safe environment for the child have asked this
parent to seek information from you about:
•
known allergens
•
medication prescribed
•
when and how medication should be administered
•
any other details you believe are important.
This information should be provided to the parent so that it can be conveyed to the
centre. Please provide this information on the attached form or in your own format. This
information will be critical in managing this child should a severe allergic or
anaphylactic reaction occur.
Please phone the centre on _______________________ if you require further information.
Thank you for your attention to this matter.
Yours sincerely,
Director
I _________________________________consent to this information being provided
(parent)
for the child care centre’s use.
Parent signature: .................................................. Date...................
Food Allergies and Anaphylaxis
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FORM E: - INFORMATION FOR THE CENTRE FROM THE MEDICAL PRACTITIONER
Name of patient: __________________________________________________________
Date of Birth: ______________________________________________________________
This patient has allergies to:
1.
____________________________________________________________
2.
____________________________________________________________
3.
____________________________________________________________
Symptoms the child may exhibit when having an allergic or anaphylactic reaction
1.
____________________________________________________________
2.
____________________________________________________________
3.
____________________________________________________________
First aid steps to be followed if the child is inadvertently exposed to the trigger.
1.
____________________________________________________________
2.
____________________________________________________________
3.
____________________________________________________________
Prescribed medication: ____________________________________________________
______________________________________________________________________
Other information: _______________________________________________________
______________________________________________________________________
Medical practitioner: ______________________________________________________
Address: ________________________________________________________________
Phone: _________________________________________________________________
Fax: ___________________________________________________________________
Email: _________________________________________________________________
Date: _________________________
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Community Child Care Co-operative (NSW)
FORM F: - INDIVIDUAL MANAGEMENT PLAN
–
The plan is to be completed by the director and the parent(s) on the basis of information
from the child’s medical practitioner.
Child name:
DOB:
Severely allergic to:
Parent Contact:
Parent Information (1)
Parent Information (2)
Name/s:
Relationship to child:
Name/s:
Relationship to child:
Address:
Address:
Home Phone:
Home Phone:
Work Phone:
Work Phone:
Mobile Phone:
Mobile Phone:
Other emergency
contacts (if parent
unavailable)
Medical practitioner
contact:
Name:
Address:
Phone:
Mobile (If known):
Email (If known):
Fax: (If known):
The following individual health care plan has been developed with my knowledge and input and
will be reviewed on .............................................. (insert date of proposed review)
Signature of parent: .................................................... Date ..................
Signature of Principal: .................................................... Date ..................
Food Allergies and Anaphylaxis
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FORM G: - EMERGENCY RESPONSE DISPLAY POSTER
–
A poster is to be completed by the director on the basis of Information provided by the
parent and/or medical practitioner and needs to be displayed around the centre.
Emergency Treatment Plan posters.
This poster can be sent to you by Community Child Care (ph 9560 4771)
Allergy Australia also has a poster that can be ordered from them.
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Community Child Care Co-operative (NSW)
FORM H: - STRATEGIES TO AVOID ALLERGENS
Student’s name:
...................................................................................................
DOB:............................................
Known allergens:
• ...................................................................................................................
• ..................................................................................................................
• ...................................................................................................................
Risk
Strategy
•
Person/s responsible
•
•
•
•
•
•
•
•
•
•
•
•
•
Food Allergies and Anaphylaxis
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5.TRAINING STAFF
•
All child care staff should receive training in anaphylaxis prevention, recognition and
management.
•
In a child care situation, caring for a child with a medically recognised food allergy can be an
extremely demanding task.
•
Carers may accept the responsibility of caring for a child with severe food allergies, on the basis
that they won’t have to deal with a crisis themselves. This is not the case, as carers do need to
accept that they have a duty of care to deal with emergency situations.
•
It’s important to remember that at any time, any one of the children in your centre can present
an emergency situation, that the staff will be required to deal with. The difference with having
an emergency situation arise with a child having an anaphylactic reaction, is that the staff have
specific procedures to allow them to deal with the situation to the best of their ability.
•
Staff may have no prior experience with food reactions, and be totally unaware that foods like
peanuts and nuts can cause such severe reactions from contact with miniscule amounts of these
foods.
