One child in your care cannot eat peanuts, another cannot drink milk, and yet another child must avoid eggs. Food allergy in children is not uncommon and a childcare setting may have several children with dietary concerns that must be monitored.

The term “allergy” refers to a variety of conditions caused by an adverse  reaction of the immune system to substances in the environment. Some substances (e.g., dust mites, animal dander, molds, pollens) can be inhaled.

Others (e.g., poison ivy) cause reactions upon contact with skin. Some substances are ingested, such as food. Allergic reactions to foods can be dangerous and even life threatening.

When a potentially harmful substance enters the body, the  immune system reacts to protect the body by fighting infection and disease. That is a good reaction for germs, but not good when it happens with a food item. Sometimes the reaction is excessive or inappropriate.

Although a child can be allergic to any food, just eight foods account for 90 percent of all allergic reactions to food: milk, eggs, peanuts, tree nuts (e.g., cashews, walnuts), soy, wheat, fish, and shellfish. The Centers for Disease Control and Prevention (CDC) estimate that 4-6 percent of children ages 4 years and younger have a food allergy.

Allergic Reactions

With a food allergy, the body reacts as though that particular food product is harmful. Once the body has made antibodies against a certain food, those antibodies instantly recognize that food.

Each time the person eats the food, the body releases histamine into the bloodstream again, creating allergy symptoms. In severe food allergies, reactions can occur even if the person touches or breathes in particles of the food.

Symptoms usually occur within a few minutes after exposure, or up to two hours after exposure. Food allergy reactions vary, however, watch for these symptoms in young children:

• Skin problems (itching, rash, hives)
• Gastrointestinal problems (diarrhea, abdominal pain, vomiting, burning of the mouth, throat)
• Respiratory difficulties (wheezing, runny nose, nasal congestion).

Serious reactions can occur quickly. Anaphylaxis is a severe, potentially life-threatening allergic reaction. The flood of chemicals released by the immune system during anaphylaxis can cause a child to go into shock. The blood pressure drops suddenly and the airways narrow, blocking normal breathing. There is a risk of anaphylaxis, even if previous reactions have been mild.

Childcare and Allergies

An “allergy action plan” for each child with known allergies should be in place at every childcare program. Upon admission of each child to your program, be sure to ask parents about known food allergies.

If a child does have diagnosed allergies, parents, caregivers, health care professionals, cooks, and other staff members can collaborate to create an effective allergy action plan for the child.

A food allergy action plan includes the following information:

• Name, date of birth, caregiver, and a photo of the child.
• What symptoms to look for as signs of an allergic reaction and where they are most likely to appear--mouth, throat, skin, stomach, lungs, and heart.
• Contact information for the child’s parent/family, health care provider, and other emergency contact persons.
• Medically appropriate actions to be taken in the event of an allergic reaction.

If the child’s physician prescribes an epinephrine injection kit, it must be readily accessible at all times. Staff members, properly trained on how to safely administer the epinephrine, could save a child’s life.

Food-safe Childcare

Childcare programs should have clearly written policy and procedures regarding food allergies. The most effective way to prevent food allergen exposure is to eliminate the problem foods from the facility. This approach requires that both staff and parents be informed about all foods and ingredients.

For example, if a child in your care has a peanut allergy, post large and visible signs to remind parents and visitors. If your program does not ban peanuts, but instead works to keep peanut products from an allergic child, then thorough hand washing after meals and snacks is necessary to eliminate traces of peanut that could be transferred from hands to toys or doorknobs.

If children bring food from home for snacks or meals, serve the foods for children with food allergies first. Have a caregiver sit at the table when the food is served to make sure children do not share their foods.

Food preparation surfaces, utensils, and equipment used to prepare meals need to be thoroughly cleaned prior to each use.

When possible, serve fresh foods rather than processed foods. When using packaged or canned foods, carefully check food labels and the ingredients list. New government regulations require food manufacturers to list the presence of eight potential food allergens (such as peanuts).

Check the labels each time a food product is used. Manufacturers can change ingredients and processing methods. Also, ask parents of children with food allergies to provide a list of safe foods or--if allowed by local program policies--to bring safe food items to your program.

Child Activities

Caring for children with food allergies is challenging, yet manageable. Make certain that children with food allergies are included in all activities. For example, when engaging children in food preparation, use cream cheese or fruit spread instead of peanut butter. Choose healthy foods and ingredients that all children can enjoy equally.

Recognize opportunities to help staff, children, and families learn about diversity. Other children may not understand why the allergic child cannot have some foods. Use books, guest speakers, puppets, and dramatic play to educate children about dealing with food allergies and the feelings they may experience. Recognize differences, but emphasize similarities.

Madeleine Sigman-Grant, PhD, RD, Area Extension Specialist

Internet Resources

Asthma and Allergies, www.aafa.org

Beyond the Peanut, www.beyondapeanut.com/FoodAllergyManagementforChildCare.html

Caring for Our Children, national standards, nrckids.org/CFOC/HTMLVersion/Chapter_4.html

Child Health & Safety Radio, www.childhealthonline.org/radio

Food Allergy & Anaphylaxis Network, www.foodallergy.org