Webinar: Managing your child’s food allergy in childcare service

Do you have a child in a children’s education and care service?

In 2022, Allergy and Anaphylaxis Australia (A&AA) partnered with the National Allergy Council to hold a webinar about how to manage food allergies and anaphylaxis in children’s education and care (CEC) services such as childcare centres, preschools, and long day care. The webinar includes a short presentation from Dr Katie Frith, paediatric clinical immunology/allergy specialist and Ms Maria Said AM, CEO of Allergy & Anaphylaxis Australia and Co-chair of the National Allergy Council. This is followed by a question and answer session, including answers from Dr Merryn Netting, an experienced allergy dietitian.

Webinar Details

Recorded: 23 March 2021

Managing your child’s food allergy in childcare – Full webinar

Questions

1. Can my child have an allergic reaction if another child has had peanut butter on their hands and they’re playing with the same equipment? (watch at 30:04)
2. We’re repeatedly given action plans from parents that are in black and white. We ask for a coloured plan as per the Allergy Aware website or give a colored blank plan to give to a doctor. But parents have difficulty getting repeat appointments and often they don’t want to go back to get these completed. Can we use the black and white plan or should we insist on a coloured plan? (watch at 33:12)
3. My child has a milk allergy and they’ve already had one reaction in childcare because they were given milk. I’ve asked the centre to go milk-free, but they won’t. (watch at 37:48)
4. The centre will outsource a chef to cook all the foods which will be delivered to the centre. They do not allow families to bring in food. My child is anaphylactic to wheat, peanuts, tree nuts, and egg, and highly sensitive. Is it unreasonable to compromise and ask that they will eat food cooked from home? (watch at 39:01)
5. Will a child having a mild to moderate reaction regularly through contact with food, through contact on play equipment and things, and ingesting traces on toy surfaces increase the severity of their allergy? (watch at 44:06)
6. Can the severity of a child’s food allergy change over time? If it’s a low allergy can this increase? Can a child ‘outgrow’ an allergy?
   • Yes, allergies can evolve over time. Some children will outgrow their allergy, which is more common with certain foods such as egg and cow’s milk, while other children will remain allergic. A food allergy that is diagnosed as mild or moderate can change over time, but reactions are also dependent on the amount of allergen ingested, exercise, illness, hormones (menstrual cycle), alcohol and other factors.
7. Can extremes in temperature (such as cold) cause anaphylaxis?
   • Yes, some people have a condition called cold urticaria and a proportion of these people will be at risk of anaphylaxis with exposure to cold environments and potentially cold/ frozen foods. This usually happens with sudden exposure to cold such as swimming in the ocean. This is not a common trigger.
8. At our preschool we have a range of strategies in place to ensure our children with allergies are safe. One of these is storing the children with allergies’ lunch boxes separately. So not in the fridge, but in in a cooler bag. Is this best practice or not necessary?
   • We do not suggest separate storage of lunch boxes is necessary to avoid cross contamination but do advise that the lunch boxes be sealed and labelled with the child’s name and their food allergy. They could be stored in a high section of the fridge to avoid any food/juice dripping on to the lunch boxes. Microbial food safety needs to be considered for all children so foods requiring refrigeration, should be stored in the fridge.
9. My son has anaphylaxis to peanut, egg and milk. He had anaphylaxis at day care recently. The centre is on high alert but is now calling me almost daily to check whether to give an antihistamine for hives. I have suggested giving the antihistamine to my child before they go outside, which is every day really. Would you recommend giving antihistamine to prevent hives in this way?
   • No, giving antihistamines regularly in this way to prevent hives caused by exposure to food allergens, is not recommended. Antihistamines will not prevent anaphylaxis. It is important that the childcare service is aware of any potential exposures and for them to review their allergen risk minimisation strategies as an Allergy Aware approach will help to reduce your child’s risk of being accidentally exposed to their allergens.
10. I teach first aid in an education and care setting. What is the best way for me to explain antihistamine doesn’t stop anaphylaxis, but is often part of the action plan?
    • Antihistamine is helpful to treat the skin and gut symptoms of an allergic reaction. These are considered mild to moderate symptoms only for food allergy (gut symptoms for insect allergy is a severe symptom). Antihistamine is given as a comfort measure and will not treat or prevent anaphylaxis. Antihistamines do not treat or stop respiratory or cardiac symptoms, which are severe symptoms. Adrenaline is the first line medication for treating anaphylaxis. If anaphylaxis resolves (gets better) without adrenaline being given, it would have resolved whether antihistamine was given or not. Always remember that if antihistamines are given, they should be non-sedating antihistamines. Sedating antihistamines can make the patient drowsy which can then be confused with symptoms of anaphylaxis.
11. Could you please clarify food products that say they may have traces of tree nuts which can be found in food products but not found in the ingredients?
    • By law, packaged foods must include the common food allergens if they are an ingredient, additive, or processing aid in the food. However, where unintentional presence of a food allergen occurs (through cross contamination), a precautionary allergen labelling (PAL) statement may be used, such as ‘may contain traces’ or ‘may be present’. The PAL statement is voluntary and not required by law and the wording is not regulated either.
12. I am a food provider at a school and find the separation of meals sometimes makes the students feel uncomfortable. Is there any suggestion on how to make them feel comfortable? We generally pack, seal and label any dietary needs at mealtimes.
    • The main reason for separating foods for students with food allergies is to avoid cross contamination with other foods. You should have good processes in place to prevent cross contamination of food for students with food allergy. If you have good processes in place, then the degree of separation required can be considered. For example, if you are serving food from a Bain Marie, then you may have one tray that has all the food for students with food allergy packed and labelled. While we do not want to make these students feel different, safety is the priority.
13. I’m a first aid trainer, and I always feel concerned when I have childcare kitchen staff come in for anaphylaxis training. Although this training is interesting, given they have little to do with the children, but all to do with food preparation, is there a specific food handling course that deals with allergy and anaphylaxis that I can refer them to?
    • Yes. The National Allergy Strategy provides free online food allergen training. The All about Allergens for Children’s education and care (CEC) course is designed for kitchen staff, educators and teachers gain knowledge and understanding about food allergens, and to develop best practice procedures to make sure that the right food is given to the right child. The course is also applicable to services where all children bring their food to the service. Even when food is being provided, there are still requirements to store food and supervise children eating.

Presenters