•
All permanent staff should be able to recognise if a child is having an anaphylactic reaction.
Training should be given at the first staff meeting each year. Accidental exposure to triggers
can occur despite avoidance measures. Management should be immediately available for these
emergency situations.
•
All staff members should be trained to administer adrenalin in an emergency situation via the
EpiPen™.
TRAINING COURSES
Anaphylaxis (EpiPen™) Training Course
This course teaches the knowledge and skills required to safely use the EpiPen™ in the event of a
severe allergic reaction. It is strongly recommended that participants have basic CPR training or a
current first aid certificate.
Course content:
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•
Defines anaphylaxis
•
Prevention strategies
•
Identifies the triggers which can cause anaphylaxis
Community Child Care Co-operative (NSW)
•
Explains the mechanism of anaphylaxis
•
Recognition of an anaphylaxis Reaction
•
Differentiates from other conditions
•
Management of the condition
•
What to do after an anaphylaxis episode
Course location: Currently only available for on-site courses with a minimum of 10 participants
throughout the Sydney Metropolitan area and in some country centres.
available from: Red Cross
phone: 9299 4100 or 1300 367 428
e-mail: [email protected].
cost: $25 per head
MANAGING FOOD ALLERGIES AND ANAPHYALAXIS
As more and more children are being diagnosed with a food allergy, children’s services will need to
develop policies and procedures to deal with the children suffering from allergies or at risk of
anaphylaxis. This workshop gives background information about allergies and intolerances and explains
what anaphylaxis is and how it is diagnosed.
Issues covered include:
•
Development of Individual management plans, including responsibilities of parents
•
responsibilities of the centre and duty of care
•
information & guidelines for staff
•
Strategies for maintaining a safe environment.
•
Developing policies & procedures
•
legal issues
•
emergency response plan – first aid
Workshop length: 3 Hours
available from: Community Child Care
phone: 02 9560 4771 or 1800 629 397
website: www.ccccnsw.org.au
e-mail: [email protected]
cost: $450 plus travel
Food Allergies and Anaphylaxis
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APPENDICES
LEGAL RESPONSIBILITY
Potential legal liability is a common concern of caregivers. Some caregivers never even consider their
legal liability if the child has a reaction and they need to administer the EpiPen injection. However,
other caregivers report potential liability as the leading reason why they would rather not care for a
food-allergic child.
Food-allergic children have legal rights entitling them to receive safe care, and refusing that child care
may be legally unsound. All children have the right to care and protection.
Although the laws are sometimes conflicting, they can provide you with legal guidelines for caring for a
child with food allergies.
In the past, some caregivers have asked parents to sign a waiver of liability to protect themselves from
any legal consequences for negligence or failure to provide emergency treatment.
This effort to protect yourself is not foolproof, as courts may invalidate various waivers. For those
caregivers still concerned about liability, the best protection is working with parents to create a formal
written plan to minimise risks.
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Community Child Care Co-operative (NSW)
RESOURCES
Many resources that may be useful for your centre are available. These are the ones that Community
Child Care finds the most useful to centres.
ANAPHYLAXIS: PLANNING AND SUPPORT GUIDE FOR SCHOOLS, PRESCHOOLS AND CHILDCARE SERVICES.
The South Australian Department of Education and Children’s Services (DECS) has worked in partnership
with the Women's and Children's Hospital in Adelaide to develop Australia's first information and
training package for education and childcare staff supporting children and students who have had a life
threatening allergic reaction (anaphylaxis).
available from: SA Women's and Children's Hospital Information Centre,
phone: (08) 8161 6875
e-mail: [email protected]
cost: $8.80
EPIPEN™TRAINER
This is recommended for teaching children/carers how to give Epipens™
available from: ALLERGY AUSTRALIA (FORMERLY FACTS)
phone: 02 9832 7072 or 1300 728 000
website: www.allergyfacts.org.au
e-mail: [email protected]
cost: $15
EMERGENCY TREATMENT PLAN POSTER
An easy, almost ready to use emergency plan specifically for individuals with anaphylaxis. Services may
well wish to develop their own treatment plan posters but this is useful in showing centres what
information a poster should contain
available from: ALLERGY AUSTRALIA (FORMERLY FACTS)
phone: 02 9832 7072 or 1300 728 000
website: www.allergyfacts.org.au
e-mail: [email protected]
cost: $6.00
Food Allergies and Anaphylaxis
23
ANAPHYLAXIS TRAINING KIT
Ideal resource for child care centres. Includes Information on emergency procedures, important facts
about Anaphylaxis, an Epipen™Trainer, Handy Hints & other booklets.
