Managing Chronic Health Needs in Child Care and Schools—Anaphylaxis

Medications

• Anaphylaxis is treated with injected epinephrine, which is commonly packaged in an automatically injected device like EpiPen or EpiPen Jr. The pen is pressed against the skin (usually the thigh) and activated.

• Always call EMS/911 when injected epinephrine is used.

• Always call parents/guardians and tell them what hospital the child has been transported to.

• Injected epinephrine is effective for 15 to 20 minutes. It may need to be used a second time if EMS/911 are not able to respond quickly.

  • Side effects of epinephrine include pallor, vomiting, fast heart rate, and jitteriness.

• There may be instructions to use other medications as well for allergies such as diphenhydramine (Benadryl is one brand name).

  • Side effects of diphenhydramine include sleepiness, but some children may experience excitement.

• All medications should be properly stored. Procedures should be in place to check expiration dates and obtain fresh medication as needed.

• Staff training on EpiPen and Benadryl use is very important.

Dietary considerations

• Avoiding foods that cause anaphylaxis for the involved child is crucial. Some foods that are common allergens include peanuts, tree nuts, soy, eggs, and milk. It is not easy to avoid peanuts because peanut oil is in many products. Cross contamination can occur when foods are processed and packaged. Strategies include starting a table that has whatever food restriction is necessary or making the classroom and any other areas the child uses free of the allergen. In some cases, strict hand-washing precautions after eating or avoiding the offending food must involve all the children who share the spaces that the allergic child uses to protect the allergic child from exposure to the allergen while at the child care or school. Even touching a surface touched by a child who has had contact with the allergen can be sufficient to cause a reaction for very sensitive children. Using specially marked place mats to remind caregivers which child has a food allergy can be helpful, but it does not stop children from sharing food.

• In some cases, it is best for parents/guardians to supply food for the child with the allergy. In other cases, the child care/school staff may be able to provide food as long as they have been fully educated about avoiding specific food allergens.

• A policy about accepting foods from parents/guardians should be maintained (see Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs, 2nd Edition, Standard 4.040). Parents/guardians of all the children in the child's class should be advised to avoid any known allergens in any treats that they supply to the class.

• Store-bought or commercial products are acceptable as long as the package list of ingredients is provided. Parents of children with food allergies are usually very willing to take time to read these ingredients to ensure the safety of their children.

• The American Academy of Allergy, Asthma & Immunology position paper, "Anaphylaxis in Schools and Other Child-Care Settings" (www.aaaai.org/members/academy_statements/position_statements/ps34.asp), states, "...hand washing after food handling should be encouraged in day care and preschool settings, as well as in lower schools." Soap and warm water should be sufficient for washing (see Caring for Our Children, 2nd Edition, standards 3.020–3.021).

• A list of children with any known allergies should be posted where it can be easily seen by staff but not by the public and other children.

Physical environment

The key adaptation to avoiding anaphylaxis is to try to avoid the allergen. This may mean

• Avoiding products with latex or those with strong perfumes.

• Being extra cautious during outside play if stinging insects are around, and avoiding eating outside. Encourage closed-toe shoes in children with known allergies.

• Avoiding food allergens. In some cases, just physical contact with the food can cause a reaction even if the child doesn't eat it.

Transportation considerations

• Injectable epinephrine should be available as the child is transported to and from child care or school. For field trips, the injectable epinephrine and someone who can administer it should be available. A mobile phone and a copy of the child's Care Plan should be carried at all times.

• In emergency evacuation situations, injectable epinephrine should be carried.