A food allergy occurs when the immune system mistakes a protein in a food as a dangerous invader and produces chemicals to protect the body. This triggers an allergic reaction. The symptoms of an allergic reaction vary, but can include difficulty breathing, swelling of the tongue and throat, itching inside the mouth, vomiting, abdominal cramps, diarrhea, hives, and eczema.

In severe cases, a systemic allergic reaction, known as anaphylaxis, can occur. Anaphylaxis is extremely serious and can result in loss of consciousness and even death, but it can be treated with the drug epinephrine.

The primary way to prevent the possibility of an allergic reaction is strict avoidance of the allergy-causing food. Allergic reactions can be triggered by eating the food, contact with the food on a contaminated surface, or, in rare instances, by just being near the food.

Food Allergies in Young Children

Young children, possibly because of their immature immune systems, have the highest incidence of food allergies of any age group. One in 17 children under age three has a food allergy and the most common allergens are cows’ milk, eggs, soybeans, wheat, peanuts, tree nuts (cashews, almonds, pecans, walnuts), fish, and shellfish.

When young children have an allergic reaction, they tend to describe it very differently than adults do. Children may say things like, “My tongue/mouth itches,” or “It (my tongue) feels like there is hair on it,” or even “My tongue (or mouth) is tingling (or burning).” Childcare providers should be alert for this “child language” that can signal an allergic reaction.

Food Allergies and Childcare

A child could have a first allergic reaction while in your care, so you must be prepared to react quickly and effectively. Food allergy training should be required for all childcare staff, even if a childcare program has no enrolled children with known food allergies.

Training should be conducted by a childcare health consultant or other healthcare provider. Include information on preventing exposure to the specific allergic food, recognizing the symptoms of allergic reactions, and treating allergic reactions.

Regulations, Recommendations and Documentation

Caring for our Children: National Health & Safety Performance Standards recommends that each child with a food allergy have a special care plan that includes information about foods that may trigger an allergic reaction, steps for avoiding the food, and a treatment plan for use in the event of an allergic reaction.

The treatment plan should include the specifics of medication administration for an allergic reaction, including the name of the medication, dose, and how the medication should be administered. The plan also should include possible symptoms of an allergic reaction,  instructions on notifying the parents, and when to contact emergency services.

Childcare programs should have a written policy for food allergies that specifically defines the responsibilities of the child’s family and the childcare program in managing the food allergy. The family’s responsibilities might include providing documentation of the food allergies from the child’s physician, providing instructions that need to be taken for avoiding the allergic foods, and supplying the doctor’s order for medication administration.

Childcare programs will provide food allergy training to staff that includes emergency procedures, developing policies and procedures to prevent food-allergic reactions, communicating their policies to families so that they are understood and adhered to, maintaining required documentation about the child’s food allergies, and taking appropriate steps to keep the allergic foods away from the child.

The specifics of a child’s food allergies, along with up-to-date documentation, should be maintained in the child’s records. Any forms and correspondence between the childcare program, the child’s family, and the child’s healthcare provider should be included along with any other relevant information.

The childcare program should post a list of children and their food allergies, along with acceptable substitutions, in the food preparation and serving areas where it can easily be accessed by appropriate staff. A list of children and their food allergies also should be posted in their rooms so that all staff members (including substitutes) can reference it, but in a manner that confidentiality is maintained to the degree possible. All staff members should know where emergency medication is located and how to correctly administer it.

Planning Menus and Serving Food

Management of a food allergy requires careful menu planning. Programs which provide meals and snack for children should work with parents to assure that the child’s nutritional needs are met while avoiding problem foods.

Children who have food allergies can have nutrient deficiencies as a result of foods being eliminated from their diets. When possible, plan menus that help compensate for nutrients that may be lacking in the child’s diet. For instance, a child who is allergic to milk may be able to substitute calcium-fortified orange juice or bread for dairy products.

Everyone involved in preparing and serving food should be vigilant about accommodating food allergies. Ask families for help in developing safe menus for their child. Train staff to carefully read food labels and recognize allergens in ingredient lists.

Organize kitchen space to keep foods for a food-allergic child separate from other foods. For example, you might label pantry and refrigerator shelves that hold foods that are “safe” for the child and then inform all staff of the organization system or post information on the organization system in the pantry area. To prevent cross-contamination, prepare foods for the allergic child first.

It may be difficult for children to understand that sharing, which is usually encouraged, is not allowed when there is a child with a food allergy. Closely supervise children during meals and snacks.

Situations That Require Extra Planning

Young children enjoy field trips and celebrations; for food-allergic children, planning is the key. You might provide a safe food alternative or you may ask the family to bring one, depending on your program policy.

If you will be serving brown-bag lunches clearly mark (and check before serving) the lunch that is prepared for the child. Also, bring signed authorization forms, emergency contact information, action plans, and medication, not only for food-allergic children, but for all children with special needs.

Managing food allergies in childcare programs is a collaborative effort. Staff training, proper documentation, effective and clear communication with families, and careful planning for day-to-day situations, as well as emergencies, will ensure a safe environment.

Marna Holland, EdD
Parent Educator, Asheville City Schools Preschool, Asheville, NC

Resources

The Food Allergy and Anaphylaxis Network (FAAN), 11781 Lee Jackson Hwy., Ste. 60, Fairfax, VA 22033; 800-929-4040; www.foodallergy.org

Internet Resources

Anaphylaxis in schools and child care settings, American Academy of Allergy Asthma and Immunology (AAAI), www.aaaai.org/members/academy_statements/position_statements/ps34.asp

Caring for Our Children: National Health and Safety Performance Standards, National Resource Center for Health and Safety in Child Care and Early Education, nrc.uchsc.edu/CFOC/PDFVersion/list.html

Life-threatening food allergies in school and child care settings, British Columbia Ministry for Children and Families, vancouver.ca/COMMSVCS/socialplanning/initiatives/childcare/PDF/food/FoodAllergiesResource.pdf

That food makes me sick! Managing food allergies and intolerances in early childhood settings, Young Children, tyc.naeyc.org/pdf/Holland.pdf