available from: ALLERGY AUSTRALIA (FORMERLY FACTS)
phone: 02 9832 7072 or 1300 728 000
website: www.allergyfacts.org.au
e-mail: [email protected]
cost: $60
VIDEO
"Dealing with Food Allergies" For training teachers and carers – includes support material. An Australian
video that explains what allergies are, preventative measures and demonstrates emergency treatment.
available from: FACTS
phone: 02 9832 7072 or 1300 728 000
website: www.allergyfacts.org.au
e-mail: [email protected]
cost: $25
WEBSITES
The Australasian Society of Clinical Immunology and Allergy Inc (ASCIA)
www.allergy.org.au
Allergy Australia (formerly FACTS)
www.allergyfacts.org.au
24
Community Child Care Co-operative (NSW)
Forms and letters
Letter to families re banning certain foods from centres where children bring own food to centre.
Dear Families,
XYZ child care centre tries as much as possible to assist parent’s in the management of their
children’s health. We encourage families using the service to assist us, where possible, in
fulfilling our duty of care to each child enrolled at the centre.
The centre has recently reviewed its policy relating to food allergy and anaphylaxis. As a
consequence of that review we have decided to make XYZ child care centre a nut and
shellfish free centre.
The aim of this policy is to ensure that any child with severe food allergies who attends the
centre is provided with an environment that is as safe as possible and allows them to
participate in the daily routine without risk or fear of being exposed to traces of their
allergen. This policy acknowledges that we have a role in the prevention, recognition and
management of food allergy and anaphylaxis in all children under our care.
We realise that taking this step may seem extreme to some parents. However, the prevalence
of food allergy is rising. Not all children who will be diagnosed as allergic to these products
will have been diagnosed by the time they start at the centre and for some children their first
exposure to these products could occur at the centre.
The centre needs to ensure the safety of all children who attend the centre. We have
distinguished the above foods from other potential allergens in the decision to remove the
foods from the Centre because of the quantities that can cause an anaphylactic reaction.
Minute quantities of nuts, shellfish and seeds can cause extreme reactions. With allergens
such as milk or egg large amounts need to be ingested to cause an anaphylactic reaction.
The most common foods associated with allergic problems in children are milk, soy, egg,
wheat, fish, shellfish, peanut and tree nuts. For a small but significant number of children
with food allergy, minute amounts of certain foods (eg peanuts) when ingested can be life
threatening. Opening containers of the food and releasing vapours of the food in the presence
of the child, are all potential causes of severe allergic reactions.
Food Allergies and Anaphylaxis
25
Avoidance of a specific trigger is the cornerstone of management in preventing food allergy
and anaphylaxis. Appropriate avoidance depends on the elimination of certain foods from the
Centre, specifically nut products, including peanut butter and peanut oil as well as other
nuts, shellfish and seeds.
The above policy is to apply even when there is no known allergic children enrolled at the
centre at the time. This is because for some children their first exposure to nut products
could occur at the centre.
What does this mean in practical terms?
All parents are asked to ensure that their children’s lunchboxes do not contain nut or shellfish
products. This includes peanut butter.
Parent’s are asked to wash their children’s hands and mouths thoroughly before arriving at
the centre each day – particularly if they have consumed peanut butter for breakfast.
All children will be asked to wash their hands thoroughly on arrival at the centre each
morning before joining in the program.
Birthday cakes??
XYZ child care centre will shortly be enrolling a child with severe food allergies. As I stressed
before we believe the banning of peanut and shellfish products from the centre is a sensible
risk management plan anyway, but obviously it is vitally important to this child’s life that no
peanut products especially enter the centre.
