Any parent of a severely allergic child will have been deeply shocked and distressed by the death of little Thomas Egan and our hearts go out to his mother and father.
Thomas, who was five months old, died as a result of an overwhelming allergic reaction to cow's milk. Staff at his local day nursery knew Thomas should not be given milk but one morning a staff member gave him a bowl of cereal without reading the list of ingredients. The cereal contained milk protein, which was declared clearly on the packet.
Thomas's death is bound to raise in parents' minds the question of whether any severely allergic child is safe in a childcare setting.
Fortunately, it is entirely possible to offer reassurance to other parents and childcare staff that allergic children can be well protected.
Fatal allergic reactions are exceedingly rare among young children – in fact Thomas's death is the only confirmed infant death from milk allergy in the UK in the last ten years. The risks are negligible when the level of communication is high and robust measures are set up to manage a child's allergy.
Parents or childcare staff who are anxious about the implications of Thomas's death can be assured that a robust management plan – covering allergen avoidance, medical procedures and staff training – will protect allergic children in the vast majority of cases and the Anaphylaxis Campaign helpline is available for anyone wishing to talk this through. Tel: 0044-252-542029.
Many pre-schools in the country provide effective support for allergic children in their care. The purpose of the notes that follow is to provide basic information about anaphylaxis, to suggest ways in which staff and parents can work together to minimise risks and to emphasise the importance of having an agreed health care plan.
Anaphylaxis is an excessive reaction of the immune system to the presence of a foreign body which it wrongly perceives as a threat. In its most severe form, it may be life-threatening. Thousands of children across the UK are believed to be affected.
Anaphylaxis can be triggered by certain foods, such as peanuts, nuts, cow's milk, eggs, shellfish or fish; insect stings; latex; and some drugs. Symptoms may include:
The above symptoms usually occur within minutes of exposure to the allergen, although they can occasionally occur after a few hours. No child would necessarily experience all these symptoms.
It is a good idea to draw up a management plan, together with the parent, before the child starts pre-school. This will ensure that the child receives proper care and support and will help allay any concerns held by the parents or staff. A management plan could take the following form:
These would include name, address, date of birth and brief account of allergy.
These would include a parent's name and telephone number and a second contact name and telephone number.
Many parents will have been issued with such a procedure by their hospital consultant. It should be kept with the records on the premises and a copy attached to the medication pack so it would be readily accessible. All staff should be made familiar with this procedure, which would include assessment of symptoms, administration of medicine as appropriate, contact numbers and the ambulance procedure.
The medication often prescribed for a child at risk of anaphylaxis is injectable adrenaline (administered by use of the EpiPen or Anapen). Oral antihistamines may also be prescribed. It is important that the parent explains what medication his or her child has been prescribed, what symptoms may occur and when and how to use the emergency pack. All staff will need to know where the medication is stored. This should be out of reach of children but readily accessible. It should be labelled clearly with the child's name and instructions for use. Responsibility for ensuring the medication is "in date" rests with the parent. Social Services should be informed and the insurance company notified of the details. Make sure insurance arrangements provide full cover for staff acting within the scope of their employment.
An emergency may never arise, but if it does, the child will need prompt medical treatment and staff will need to know what to do. In many schools and nurseries across the country, staff have volunteered to be trained to administer medication for the treatment of anaphylaxis. In the case of pre-school groups, training could be arranged through the health visitor, local school doctor or the child's consultant. The community child health clinic may offer advice. The Anaphylaxis Campaign training video is a useful resource to have at hand to show any new staff or parent helpers and could be included on a staff/committee meeting agenda as a means of raising awareness.
If the child is, for example, allergic to peanuts, it would be prudent for the pre-school to exclude all peanut products from the premises in order to minimise the risks. The child would bring his own packed food to any party or social event and the supervisor could keep a supply of "treats" for those unexpected occasions when birthday cakes or sweets are brought in. Any policy you decide to make can be formalised at your AGM.
Vigilance would be ongoing. For example, it would include the avoidance of nut cereal packets for junk modelling, reading ingredients carefully on biscuit packets, and checking cooking ingredients or items used in science or nature activities. Parents could be informed through a newsletter and staff reminded of the health care plan at meetings.
Parents must give written consent for staff to take responsibility of administering medication in the unlikely event of an allergic reaction occurring.
A child at risk of anaphylaxis presents a challenge to any pre-school group. However, with sound precautionary measures and support from the staff and the authorities, life in nursery may continue as normal for all concerned.
If you would like further information please send an SAE to the Anaphylaxis Campaign, PO Box 275, Farnborough, Hampshire, GU14 6SX. Or telephone 01252 542029. The Department for Education and Employment (DfEE) and the Department of Health have issued good practice guidance entitled "Supporting pupils with medical needs". This can be obtained from DfEE Publications, PO Box 5050, Sudbury, Suffolk CO10 6ZQ. Tel 0845 6022260.
| 1. Full name. | |
|---|---|
| 2. Address. | |
| 3. Date of birth | |
| 4. Allergy |
| 1. Name of parent | |
|---|---|
| 2. Telephone number | |
| 3. Second contact name and number |
| 1. Name | |
|---|---|
| 2. Telephone number |
| 1. Name(s) of medication | |
|---|---|
| 2. Expiry details | |
| 3. Storage |
| 1. Names of staff volunteers | |
|---|---|
| 2. Date of last training of staff | |
| 3. Names of staff who are aware of all procedures. |
| 1. | |
|---|---|
| 2. | |
| 3. |
I agree to the staff taking responsibility and administering medication in the event of a reaction taking place.
| 1. Name | |
|---|---|
| 2. Signature |