Anaphylaxis and Allergy Prevention and Management
Guidance for anaphylaxis prevention and management in education and care services
Developed by the National Allergy Strategy, the Best practice guidelines for anaphylaxis prevention and management in children’s education and care launched on 7 October 2021.
While the best practice guidelines are designed to provide guidance to early childhood education and care (ECEC) and outside school hours care (OSHC) services within Australia, services must consider the Children (Education and Care Services) National Law (National Law) and the Education and Care Services National Regulations (National Regulations) in conjunction with this document.
Meal Checkpoint Resource
The NSW Department of Education has developed the Meal Checkpoint Resource to help minimise allergy and anaphylaxis risk in ECEC settings where meals are prepared and served. The risk minimisation tool should be used at mealtimes to ensure a two-person check occurs before serving meals to children diagnosed with allergy and/or anaphylaxis.
ASCIA Action Plans and medical management plans
ASCIA Action Plans are the nationally recognised and standardised medical response plans for people who have diagnosed allergies and/or are at risk of anaphylaxis. ASCIA Action Plans meet the requirements of regulation 90 as a medical management plan and should guide your immediate response and treatment of allergy and anaphylaxis.
New versions of the ASCIA Action Plans were released in June 2023. To improve useability, personal information is now grouped together at the top of the plan and instructions for the management of mild to moderate allergic reactions have been simplified. The general version of the plan now includes colour-coded instructions for both brands of adrenaline injectors. However, device-specific action plans are still available as a choice.
Services are advised to start using the new ASCIA Action Plan in consultation with families and registered medical practitioners, ideally over the next 12 months. Previous versions of ASCIA Action Plans will continue to meet regulatory requirements at this stage.
When updating ASCIA Action Plans, services are encouraged to conduct a thorough review of service-specific policies and procedures to ensure medical management practices are in line with current recommendations and preventative measures are in place to protect children in care.
ASCIA Action Plans for Anaphylaxis (Red) are for children with medically confirmed allergies who have been prescribed adrenaline injectors. EpiPen® and Anapen® are available on the PBS in Australia.
ASCIA Action Plans for Allergic Reactions (Green) are for children with a confirmed allergy who have not been prescribed an adrenaline injector, as they are considered to be at low risk of anaphylaxis.
ASCIA Action Plans for Anaphylaxis (Orange) are general use and can be used as a poster outlining the actions if allergy or anaphylaxis presents in a child who is undiagnosed or has presented symptoms for the first time.
Risk minimisation plans are also required under regulation 90(1)(c)(iii) of the National Regulations. Risk minimisation plans should be developed in consultation with families and identify service-specific risks and strategies to prevent exposure to known allergens. Services must review and update these risks and risk minimisation strategies regularly, particularly when changes in a child’s condition occur, such as changes in known triggers or medical responses. Note: Risk management strategies should be specific to the service environment and individual children’s health needs.
ASCIA Action Plans and risk minimisation plans must be communicated to and followed by all staff. This includes management, educators and casual or relief staff. A communication plan, as required under regulation 90(10(c)(iv), should outline how this communication process will occur and who will be involved.
These required documents should always be readily available within a service.
Requirements under the National Law and Regulations
Regulation 168(2)(d) of the National Regulations require approved providers of ECEC services to have policies and procedures that deal with medical conditions in children.
Regulation 90 of the National Regulations outlines the practices that must be included in medical conditions policies. In particular, practices relating to the management of medical conditions, including asthma, diabetes or a diagnosis that a child is at risk of anaphylaxis. If a child enrolled at a service has a specific health care need, allergy or relevant medical condition, that service is required to have a medical management plan, risk minimisation plan and communication plan.
Regulation 91 of the National Regulations requires the approved provider to provide a copy of the medical conditions policy to the parent of a child enrolled at the service, if the provider is aware that the child has a specific health care need, allergy or other relevant medical condition.
Section 172(f) of the National Law and regulation 173(2)(f) of the National Regulations state that approved providers must ensure the following:
In a centre-based service, a notice is clearly visible to anyone from the main entrance of the service premises stating that a child who has been diagnosed as at risk of anaphylaxis is enrolled at the service.
- In a family day care (FDC) residence or approved venue, a notice is clearly visible to anyone from the main entrance of the service premises stating that a child who has been diagnosed as at risk of anaphylaxis:
- is enrolled at the FDC service
- attends the FDC residence or FDC venue.
The above statements should not identify the child.
ASCIA Action Plans should be easily available to educators and other staff at all times. Parental permission should be sought and documented if a detailed ASCIA Action Plan is displayed in publicly available spaces within the service premises, for example on a classroom wall. If privacy is a concern, the action plan could be kept in a folder in public spaces and stored with the prescribed adrenaline injector.
The First Aid Action Plan for Anaphylaxis (Orange) can be displayed for reference in public areas throughout the service as it does not have children’s personal details on it.
Regulation 94 (Exception to authorisation requirement – anaphylaxis or asthma emergency) of the National Regulations states medication may be administered to a child without an authorisation in case of an anaphylaxis or asthma emergency.
Always follow an ASCIA Action Plan in the case of an allergic reaction. If the child having an allergic reaction has no known allergies, the ASCIA First Aid Plan for Anaphylaxis should be followed and the first aid adrenaline injector given if required.
