4/2014

Allergies are caused by an overreaction of the body’s immune system in response to a substance that it believes is harmful. As a result, the body creates antibodies that fight against the substance.

The safety of children with food allergies is everyone’s responsibility. An estimated five percent of children in the U.S. are affected by food allergies. Allergies can begin at any age, so children may already have a food allergy or may develop one. The most common food allergies are related to tree nuts, eggs, milk, and wheat. Allergic reactions that children experience may range from mild to severe, even life-threatening, anaphylactic reactions. Health leaders working directly with families can prepare programs for children with allergies. As the health manager, you can help your program prevent and manage allergic reactions, as well as support children, staff, and families on ways to avoid exposure to allergens. As part of the Health Services Advisory Committee (HSAC), staff, administrators, families, and primary care providers can establish systems, routines, and practices that allow all children to safely participate.

Developing and Implementing Policies

Your program should have:

• A policy for asking parents during initial intake about known allergies
• Individualized written care plans for each child with food allergies, developed with and approved by the family and health care provider
• A communication plan that alerts all staff, substitutes, and volunteers to individualized care plans while maintaining confidentiality
• A policy for medication administration and training
• A written plan for urgent medical care
• A policy regarding whether it is permissible to bring food from home to the program

Supporting Staff

Clear systems, policies, and practices ensure all staff has information and training to recognize and take immediate action in the event of an allergic reaction.

Make sure all staff, including food preparation staff, receives training in:

• Reading food labels and recognizing ingredients that may trigger reactions
• Preventing exposure to foods to which children are allergic
• Recognizing symptoms of an allergic reaction
• Administering prescribed and over-the-counter medications
• Understanding when to seek routine or emergency medical care
• Effective communication with families

A major factor in death from anaphylaxis has been a delay in the administration of life-saving emergency medication, particularly epinephrine.

The Centers for Disease Control and Prevention’s (CDC) Voluntary Guidelines for Managing Food Allergies in School and Early Care and Education Programs [PDF, 11MB] provides more detailed guidance on reducing allergic reactions and responding to life-threatening situations.

Engaging Families

Draw on families’ strengths by asking them about their child’s allergies and the most effective strategies they have used to deal with an allergic reaction. If the physician has recommended an over-the-counter or prescription medication, be sure the family understands your program’s medication administration policies and procedures. As you develop the child’s individual health plan, discuss his medical history and review with families which food(s) their physician has documented their child must avoid. Talk about procedures the program will put in place to meet the child’s nutritional needs while striving to keep him safe from exposure to allergens. This is a good time to discuss the program’s plan for urgent medical care and strategies families can use at home to prevent or address an allergic reaction. Together, you can develop a care plan that will encourage a consistent approach to keeping the child safe and healthy, and give families confidence in your ability to protect their child.

Questions to Ask Families

• What are the first signs when your child has an allergic reaction?
• How do you calm or reassure your child when she has a reaction?
• Is there a special way to help him take his medication, such as on your lap, rubbing his back, or singing a special song?
• What Is the Difference Between Food Allergy and Food Intolerance?

Food allergies trigger a reaction by the body’s immune system. For example, a milk allergy involves the immune system and symptoms may include hives and breathing problems. While many people consider themselves allergic to certain foods, they actually have intolerance to the food that causes a number of unpleasant symptoms, but is not an allergy. For example, lactose (dairy) intolerance may cause bloating, cramping, and other gastrointestinal symptoms, which do not involve the immune system.

What Is Anaphylaxis?

Anaphylaxis is a severe and potentially life-threatening allergic reaction. It develops extremely rapidly and must be treated promptly with epinephrine, either by emergency medical personnel or by trained program staff administering the child’s prescribed dosage. Symptoms may include shortness of breath or wheezing; swelling of lips, tongue, or throat; nausea or vomiting; rash; stomach pain; or other symptoms.

What Next?

• Providing a safe environment for children with food allergies takes vigilance and commitment across the program. Here are some other steps you can take.
• Post information about each child’s allergies, with a clear photo of the child, in every room in which the child spends time, that is accessible to staff but not in a publicly-visible location.
• Ensure that when the child is on the playground, a field trip, or Head Start transportation, someone familiar with a child’s care plan and trained in relevant medication administration accompanies the child with prescribed emergency medication (e.g., EpiPen).
• Consider adding a clinician or dietician with a specialty in pediatric allergies to your HSAC.
• Engage your HSAC in reviewing policies and procedures to address food allergies.

Source: National Center on Health

Available at: http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/health/docs/health-services-newsletter-201404.pdf