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Approaching the management of anaphylaxis in schools/childcare

Mother chatting with daughter

Life has many dangers. We are taught how to live safely and be responsible. People at risk of anaphylaxis have an added ‘danger’. As a parent of a child (now an adult) at risk of anaphylaxis, I know just how much I want my son to NEVER have another anaphylaxis. We speak of milk or peanuts or sesame as being like rat poison. Our fear motivates us to do what we can to keep individuals with potentially life-threatening allergies safe. Our knowledge, which increases with time, experience, and research, motivates us to teach individuals how to manage all aspects of this condition in everyday life.

Think of road safety for a moment. The road is a very dangerous place for young children. As adults, we slowly educate children on the dangers and guide them across the road with added safety. Roads are NEVER risk free, but we teach children what to do to help keep themselves safe when crossing a road. We remind them to look left/right; never cross without an adult until they are at an age when they can be trusted with decision making of when and where to best cross a road if there is no pedestrian crossing close by. We can NEVER remove the risk of injury completely, but we can certainly educate others on how to best manage crossing the road safely.

Having a severe allergy is a little like crossing a road. It is always dangerous, but we can work on strategies (actions or ways of doing things) to make it safer. Someone at risk of anaphylaxis is always at risk but we as parents, childcare workers, teachers or individuals do what we can to reduce that risk.

It’s so important for us and others caring for children to put strategies in place for the overall, long-term management of severe allergy. I encourage people with young children to reduce the allergen as part of an overall management plan. Reducing the amount of allergen in their environment cannot be the only safety strategy in place. Beware of ‘banning’ food from a childcare or school environment. We can never say any food is truly banned from any environment; it is not realistic. Can we say peanut or egg is ‘banned’ when so much food contains peanut or egg or ‘May contain peanut or egg’? In my now more than 30 years of working in the area of food allergy with school and childcare, I can say that foods that were supposedly banned in a school have often been found there. How can we expect people who do not live with food allergy to check the ingredients of every food they send to childcare or school and know in which foods food allergens may be hidden? Trusting a food ban to keep our children safe means that we are not considering all the other possible risk minimisation strategies that can be used. Having many safety strategies means we have other strategies to help protect children when one strategy is missed.

As a parent back in the 1990’s I wanted a ban on the food that my child was allergic to, but I soon learned that the ban could not be relied upon. For many, the food ban created a false sense of security as people thought the allergen ban meant the environment was safe. Can we ever completely remove peanut or egg or sesame from a school or childcare environment? Even in my role as CEO, I sent bread with sesame seeds for my daughter who had a child in her class with sesame allergy when teachers had asked parents to not send in bread with sesame. In my rush to make lunches for my children one Monday morning, I forgot. My daughter was very upset with me!

In childcare and early primary school years, we encourage communication with parents/guardians in classes that have a student with food allergies about not sending ‘messy’ foods that contain the student’s food allergens where possible. For example, sliced cheese is less messy and therefore less risk than grated cheese. Staff need to be aware of students who are eating food that can be messy (such as egg sandwiches, milk in tetra packs or yoghurt tubs/pouches) and be prepared to clean appropriately. If there is a child with a peanut allergy in a class, it is reasonable to ask that peanut butter not be sent to that classroom, if possible. It is very sticky/greasy and difficult to remove from surfaces. There can be some reasonable food restrictions, but this isn’t the same as a food ban. We must not think that a food has ever really been banned or removed completely. If we think the food has been removed from the class/school/childcare, we may not think all the other risk minimisation strategies are necessary but these strategies are vital for the safety of our children.

Our focus needs to be on how we can manage to keep our children safe - how to cross that road safely. We must step ahead and educate our children from an early age so that they can eventually learn how to care for themselves.

Safety strategies or ways we can help keep children safe include:

  • Always eating food that mum or dad or a trusted adult have packed from home.

  • Children with food allergy never accepting food from their friends/classmates.

  • Teachers always talking with parents about activities that involve food, excursions etc at least a week ahead so parents can help come up with a safety plan for their child.

  • Children always washing hands before eating if they have food allergy.

  • Parents and teachers always having children in the care of people who know they have an allergy, can recognise signs of an allergic reaction and know how to use the adrenaline (epinephrine) injector (EpiPen® or Anapen®) in an emergency.

  • Always having the adrenaline injector easily accessible.

  • Having an individualised ASCIA Action Plan for Anaphylaxis with the child’s adrenaline injector/s.

  • Minimising the amount of allergen where possible, especially in early years as the child is learning to care for themselves. For example, ask parents not to send peanut butter, egg sandwiches or messy yoghurt pouches if there is a child in that class with an allergy to that food (this is only one of many strategies that will help keep the young child with food allergy safe).

  • Separating children with food that contains the allergen in younger age groups. Try to move the children without food allergy so it is not always the child with food allergy who sits at a separate table.

  • Children who eat food that one of their classmates is allergic to washing their hands after eating.

  • Having children eat in a supervised eating area before they go out to play in playground.

  • Parents providing special ‘safe’ treats for their child with food allergy.

  • Teachers considering non-food rewards at school/childcare.

  • Ensuring staff have anaphylaxis training (including recognition and emergency treatment of anaphylaxis). Click here for free ASCIA e-training.

  • Educating other children on the seriousness of food and insect allergy and what they can do to help keep their classmates safe.

  • Giving out bookmarks and other resources available from Allergy & Anaphylaxis Australia’s online shop. 

  • Keep up to date with the latest Best Practice Guidelines for anaphylaxis prevention and management in schools and children’s education and care services found on the Allergy Aware website.

The list of things we can do to help increase safety of children with food allergy goes on and on. The list is different depending on each child, their allergies, their age, their level of maturity and responsibility and so on. As adults we must do what we can for our children to help them become independent and learn to look after themselves in a world where there are peanuts, milk and eggs … and they do have to cross busy roads.

Maria Said AM

Mother of son aged 33 years who has food allergy, asthma, allergic rhinitis, and eczema. He lives a full life and is now a dad of twins!

Updated January 2024