Allergies and Child Care

Created by Pettengill Academy for use in our child care centers.

Resource used was the CDC Voluntary Guidelines for managing Food Allergies in Schools and Early Care and Education Program.

About AllergiesA allergy is defined as an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given allergen.

The following 8 foods or food groups account for 90% of serious allergic reaction: milk, eggs, fish, crustacean shellfish, wheat, soy, peanuts and tree nuts.

Some non-food products can contain allergens such as clay, paints, and paste.

Symptoms of an Allergic Reaction

Mucous Membrane Symptoms: red, watery eyes or swollen lip, tongue or eyes.

Skin Symptoms: flushing, rash or hives.

Gastrointestinal Symptoms: nausea, cramping, vomiting, diarrhea, or acid reflux.

Upper Respiratory: nasal congestion, sneezing,hoarse voice, trouble swallowing, dry staccato cough, or numbness around mouth.

Lower Respiratory Symptoms: deep cough, wheezing, shortness of breath, or difficulty breathing or chest tightness.

Cardiovascular Symptoms: pale or blue skin color, weak pulse, dizziness, or fainting, confusion or shock, hypotension or loss of consciousness.

Mental or Emotional Symptoms: sense of impending doom, irritability, change in alertness, mood change, or confusion.

Fatal Allergy ReactionsRisk Factors:

Delayed administration of epinephrine.

Reliance on oral antihistamines alone to treat symptoms.

Consuming alcohol and allergen at the same time.

Groups at higher risk: Adolescents and young adults, children with known allergy, children with a prior history of anaphylaxis.

Children with asthma, particularly those with poorly controlled asthma.

Timing of SymptomsAllergens typically occur within several minutes to several hours after exposure. Death due to exposure may occur 30 minutes to 2 hours after.

Symptoms of anaphylaxis can be mild skin symptoms that progress slowly, appear rapidly with more severe symptoms or with shock in the absence of no symptoms.

Up to 20% of anaphylactic shock reactions recur after 4-8 hours.

Using EpinephrineNo treatments exist to prevent reactions to food allergens other than avoidance. However, avoidance isn’t always possible.

First Line of Treat of Anaphylaxis is the use of Epinephrine.

Epinephrine rapidly improves breathing, increases heart rate and reduces swelling of the face, lips, and throat.

No guidelines for use of epinephrine to treat an allergic reaction other than clinical experience and judgement to recognize symptoms.

Effects of Allergies and Behaviors

Studies are showing a link between allergies having an effect on learning and behavior.

One of the side effects of allergies is chronic congestion.

Chronic ear infections have a negative impact on hearing and as we all know, hearing is critical to both learning and behavior.

It can cause digestive discomfort and malfunction leading to long trips to the bathroom that pull kids out of class.

It can disrupt the respiratory system and leads to difficulty breathing.

Inflammation can disrupt information processing, interrupts reading and direction comprehension; disrupts attention span, which is why many kids with hidden allergies are misdiagnosed with ADHD.

It also messes with neurotransmitters which are responsible for emotional and behavioral responses, and is what leads to the inability to sit still or creates emotional outbursts.

Source: http://ilslearningcorner.com

Pettengill Academy’s Allergy Management Plan

Step 1: Identify At time of enrollment, parents will be required to fill out a Allergy Health Care Plan that needs to be signed by the child’s physician. This form will be placed in the child’s file, in the child’s classroom (green binder) and also in the kitchen.

We will ask parents to have the child wear a medical id bracelet but not require it.

PreventionWhen identified, the classroom teachers and kitchen will be given a index card with the child’s name and allergy written on it. Along with the allergy plan. Place card in the front of the binder for quick viewing.

In the kitchen, the child’s initials and allergy written on the big board under their classroom. This will also be done in the cafe. This will be done for both food and non-food allergies.

If the allergy is severe with contact, we will set up an allergy free seating area for meal times. With infants we will assign an allergy free high chair.

Check classroom supplies for allergens (paints, play dough etc.) If a child is allergic to certain types of hand soaps, we will ask parents to supply proper soap for their child. Latex gloves will not be used, along with latex balloons with the class that has the allergen risk.

Check food labels before prep and serving.

If parents bring food from home to share, ask them to bring in a list of ingredients.

If parents wish, continue to allow them to bring their own foods to guarantee what their child is eating. We give menus ahead of time to families through Bright Wheel.

Prevention

Encourage children to wash hands after meals.

Wash all tables and chairs before and after each meal.

Keep food labels from all foods for 24 hours after serving the food in case of reaction. Place in a magnet clip on fridge.

