Approaching the management of anaphylaxis in schools/childcare
Insights from A&AA’s CEO.
Life has many dangers. We are taught how to live safely and be responsible beings. 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 nuts 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 cross the road. We can NEVER eliminate the risk of injury completely, but we can certainly educate 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 to make it safer. Someone at risk of anaphylaxis is always at risk but we as parents, as 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 implement strategies that address the overall, long-term management of severe allergy. I encourage people with young children to minimise the allergen as part of an overall management plan. Beware of ‘banning’ food from a childcare or school environment. Implementing this 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 almost 30 years of working with school and childcare environments, 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? Relying on a food ban to keep our children safe means that we may not be utilising all the other risk minimisation strategies.
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 peanut ban meant the environment was safe. Can we ever completely remove peanut or egg or wheat from a school or childcare environment. 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 school. It is very sticky 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 assume that a food has ever really been banned or removed totally. If we think the food has been removed from the environment, we may not think all the other risk minimisation measures are necessary but these measures 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.
- Always eat food that mum or dad has packed from home.
- Do not accept food from your friends/classmates
- Always wash your hands before eating if you have food allergy. All children should wash hands before eating as part of normal hygiene.
- Always have children in the care of people who know they have an allergy, can recognise signs of a reaction and know how to use the adrenaline(epinephrine) injector (EpiPen® or Anapen®) in an emergency.
- Always have the adrenaline injector easily accessible.
- Have an individualised ASCIA Action Plan for Anaphylaxis with the adrenaline injector/s.
- Minimise the allergen where possible. For example, ask parents not to send peanut butter, egg sandwiches or milk shakes (this is one of many strategies that will help keep the young child with food allergy safe).
- Separate 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 should wash their hands after eating.
- Have children eat in a supervised designated area before they go out to play in playground.
- Provide special ‘safe’ treats for your child and encourage non-food rewards at school/childcare where possible.
- Educate all staff on food and insect allergy (including recognition and emergency treatment of anaphylaxis) and the special needs of particular children.
- Make sure staff have had specific Anaphylaxis Training. Click here for free ASCIA e-training.
- Educate other children on the seriousness of food and insect allergy and what they can do to help keep their friend safe.
- Distribute resource materials available through allergyfacts.org.au and https://allergyaware.org.au/
The list of safety strategies 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 nurture the need for our children to become independent and learn to look after themselves in a world where there are peanuts, wheat and eggs and they do have to cross busy roads.
CEO of A&AA
Mother of son aged 31 years who is allergic to peanut, and has asthma, allergic rhinitis, and eczema. Developed cold urticaria when he was 8 years old and then latex allergy when he was 9 years old. He has since outgrown both his latex allergy and cold urticaria. He lives a full life as a police officer always carrying his two adrenaline injectors in case of accidentally eating peanut.