Minimising children’s risk for allergies and anaphylaxis

Insights and advice on the critical need for services to proactively manage risks related to food allergies.

For over 8 years, Kathryn Mulligan has worked as a Clinical Nurse Specialist at the NSW Anaphylaxis Education Program (NSWAEP), the peak training body for recognition and management of anaphylaxis across the state. The NSWAEP provides free specialised education to ECEC services, schools, health professionals, families and communities.

“Our overarching job is to support children in the community with allergies to say safe,” Kathryn said.

Healthy eating supports children’s learning, growth and development and, under Quality Area 2, ECEC services are responsible for ensuring that healthy eating is promoted and appropriate for each child.

Australian medical professionals agree that allergies and rates of anaphylaxis are increasing, which has caused a rise in hospitalisation rates, with children aged 0-4 now making up nearly 50% of anaphylaxis hospital admissions compared to around 8% in 19991.

“People sometimes wonder if an increase in allergies is real or if we’re just more aware of it, and it is definitely real,” Kathryn said.

Kathryn believes that early childhood educators play a vital role in protecting children with food allergies, with some children having their first allergic reaction in ECEC services.

“We know that 10% of 1-year-olds have confirmed food allergies. So, when you think about the population of children at early childhood education and care services, it’s quite a significant number.”

“This figure drops to about 5% in teen years as children outgrow allergies as they get older. So, the time of greatest allergies is in early childhood.”

Data from October 2021 to April 2022 shows that around 36% of allergic reactions in NSW ECEC services occur as a result of children being fed their allergens and Kathryn said this is generally due to a lack of knowledge about a child’s allergens, or confusion about the system of food delivery.

To address these gaps, Kathryn’s main piece of advice is for services is for all staff to be educated on managing allergies and anaphylaxis, accessing the available resources, and to implement a structured and consistent system for orderly mealtimes.

“The best thing a service can do to prevent a child being fed their allergen is to minimise chaos at mealtimes. I recommend a traffic light system for mealtimes using red, orange and green plates to organise meals for different children.”

“When preparing meals, educators can work through the red plates first and these are for children with allergies. Orange plates can then be used for children with food intolerances, which is very different to allergies, or for children with religious dietary requirements. Children with no food restrictions can be given a green plate.”

“When food can adversely affect your health, you have to treat it like medicine. So it can also help to have two educators checking meals before they are given to children.”

“Services have found that introducing progressive meals can also help to minimise chaos at mealtimes by allowing for a higher educator to child ratio and therefore higher supervision.”

To avoid indirect contamination with food allergens, Kathryn also recommended that services implement a hand washing routine before and after eating and ensure there is no swapping of cutlery or drink bottles.

According to Kathryn, the best allergy risk management strategies are those that are methodical and can be embedded into a service’s daily routine, regardless of whether or not children with allergies are attending that day.

“Something I hear from services is that risk management strategies are put in place in days when the child [with an allergy] is there, and those strategies fall by the wayside after a few weeks because they’re not part of the everyday routine.”

With 22% of deployed adrenaline injectors (EpiPens or Anapens) being used on children with no known history of allergies, Kathryn said it is vital that ECEC staff are also educated in recognising an allergic reaction, and correctly storing and administering an adrenaline injector.

“Services don’t know what they don’t know until they have an incident. And we don’t want a child to have to get sick for them to find out.”

“It’s important that a service’s first aid provider builds their anaphylaxis training around how to read an ASCIA Action Plan. It’s one thing to know how to use an adrenaline injector, but it’s another thing to know when to.”

Kathryn said ASCIA Action Plans are essential for simplifying difficult decisions for staff, including recognising the difference between asthma and anaphylaxis or a mild to moderate allergic reaction, and how to respond.

“We know that in early childhood settings there are 3 risk factors for fatality: asthma and food allergies, an upright posture, and delay in administration of adrenaline. These factors are all addressed in the Action Plan, and it is vital that allergy management training covers the plan.”

“An educator should be able to look at the action plan and say, ’I know how to read this, and I know what to do’.”

“Paperwork also needs to be very explicit. Directors should make sure staff are aware that, for example, dairy equals milk, so things like cheese, yoghurt and lactose-free milk all equal dairy.”

For more information and advice on managing allergies and anaphylaxis in your service, please see the below resources:

While the National Allergy Council (NAC) Best Practice Guidelines are designed to provide guidance and support to ECEC services within Australia, this document must be considered in conjunction with the National Law and National Regulations. Services’ responsibilities to manage anaphylaxis and allergies are set out in Regulation 90, Regulation 168(2)(d) and Regulation 162.

Under Reguation 162, the following health information is to be kept in the enrolment record for each child enrolled at the education and care service:

(a) the name, address and telephone number of the child’s registered medical practitioner or medical service; and

(b) if available, the child’s Medicare number; and

(c) details of any—

(i) specific healthcare needs of the child, including any medical condition; and

(ii) allergies, including whether the child has been diagnosed as at risk of anaphylaxis; and

(d) any medical management plan, anaphylaxis medical management plan or risk minimisation plan to be followed with respect to a specific healthcare need, medical condition or allergy referred to in paragraph (c); and

(e) details of any dietary restrictions for the child;

1 Parliament of Australia 2020, Walking the allergy tightrope, Canberra

Image: Kathryn Mulligan
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