Require all families to bring in their own sunscreens, bug sprays and diaper creams. Families will fill out a form giving staff permissions to apply on their child.

If child is severely allergic to outdoor environment allergen, epinephrine will be brought outdoors with them.

Prevention

Emergency Plan

Parents are required to supply any required medications and emergency epinephrine.

All emergency medications are stored in the cabinet behind the director’s desk in the locked box.

If a severe reaction causes the use of epinephrine, the center must call 911. Tell 911 that the emergency is due to a reaction, epinephrine was used and when it was used.

If a child was exposed to an allergen, and there is so not a medical emergency, the parents need to be contacted with an explanation of symptoms. The staff then documents the incident on a incident report.

Emergency Plan

In the case of an emergency, the lead class teacher tends to the child while the director calls 911 and/or parents. The assistant teacher will tend to the other children.

After the child is tended too and everything is clear, the director, the teacher and other witnesses will write an incident report on the occurrence.

Emergency Plan

If an allergic reaction happens to a child with no previous history of allergies but is showing signs of symptoms, contact parents immediately and explain the symptoms and what the child has been exposed to.

If the child is showing signs of anaphylaxis, contact 911 immediately. Lead classroom teacher tends to the child, the director calls 911 and/or parents, and the assistant teacher tends to the other children.

Emergency Plan

Document all reactions: Time and Location, food allergen that triggered the reaction, if epinephrine was used and time used, notification of parents and EMS and staff members who responded to the emergency.

Emergency Plan

24 Hours After:

Call parent to follow up on the child’s condition, review the episode with the parents such as symptoms, review actions taken, positive and negative outcomes, discuss revisions needed based on outcomes, ask to replace Epinedrine dose, if it was used.

Emergency Plan

Signs of Anaphylaxis

How to use an Epi-Pen

How to Read a Food Label

The Food Allergen Labeling and Consumer Protection Act (FALCPA), which took effect January 1, 2006, requires that the labels of foods (including conventional foods, dietary supplements, infant formula, and medical foods) containing major food allergens (milk, eggs, fish, crustacean shellfish, peanuts, tree nuts, wheat and soy) note the allergen in plain language, either in the ingredient list or via:

• the word “Contains” followed by the name of the major food allergen – for example, “Contains milk, wheat” – OR

• in the ingredient list in parentheses – for example, “albumin (egg)”

Manufacturers must list the specific nut (e.g., almond, walnut, cashew) or seafood (e.g., tuna, salmon, shrimp, lobster) that is used.

The use of advisory labeling (i.e., precautionary statements such as “may contain,” “processed in a facility that also processes,” or “made on equipment with”) is voluntary and optional for manufacturers. If you are unsure whether or not a product could be contaminated, you should call the manufacturer to ask about their ingredients and manufacturing practices.

For a Milk Free Diet These foods may contain milk

• Artificial butter flavor • Butter, butter fat, butter oil • Casein, casein hydrolysates  • Caseinates (ammonium, calcium, magnesium,

potassium, sodium) • Cheese, cottage cheese • Cream • Custard, pudding • Ghee • Half and Half • Hydrolysates (casein, milk protein, protein, whey,

whey protein) • Lactalbumin, lactalbumin phosphate • Lactoglobulin, lactoferrin  • Lactose, lactulose  • Milk • Derivative, protein, solids, malted, condensed,

evaporated, or dry • Whole, low-fat, nonfat, skim • Goat's milk and milk from other animals • Nisin • Nougat • Recaldent • Rennet casein • Sour cream or sour cream solids • Whey (delactosed, demineralized, protein

concentrate) • Yogurt

• Brown sugar flavoring • Caramel flavoring • Chocolate • Flavorings (natural and artificial)  • High protein flour • Lactose • Luncheon meats, hot dogs, sausages  • Margarine • Simplesse

For an Egg Free Diet These foods may contain eggs

• Albumin • Egg white • Egg yolk • Dried egg • Egg powder • Egg solids • Egg substitutes • Globulin • Livetin • Lysozyme (used in Europe) • Mayonnaise • Meringue • Ovalbumin • Ovomucin • Ovomucoid • Ovovitellin • Simplesse

• A shiny glaze or yellow-colored baked goods may indicate the presence of egg. • Egg white and shells may be used as clarifying agents in soup stocks,

consommes, bouillons, and coffees.

For a Wheat Free Diet These foods may contain wheat.