If medication is administered to a child in case of an anaphylaxis emergency, all required notifications under the National Law and National Regulations must be made. This includes a notification to the parent and/or carer of the child, which would ideally occur as soon as practicable after emergency services have been called.
Regulation 136 (First aid qualifications) of the National Regulations outlines the anaphylaxis management training requirement for ECEC services.
For centre-based services, the approved provider must ensure at least one staff member or one nominated supervisor of the service who has undertaken current approved anaphylaxis management training is:
- in attendance at all times and any place where children are being educated and cared for by the service
- immediately available in an emergency (regulation 136(1)(b)).
Where the service premises is located on a school site, at least one school staff member who has undertaken current approved anaphylaxis management training must be in attendance at the school site and immediately available in an emergency (regulation 136(2)(b)).
- For FDC services, the approved provider must ensure that each FDC educator and FDC educator assistant engaged by or registered with the service has undertaken current approved anaphylaxis management training (regulation 136(3)(b)).
It is strongly recommended that as many staff as possible receive approved anaphylaxis management training to ensure that any allergic reactions are identified and treated early.
Use ACECQA’s qualification checker to check whether your anaphylaxis management training is approved under the National Quality Framework.
First aid adrenaline injectors
The National Law does not require services to have a general use adrenaline injector. However, the National Allergy Strategy best practice guidelines strongly recommend that services have at least one general use adrenaline injector and undertake a risk assessment to determine if additional devices are required. General use adrenaline injectors can be used for a child with no prescribed adrenaline injector who is presenting symptoms of anaphylaxis or if a second dose is required for a child with a prescribed adrenaline injector. General use adrenaline injectors are additional to a child’s prescribed adrenaline injector and not a substitute for prescribed devices. A copy of the ASCIA First Aid Plan for Anaphylaxis (Orange) must be stored with each general use device.
The guidelines recommend services should have a 0.15mg adrenaline injector available as the general use device, as most children would be less than 20kg. OSHC services should have a 0.30mg device. However, services need to consider the age of the children they primarily care for.
Adrenaline injectors do not need to be stored in locked first aid cabinets. They should be easily accessible to staff but out of reach of children.
If a child has an ASCIA Action Plan for Anaphylaxis, one of the child’s prescribed adrenaline injectors and ASCIA Action Plan must be available at the service while they are in attendance.
For older children attending OSHC or vacation care, the child may carry their own adrenaline injector. This is dependent on the parent and child’s preference and the child’s ability to manage their own medication.
It may be unreasonable to ask a family to leave an adrenaline injector at a service if this means the family will be without one at home. Procedures should be established for handover of the child’s medication.
Food allergies
Being an ‘Allergy Aware’ service is an approach encouraged by NSW Health and NSW Department of Education. This approach focuses on implementing a range of appropriate risk minimisation strategies, regardless of the allergen. The National Allergy Strategy best practice guidelines provide a range of possible strategies for minimising risk.
It is not recommended that ECEC services ban food. ECEC services should not claim to be free of any allergen, for example ‘nut free’.
If the children are of a young age (for example, infants or toddlers) or have cognitive impairments limiting their ability to manage their own food allergies, services may implement allergen-restricted zones to reduce the risk that the children will accidentally eat a food allergen. For example, this may be appropriate if there are children eating messy egg meals, grated cheese or drinking milk so they are not sitting next to children with a dairy allergy. Children with a food allergy must not be isolated from others.
Some ECEC services do not include peanuts and tree nuts in their menus as these are not essential foods and can easily be eaten at home. Foods such as wheat, milk (dairy), egg and soy are staple foods providing important nutrition and, therefore, cannot be removed in ECEC services. Allergen-restricted areas are one of many risk management strategies that can be implemented to reduce risk. The food service provider (employed staff or external provider) may choose to remove peanuts and tree nuts from the menu to minimise the risk of accidental exposure through errors or cross contamination.
Where the ECEC service does not provide meals and parents provide food for their children, services may request that food provided by parents does not contain peanuts or tree nuts.
Education for children about allergies, anaphylaxis and the role it plays in their lives forms a key component of an ‘Allergy Aware’ service. Educating children about not sharing food, eating utensils, drink bottles or cups promotes good hygiene skills and aids in minimising risk of allergen exposure. Washing hands after eating is also an important risk management strategy.
The educational program provides many opportunities to address dietary and allergy-aware discussion and activities. Educators should be mindful of food substitutions when planning for activities including cooking experiences and food craft activities.
Resources
- National Allergy Strategy – Best Practice guidelines for anaphylaxis prevention and management in early childhood education and school aged care services
- ASCIA:
- How to administer an adrenaline injector – Anapen and EpiPen
- ASCIA Action, First Aid, Management, Travel and Treatment Plans and Guidelines
- Signs and symptoms of allergic reactions
- Food – other adverse reactions
- All about Allergens – Food preparation and service resources
- Allergy Aware – Examples of anaphylaxis risk minimisation strategies for ECE services
- For additional support, the NSW Anaphylaxis Education Program (NSWAEP) can be contacted through their website, by email SCHN-anaphylaxis@health.nsw.gov.au or phone at 9845 3501.