Dealing with Allergic Reactions in Child Care – eXtension Alliance for Better Child Care

Food allergies are relatively common among children in child care programs. To keep everyone in the child care facility safe and healthy, child care providers must be informed about allergies and be prepared to deal with allergic reactions. Many allergic reactions are minor, but some reactions can be dangerous or even life-threatening, depending on the response of the individual’s immune system. To avoid as many allergic reactions as possible, child care providers should prepare, plan, and know children’s history of allergic reactions.

Preparing to Handle Allergic Reactions in a Child Care Setting

Individuals can have allergic reactions to foods, medications, animal dander, bee stings, plants, and pollens. Being prepared for allergic reasons is a major way child care facilities can keep children safe. To be allergy-safe, child care providers must:

Ask about allergies: When parents enroll their child in a child care program, the director or child care providers should ask specific questions about that child’s known allergies. Have parents specify any foods, medications, or other allergens (such as bee stings) that cause allergic reactions in the child. Ask for specific information about the symptoms the child typically displays. It is best to get this information in writing to add to the child’s file. Update the information at least once a year, or whenever there is a change in a child’s allergy status.
Plan with parents: If a child has a known allergy, work with parents to create a plan of action in case that child has an allergic reaction, based on the recommendations from the child’s doctor. If medication is required, have the parents supply that medication. Be sure parents complete an authorization form specifying when the child care provider should administer the medication and in what dose.
Prepare staff members: Ensure that every staff member knows and understands the plan of action in the case of an allergic reaction. This includes posting a list of foods and other allergens that each child is allergic to, knowing the signs and symptoms of an allergic reaction, and knowing the location of the child’s epinephrine injector or other medication and how to use it properly. Every child should have access to a staff member who is certified in CPR and first aid in case of a severe allergic reaction. If a child’s allergy is severe enough to require an epinephrine injector, be sure child care providers can access it quickly. Store each child’s auto-injector in a secure location (out of children’s reach) where all staff have quick access.
Prepare the environment: Store food out of the reach of young children. Clean and sanitize surfaces before and after children eat. See that children and adults wash their hands before and after eating and after coming in from outdoor play. Set rules prohibiting certain foods if a child in your child care setting is highly allergic. For example, many child care facilities are “nut free” due to a large number of peanut and tree nut allergies.
Know your state’s child care licensing regulations: Most states have specific rules and regulations for child care providers when administering medications to children. Check your state licensing agency’s website for more information, and contact the licensing representative if you have questions.

Symptoms of an Allergic Reaction

Most allergic reactions can be treated at the child care center without hospital help. It is very important for child care providers to know the signs and symptoms of an allergic reaction so that they can respond as quickly as possible. As soon as a child care provider notices symptoms of an allergic reaction, he or she should follow through with the action plan previously agreed on by the child’s parents and doctor. The most common symptoms of an allergic reaction are:

Stomach: vomiting, nausea, abdominal pain, diarrhea.
Breathing: wheezing; difficulty breathing; cough; throat or chest tightness.
Skin rashes: hives, itchy rashes, or red patches on the skin.
Other: difficulty swallowing; runny nose; itchy, watery, or bloodshot eyes; sneezing; anxiety; headache; feeling faint; fatigue.
Anaphylaxis: signs of shock (low blood pressure; skin that is pale or red, sweaty, or dry; confusion, anxiety, or unconsciousness); difficult or noisy breathing .

Anaphylaxis refers to a combination of allergic reaction symptoms that are sudden and potentially life-threatening. If you suspect a child is experiencing anaphylatic shock, call 911 immediately.

Treating a Severe Allergic Reaction

Most severe allergic reactions happen within seconds or minutes after exposure to the allergen. An allergic reaction should be considered severe if an individual experiences sudden or rapidly worsening symptoms; swelling of the lips, tongue, or throat; widespread rash or severe hives; vomiting; or unconsciousness. Call an ambulance if any of these symptoms occur.

Child care providers should be prepared to respond immediately when a child has an allergic reaction by following the action plan previously agreed upon with the child’s parent. If a child is experiencing a severe allergic reaction, the following steps should be included in the action plan:

Inject epinephrine (using an auto-injector) into the muscle of the outer thigh. To administer epinephrine to a child, it may be easier to place the child on your lap so that you can easily access the child’s outer thigh. Follow the instructions on the auto-injector packaging.
Call 911 and explain that the child is having a severe allergic reaction. The emergency dispatcher may ask you to describe the child’s symptoms.
Lay the child down unless he or she is vomiting or having difficulty breathing.
If symptoms do not improve or another severe reaction occurs, the child care provider may administer a second dose of epinephrine.
Contact the child’s parents or other emergency contacts and let them know about the reaction, the steps the child care staff have taken, and the next steps required.
Make sure an ambulance is on its way, or take the child to the hospital.
Be sure to bring the child’s medical information and release form to the hospital.

For More Information

To learn more about food allergies and food safety, see the following eXtension Alliance for Better Child Care articles:

Photo by Greg Friese/ CC BY https://creativecommons.org/licenses/by/2.0/