• Bran • Bread crumbs • Bulgur • Cereal extract • Couscous • Cracker meal • Durum • Einkorn • Emmer • Farina • Flour (enriched, graham, high-gluten, high-protein, whole-wheat) • Gluten • Matzoh, matzoh meal  • Pasta • Seitan • Semolina • Spelt • Vital gluten • What berries, bran, germ, gluten, grass, malt, sprouted, starch

• Gelatinized starch • Gum • Hydrolyzed vegetable protein • Kamut • Modified food starch • Modified starch • Natural flavoring • Soy sauce • Starch • Surimi • Vegetable starch

For a Soy Free Diet These foods may contain Soy

• Hydrolyzed soy protein • Miso • Edamame • Natto • Soy albumin • Soy cheese • Soy fiber • Soy yogurt • Soy ice cream • Soy bean (curd, granules) • Shoyo sauce • Soy flour • Soy grits • Soy nuts • Soy milk • Soy sprouts • Soy protein concentrate • Soy protein isolate • Soy protein hydrolyzed • Soy sauce • Tamari • Tempeh • Textured vegetable protein (TVP) • Tofu

• Asian cuisine • Flavorings • Hydrolyzed plant protein • Hydrolyzed vegetable protein • Natural flavoring • Vegetable broth • Vegetable gum • Vegetable starch  • Flavorings may be soy-based • Vitamin E contains soybean oil • Hydrolyzed plant and hydrolyzed vegetable protein are likely to be soy

For A Shellfish Free Diet These foods may contain shellfish

• Abalone • Clams, such as cherrystone, littleneck, pismo, and quahog • Crab • Crawfish, crayfish, écrevisse  • Lobster, langouste, langoustine, scampi, coral, tomalley • Mollusks • Mussels • Squid, snail • Oysters • Octopus • Scallops • Shrimp, prawns, crevette

These foods may contain shellfish: • Bouillabaisse • Cuttlefish ink • Fish stock • Seafood flavoring • Glucosamine • Seafood flavoring • Surimi

For a Tree-Nut Free Diet These foods may contain Tree-nuts

• Almonds • Beechnuts • Brazil nuts • Butternuts • Caponata (seafood salad with pine nuts) • Cashews • Chestnuts • Coconut • Filberts or hazelnuts • Gianduja (mixture of chocolate and toasted nuts in premium or imported chocolate) • Gingko nuts • Hickory nuts • Lychee nuts • Macadamia nuts • Marzipan/almond paste • Natural nut extract • Nougat • Nu-Nuts artificial nuts • Nut butters (for example, cashew or almond butter) • Nutella (a hazelnut spread) • Nut oil • Nut pastes (for example, almond paste) • Pecans • Pesto with pine nuts • Pine nuts (pignolia) • Pistachios • Praline • Walnuts

• Nu-Nuts artificial nuts are peanuts that have been deflavored and reflavored with a nut-like pecan or walnut.

• Avoid natural extracts, such as pure almond extract, and natural wintergreen extract.

• Ethnic foods, commercially-prepared baked goods, and candy can be cross-contaminated with nuts.

• Tree nuts are being added to an increasing variety of foods. These include barbecue sauces, cereals, crackers, and ice creams.

For Peanut Free Diet These foods may contain Peanuts

• Artificial nuts (Nu-Nuts) • Beer nuts • Ground nuts • Mixed nuts • Monkey nuts • Peanut butter • Peanut flour • Peanut oil

• African, Chinese, Mexican, Thai, and other ethnic dishes • Baked goods • Candy • Cereals • Chili, spaghetti sauce • Crackers • Egg rolls • Enchilada sauce • Flavoring (natural and artificial)  • Hydrolyzed plant protein • Hydrolyzed vegetable protein • Ice creams, frozen yogurts, Tofutti • Marzipan • Nougat

For Fish Free Diet These foods may contain Fish

Foods to Avoid with a Fish Allergy:

Anchovies Bass Catfish Cod Flounder Grouper Haddock Hake Halibut Herring Mahi Mahi  Perch Pike Pollock Salmon Scrod Swordfish Sole Snapper Tilapia Trout Tuna

Foods that Commonly Containing Fish:

Caesar salad dressing Worcestershire sauce Ceviche (fish or shellfish "cooked" in an acidic citrus marinade) Caviar Gelatin (when made from the skin and bone of fish) Cioppino (a fish stew) Nam pla (Thai fish sauce) Bouillabaisse (a fish stew) Fumet (fish stock) Surimi (an imitation or artificial fish or shellfish) Pissaladière (an open tart that looks like pizza; made with

anchovies) Omega-3 supplements  Caponata (eggplant relish)