When I worked in childcare, we had at any given time, one or two kids with a potentially life threatening (anaphylactic) food allergy in our care. In all cases, the kids were allergic to nuts—peanuts and tree nuts—and at a nut-free centre, we never experienced any issues for these children. This is how it should be! Other than on occasion having to carry a kid’s EpiPen belt when we were on a field trip at a waterpark (where otherwise it was attached to them), or checking random ingredient lists on my own work lunch foods or—on occasion—that of the kids in our care, we were extremely diligent, cautious, and prepared, but we had no issues with these kids. Again: this is how it should be. Food allergies are a big deal, always, but if proper precautions are taken by those surrounding the child with the allergy, in keeping the person’s environment free of the food or substance they are allergic to, that person is perfectly healthy.  So, how do we keep kids with food allergies that way at school? By being cautious and careful and teaching them to do the same!

At school, or daycare, or camp, or ANYWHERE, children should have a food allergy plan to follow, both outlining how reactions will be prevented (an allergy management plan) as well as what to do in an emergency (a food allergy or anaphylaxis action plan). These plans ensure that those responsible for their health and safety—caregivers, even if not parents, including teachers, principals, camp staff, or grandparents for a few examples—have no doubts about their responsibilities.

Keeping kids with food allergies safe

• Typically, special cleaning procedures are not required beyond that which would be considered normal for the environment. For instance, peanut oils/residue are documented to wash off hands and surfaces with just normal soap and water. [1] As most childcare centres and schools should be cleaning tables with soap/water and then a bleach spray, this should be enough to eradicate allergens present in trace amounts. These precautions should be sufficient for most allergens. [2]
• While many schools and childcare centres have blanket nut-free policies, or similar policies for when children with life threatening food allergy are in their care, recent evidence does not consider this to be any more effective than having an “allergy aware” table where children who sit with the child with food allergies must have allergen-free meals specific to the child with the allergy. [1] The exceptions to this are of course, very young children with high levels of physical contact, and individuals with developmental/intellectual disabilities that do not understand the gravity of their allergy. [1]
• Posting signs on classroom doors that make people aware of allergens is always a good idea, regardless of protocols in place for avoidance.
• Children and adults with life threatening food allergies should always wear a medical ID bracelet or medical ID necklace for food allergy or anaphylaxis.
  • Medical ID jewelry should, at minimum, read ALLERGIC or ANAPHYLACTIC TO [insert food or substance here],GIVE EPINEPHRINE, CALL 911
• Epinephrine auto-injectors if prescribed should always be carried by the person with the allergy. School protocols may have different requirements for very young children or those with disabilities. The only treatment for anaphylaxis is epinephrine: oral allergy medicines will not help a severe allergic reaction. [1]
  • A medical ID key chain for backpacks or purses of children who keep epinephrine in their bag may help to locate auto-injectors more quickly in an emergency.
• Even if there is only mild suspicion that a substance a person allergic to has been consumed, epinephrine should always be given—err on the side of caution!
• Other students, children’s friends, and school/childcare staff should be educated as appropriate about the child’s allergy and how to identify symptoms. This should be included in the Food Allergy Action Plan. Children should be taught to inform an adult immediately if they are concerned.

A few hours before writing this, I was on a conference call when we heard the leader’s phone jingling in the background. She excused herself and we continued discussing. Her teenage daughter was calling as she’d just eaten a peanut at school. With a history of food allergy, her teacher immediately responded in the right way: gave her epinephrine, called 911, and then the daughter alerted her mom—breathing completely fine, but waiting for the ambulance as should always be done as precaution even for a suspected allergic reaction and epinephrine injection, even though she had no evident symptoms. With remarkable calm, the mom continued on with the conference call—fifteen minutes later another call came with details of which hospital the kid was headed to. Because her teacher was well informed and followed the action plan and protocol “by the book”, we adjourned the call with well wishes, concern, but feeling reasonably assured things would be okay. Food allergies and anaphylaxis are scary, but with a straight-forward plan, thankfully, fatal reactions are most often preventable with epinephrine and medical care.