Best Practice Guidelines for Anaphylaxis Prevention and Management in Schools
The Best Practice Guidelines for Anaphylaxis Prevention and Management in Schools and Children's Education and Care (CEC) services were launched in late 2021. These guidelines can be accessed at https://www.allergyaware.org.au.
These Guidelines aim to provide best practice guidance alongside associated support documents to reduce the risk of anaphylaxis in CEC/schools while supporting children/students to participate in the full range of CEC/school life.
The Allergy Aware website has information specific for:
As a parent it can be very stressful when your child at risk of anaphylaxis commences CEC/school. In the parents/guardians section of the Allergy Aware website, you will find resources to help you safely manage your child's journey through CEC and school.
Practical strategies for food allergy management in childcare
Allergy & Anaphylaxis Australia (A&AA) is here to help childcare service operators manage food allergy and the risk of anaphylaxis. This information provides links to free training for childcare centre staff including cooks and chefs, and gives practical information about how to minimise the risk of a child in care experiencing an allergic reaction.
Key points for management of allergies in childcare:
- Obtain current medical information for the child with the allergy and develop a health care/management plan to help minimise the risk of an allergic reaction
- Ensure that ASCIA Action Plans and adrenaline (epinephrine) injectors (such as EpiPen®, Anapen®) are stored together in an unlocked location.
- Ensure regular staff training in recognising and treating anaphylaxis
- Understand that unexpected allergic reactions can happen in an undiagnosed child
- Implement practical strategies to reduce the risk of exposure to allergic triggers
- Consider purchasing an adrenaline injector for general use
Policies and Procedures
It is important to have policies and procedures in place that include strategies to reduce the risk of an allergic reaction. Decide what works for your centre – what is realistic? Don’t let these documents just sit in a drawer in case of an audit. It is important that policies are implemented, regularly reviewed and updated.
Mealtimes offer many opportunities for allergens to be shared among the children. Some simple steps can help to minimise the risk of this happening. Thorough washing of kitchen equipment with warm soapy water will remove allergens, as will thoroughly wiping down tables and highchairs after meals. Clean up posits/vomit quickly and thoroughly as they can contain food allergens. Use disposable paper towel or cloths to do this and thoroughly machine wash cloths before using again. Baby wipes can be used to remove allergens from hands if running water and soap is not available. Hand sanitiser helps prevent infection but does NOT work to remove food allergens.
To help minimise the risk of an allergic reaction, children and staff should wash their hands before and after eating. For infants with food allergy, a separate highchair is recommended. Ideally easily identifiable plate/cup/bowl/bottle (colour/animal sticker) as well as child’s name can help increase safety. Try to have two staff members check that the right child is receiving the right food.
For older children with more difficult to manage food allergies such as milk, egg or wheat allergy, try to sit the child with food allergy on a separate table with friends who are tidy eaters. Staff supervision is essential at meal and snack times. Share plates should not be used. The child with food allergy needs to learn to eat their own food and not presume they can share food, even if it is just fruit, for example. Children should always be seated to eat and drink (including babies/toddlers with milk bottles).
Special events such as theme days and outings are a high-risk time for children with food allergy. Staff can be distracted with organising extra activities. Communication with parents is the key. Let parents know about activities early, so they have an opportunity to attend, organise another carer such as a grandparent, and send appropriate food for their child. The child with the food allergy should not have to miss out, however they (or the centre as a whole) may however have to do things slightly differently to increase safety. Having a strategy in place for special events is the best way to minimise risk of an allergic reaction.
Cooking at childcare is great fun but be sure to substitute known allergens with suitable ingredients. Parents of children with food allergy should be notified of cooking activities in advance. They are a great source of information about suitable ingredient substitutes.
Be aware of craft items which can contain food allergens such as milk or egg cartons. Ensure that children don’t have access to toys while they are eating and wash toys and equipment regularly. It is important to supervise children at all times, however for children with food allergy, it is especially important after snack and mealtimes in case an allergic reaction occurs.
Soaps and Lotions
Some soaps, nappy creams, sunscreens and moisturisers contain allergens, so it is important to always check ingredients before applying. Don’t purchase topical products that contain food ingredients. Encourage parents of children with food allergy to supply their own topical treatments or ask them to check the ingredients the centre supplies.
Age appropriate learning and responsibility
Stories and role playing can help children learn how to manage their own food allergy as well as to look after their friends who have food allergy. Educate pre-school aged children to wash hands properly before and after meals; not to share food and to speak up if they are feeling unwell. These skills are an important part of transition to school.
How to respond to an allergic reaction
If a staff member identifies that a child with food allergy is experiencing symptoms, the first thing to do is to follow the child’s ASCIA Action Plan. This document clearly lays out the signs to look out for and what to do. If a child has an adrenaline injector prescribed, bring this to the child so that staff can use it if needed. Have a cordless/mobile phone readily available so that an ambulance can be called if needed. Someone should phone the parents of the child and notify them of the situation.
An allergic reaction/anaphylaxis drill can help identify where any deficiencies may be in your emergency response procedures around anaphylaxis.
Adrenaline (epinephrine) injectors for general use
A&AA recommends that childcare centres consider purchasing an adrenaline injector for general use (E.g. EpiPen® Jr (150mcg) or Anapen® Junior 150), which should kept in an easily accessible unlocked location with an ASCIA First Aid Plan for Anaphylaxis. This adrenaline injector can be used in circumstances such as where a child has a severe allergic reaction but had not been diagnosed, if a second dose is required for a child already diagnosed before the ambulance arrives or if the prescribed injector is out of date/fails to be administered appropriately.
For more information about adrenaline injectors for general use see: https://www.allergy.org.au/hp/anaphylaxis/adrenaline-autoinjectors-for-general-use
Free online training for cooks and chefs
There are two free online courses for cooks and chefs to assist in making your centre safer for children with food allergies. While these are not specifically developed for childcare, the information is suitable for childcare cooks and chefs. A certificate of completion can be printed on successful completion. https://foodallergytraining.org.au/
Free online anaphylaxis training for childcare
The Australasian Society for Clinical Immunology and Allergy (ASCIA) has free anaphylaxis management training for early childhood education/care. The training provides a consistent approach to prevention, recognition and emergency treatment of anaphylaxis. This course has ACECQA approval. The training can be accessed here: https://www.allergy.org.au/patients/anaphylaxis-e-training-schools-and-childcare
Free allergy management resources
Allergy & Anaphylaxis Australia has some helpful resources to assist you in minimising the risk to children who have allergies and manage and allergic reaction if it happens including posters you can purchase or print.
See Schooling & Childcare for information on Approaching the management of anaphylaxis in schools/childcare and Examples of risk minimisation strategies for schools, preschools and childcare services
Jeremy's Children Book Series - Jeremy's story books are available to download and print. Includes Jeremy's Cake, Jeremy's Magic School Day and Jeremy's First School Camp.
Tommy’s Big Birthday - Wiggles e-book can be used to teach children about food allergies. This e-book is free.
Content updated February 2022