I am aware that when some other children’s services have introduced a nut free policy into
their centres some parent’s have reacted negatively to being unable to provide their children
with things such as peanut butter sandwiches. I hope that all of us here understand that we
need to ensure that every child who attends the centre can do so without risk of injury. It is
the centre’s role to ensure that every child who attends XYZ child care centre is safe.
Yours faithfully,
Director.
26
Community Child Care Co-operative (NSW)
THINGS TO THINK ABOUT
Sometimes you can do your best to cover every possible base, but still something escapes your grasp.
The following list of things to think about has been developed by Community Child Care as a result of
questions we have been asked by centres.
Craft Materials. Staff need to be aware of foods that are used as craft materials and their potential to
cause an allergic reaction. The most obvious of these is the use of egg shells or egg cartons, where raw
egg may be present. Raw egg is more allergenic than cooked egg.
Staff Lunches. Staff need to be aware that the policy of certain foods being banned extends to their
own lunch foods. Foods such as satay sauce cannot be consumed on the premises during staff breaks
and if consumed off the premises, the staff members need to brush teeth and wash hands thoroughly
before returning to duties.
Excursions to animal farms. Many animal farms/zoos use peanuts and or seeds as one of the foods they
give to children to feed animals with.
Living Eggs programs. Will these be a problem to egg allergic children?
Casual staff. How will they be trained about the presence of food allergic children?
Training of replacement staff. How often are you going to train staff? What about new staff?
Excursions. What will be the process for carrying adrenaline?
Sunscreen. Some sunscreens contain peanut oil check whether yours does.
Easter Egg Drives. Some centres have chocolate drives for fundraising…. Easter eggs are rarely peanut
free.
Barbecues. One child care centre reported declaring itself egg free then blowing it a few weeks later
by serving parents at a family function egg and bacon rolls off the barbecue.
Reminding parents. Telling parents the centre is peanut free is one thing but how do constantly
remind them.
Be aware of all nut containing foods. Changing from peanut butter to Nutella on sandwiches does not
solve the problem!
Food Allergies and Anaphylaxis
27
Ageing children. An allergic child may be in a centre for a number of years. Having a photo of them on
their Action plan poster of them as a 6 month year old may not help the casual staff member recognise
the 5 year old they have become.
Birthday cakes. What are you going to do about them?
28
Community Child Care Co-operative (NSW)
Hidden Ingredients
This list reprinted with kind permission of ALLERGY AUSTRALIA (FORMERLY FACTS)
(www.allergyfacts.org.au).
NUTS
What may contain nuts?
Peanut butter, mixed nuts, crushed nuts in sauces. Asian foods eg; Satay, Indonesian and Thai Foods.
Pesto is an Italian sauce made with nuts. Arachis is an alternative terms for peanut. Marzipan is a
paste of ground almonds and sugar. Health Food confectionery bars. ALL cakes and pastries with
unknown ingredients, particularly "health cakes" such as carrot cake, pumpkin cake or pie, fruit and
nut rolls etc. Biscuits, other than plain, sweet or savoury, (especially chocolate coated), need to be
thoroughly checked.
Bouillon and worcestershire sauce both contain nuts on occasion. Confectionery such as praline and
nougat are nut products. Muesli and fruited breakfast cereals. Ingredients need to be checked on all
breakfast cereals. Hydrolysed Vegetable Protein may be nut based.
Chocolate, particularly compounded, as in easter eggs, health food bars, fancy and imported
chocolates. Vegetarian dishes. Salads and salad dressings. Ice cream and desserts. Amaretto alcoholic
drink used in cocktails. Frangelico alcoholic drink is made from nuts and is sometimes used in desserts.
Gravy (apparently peanut butter is used as a shortening or oil in some recipes for gravy or sauce. Food
additive 322 - Lecithins - may contain peanut.
Other products would include shampoos, shaving creams and health care products that may contain
peanut and almond oil. Sunscreen lotion may contain peanut oil. Some brands of lipsticks and
foundations may contain nuts. Loramine Wax and Peanutamide are alternative terms for peanut and
may be used in some cosmetics.
Prometrium, a pure progesterone taken for menopause should not be taken by women with a peanut
allergy, as it is made from peanut.
