An allergic reaction can have serious consequences for young children. Therefore, when it comes to infants and allergies, early years settings must have robust procedures in order to minimise the risks, says Judit Horvath…
Having a child start at an education setting can be stressful time for parents, but particularly if the child in question suffers from allergies.
According to contemporary statistics, in an early years setting looking after 50 children, it’s likely that between two and four children will have a problem regarding different degrees of allergies or intolerances.
An allergic reaction can happen when a person’s body, in particular the immune system, reacts to contact with a usually harmless substances as if it is an invader.
In these cases, the immune system treats the substance as a threat to the body’s health. To defend against the ‘infection’, it releases histamine, a protection substance.
The release of histamine causes the body to show the allergic symptoms. This response can develop after the smelling, breathing in, touching, tasting or eating of the substance the person is allergic to.
The following substances can cause allergic reactions in infants:
The allergic symptoms caused can differ from mild to very severe.
Mild symptoms (of any allergy) include:
Severe symptoms (of any allergy) include:
In 2010 the UK’s first guidelines for the diagnosis of allergies in infants were drafted by the National Institute for Clinical Excellence (NICE).
NICE informed doctors, general practitioners and other health professionals of how to observe the medical histories of children with particular symptoms in order to prompt the examination of possible allergies.
It also stressed that people should be aware that allergy testing outside the official medical field is not valid as a diagnosis of allergy.
It warned that inaccurate diagnosis can risk or harm children by causing nutritional deficiency through inadequate food intake when we avoid ingredients unnecessarily.
A longitudinal research study (specifically looking at food allergies) found that over one-third of parents said their child was allergic or intolerant to one or more things.
After monitoring the same children until they were three, the actual number of children with food allergies was just 60 out of 800.
This was possibly due to some children having naturally grown out of their allergies, but also because many parents were mistaken in their diagnosis.
In reality, the number of children with true allergies is about 6–8% of the under-five population.
It is possible to have multiple allergies and intolerances. Intolerances (usually to food) are more common than allergies.
Their symptoms tend to appear more slowly, often many hours after an infant has touched or consumed the allergen.
Typical symptoms include bloating, stomach cramps or abdominal discomfort. Careful observation and recording of symptoms can make it less difficult to identify what has caused the problem.
Certain intolerances can also be hard to distinguish as some digestive disorders (such as gastrointestinal obstructions or irritable bowel syndrome), bacterial or viral infections often show similar symptoms.
The main difference between intolerance and allergy is that intolerance does not involve an immunologic reaction.
Some people, for example, lack an enzyme called lactase needed to digest certain type of food, or they have really sensitive skin. Some types of intolerance can even be treated and improved.
For childcare workers the admission of allergic infants can create a dilemma: how does one distinguish the children with true allergies and intolerances from those with ‘overanxious’ parents?
Firstly, within any childcare setting, we need to approach allergies and intolerances very seriously. Professional child carers have to follow parents’ requests regardless, as caring for allergies cannot operate on trial and error basis.
Early years settings, however, have to keep records of the medical history of all children. In case of absence of evidence on medical history documents, consult parents for the evidence of diagnosis of allergy or intolerance before you apply special measures.
Plan, organise, monitor and evaluate procedures for activity involvement and catering for special diets. Preparations for days when allergic children attend have to be precise and exact. Mistakes with regard to allergies can result in serious illness and even the death of a child.
It’s necessary to have a clear policy and procedure document that you make available to parents about dealing with allergies and intolerances. This should outline how you cater for special diets within your setting.
In order to protect children with severe food allergies it’s important that we treat all infant intolerances and allergies with the same level of diligence as a severe allergy.
This means that children with allergies or intolerances should not encounter the allergen in any form. For example, you should prepare special diet food separately from the main food preparation.
Make it distinguishable from your main catering by using different coloured plates, serving bowls or labels. This will remind all staff involved with food service which children are following special diets.
When you serve food, sign a special witness form to observe and register the procedure. Key workers can have specially prepared charts, or a clipboard with all their key children’s photos and dietary needs, allergies and intolerances clearly indicated.
Infants with allergies or intolerances should not take part in activities that might use the allergen as a resource.
For example, occupy fur-allergic children elsewhere when an animal visits the setting. Apply a thorough cleaning regime straight away afterwards.
We need to make sure that children who are allergic or intolerant will not miss out. Special alternative activities and diets have to be developmentally adequate to meet young children’s learning and dietary needs.
You can adapt some activities and recipes so they are suitable for all the children in your nursery. Other activities will need special planning and execution.
On your nursery registration form, ask parents to give information about any known allergies. If a child suffers from any allergies, you can complete a care plan stating:
Parents should then update their child’s form as and when it is necessary. Give a copy of the care plan to the room the child attends, and to catering.
It is helpful to identify staff members who are trained by health professionals to administer special medication in the event of an allergic reaction.
The possibility of allergies does and should not mean that we should stop providing otherwise beneficial activities. Careful planning, training, preparation and knowledge are key factors in dealing with emergencies.
Judit Horvath is an author and nursery management advisor.
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