Visiting farms, wildlife parks or even feeding your pet bird at home need attention. Some animal/bird
feed contain peanuts and other nuts - Check animal food
Food Allergies and Anaphylaxis
29
MILK
What may contain milk?
Whey, Whey powder, Whey solids, Lactose, Casein, Caseinates, Non-milk fat, milk powder, cream,
sour cream, yoghurt, rennet, cheese, cheese spread, cottage cheese. Custard, cakes, milk
puddings and other desserts. Hot chocolate drinks and milk shakes.
Food Additive 270 - Lactic Acid - occurs naturally in sour milk. Food Additive 325 - Sodium Lactate sodium salt of Lactic Acid. Food Additive 326 - Potassium Lactate - potassium salt of Lactic Acid. Food
Additive 327 - Calcium Lactate - calcium salt of Lactic Acid. Food Additive 328 - Ammonium Lactate Lactic Acid neutralised with ammonia. Food Additive 329 - Magnesium Lactate - Magnesium salt of
Lactic Acid. Food Additive 469 -Sodium Caseinate - Sodium salt of casein. Food Additive 482 - Calcium
Lactylate - Lactic Acid.
Be aware that a "D" on food products indicates a dairy/milk ingredient is present. The "D" may stand
alone and not necessarily be found under the familiar "ingredients" tag on the product. In America
caramel colouring and flavourings are made out of burnt lactose and "Natural Flavourings" can be
milk based. Take extra precaution investigating food products with these ingredients if you have a milk
allergy. A lot of Soya Cheeses contain milk protein in the form of casein. Check the small print on all
soy products - even if marked as dairy/milk free.
EGG
What may contain eggs?
Albumin, ovalbumin, globulin, livetin, ovomucin, ovomucoid, powdered egg, dried egg, silici
albuminate, vitellin, ovovitellin, yolk, egg white.
Egg noodles, Milk puddings and custards, pavlova powder mix, macaroons, cake mixes (may instruct
to add egg), doughnuts, some biscuits. Fancy pastry items eg: choux pastry in cream puffs, etc.
Glazed rolls and bread, some icings, marzipan, etc. Hollandaise sauce, mayonnaise, tartare sauce,
some salad dressings, commercial sauce mixes. Additive 322 - Lecithins - may contain egg.
Some soups, consommes, sausages. Dessert mixes, waffles, fancy ice creams, pancakes, pikelets.
Omelettes, Quiche, meat loaf, meat jellies, marshmallows, meat moulds, meringues, spagetti and
spanish creams. Whips and wines, (many wines are cleared with egg white).
Other products would include egg protein shampoo, laxative, Agarol.
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Community Child Care Co-operative (NSW)
Action plan for
Anaphylaxis
Name:
Date of birth:
M I L D T O M O D E R AT E A L L E R G I C R E A C T I O N
Photo
• swelling of lips, face, eyes
• hives or welts
• abdominal pain, vomiting
ACTION
Known severe allergies:
Parent/carer name(s)
• stay with child and call for help
• give medications (if prescribed) ....................................
• locate EpiPen® or EpiPen® Jr
• contact parent/carer
watch for signs
of Anaphylaxis
Work Ph:
Home Ph:
ANAPHYLAXIS (SEVERE ALLERGIC REACTION)
Mobile Ph:
Plan prepared by:
Dr.
Signed
Date
How to give EpiPen®
or EpiPen® Jr
• difficulty/noisy breathing
• swelling of tongue
• swelling/tightness in throat
• difficulty talking and/or hoarse voice
• wheeze or persistent cough
• loss of consciousness and/or collapse
• pale and floppy (young children)
ACTION
1. Form fist
around EpiPen®
and pull off
grey cap.
2. Place black
end against
outer mid-thigh.
1 Give EpiPen® or EpiPen® Jr
2 Call ambulance. Telephone 000
3 Contact parent/carer
If in doubt, give EpiPen® or EpiPen® Jr
Additional Instructions
3. Push down
HARD until a
click is heard
or felt and hold
in place for
10 seconds.
4. Remove
EpiPen® and be
careful not to
touch the needle.
Massage the
injection site
for 10 seconds.
© ASCIA 2003. This plan was developed by
www.allergy.org.au