What is an allergy safe child care facility?
Managing food allergy in a child care setting is a shared responsibility between staff, parents and children. While child care facilities cannot be expected to be completely free of the foods that cause allergic reactions, they should make efforts to create and maintain a safe environment for children with food allergy. Maintaining an allergy safe child care facility includes:
- Following policies and procedures to reduce the risk of accidental exposure to foods that cause allergic reactions among children who attend the facility
- Having a care plan for each child with food allergy that contains a copy of their Anaphylaxis Emergency Plan. The plan explains what to do in case of an allergic reaction. To get a blank copy of an Anaphylaxis Emergency Plan, visit Food Allergy Canada: https://foodallergycanada.ca/wp-content/uploads/Anaphylaxis-Emergency-Plan-Form.pdf (PDF, 749KB)
- Regular staff training to ensure they have the knowledge and skills to respond to and care for a child who is having an allergic reaction
What is an allergic reaction?
An allergic reaction occurs when a person’s immune system treats a protein (an allergen) in a food as harmful. Allergic reactions can be mild or severe. Food allergy needs to be taken seriously. It involves avoiding the food that causes allergic reactions and responding appropriately to an accidental exposure. A severe allergic reaction is called anaphylaxis (an-nah-fil-axe-is). It often happens quickly and can cause death if left untreated.
What are the symptoms of a severe allergic reaction (anaphylaxis)?
Symptoms of a severe allergic reaction typically start within minutes of eating or being exposed to an allergen. In rare cases, the reaction can take up to several hours to start. Symptoms can vary from person to person and can look different each time they have a severe allergic reaction. Symptoms generally include 2 or more of the following:
- Skin: hives, swelling (face, lips, tongue), itching, warmth, redness, rash
- Respiratory (breathing): coughing, wheezing, shortness of breath, chest pain or tightness, throat tightness, hoarse voice, nasal congestion or hay fever-like symptoms (runny, itchy nose, sneezing and watery or itchy eyes), trouble swallowing
- Gastrointestinal (stomach): nausea, pain or cramps, vomiting, diarrhea
- Cardiovascular (heart): paler than normal skin colour or blue colour, weak pulse, passing out, dizziness or light-headedness, shock
- Other: anxiety, sense of doom (the feeling that something bad is about to happen), headache, uterine cramps, a metallic taste
Responding to a severe allergic reaction
Anaphylaxis can be life threatening, so it is important to respond quickly and follow these emergency steps:
- Give epinephrine device (for example, EpiPen, EpiPen Jr, or neffy) at the first sign of a known or suspected severe allergic reaction. This medication is safe, so if you are unsure, the safest option is to give the epinephrine
- Call 9-1-1 or your local emergency service. Tell them someone is having a severe allergic reaction
- Give a second dose of epinephrine as early as 5 minutes after the first dose if there is no improvement in their symptoms
- Go to the nearest hospital immediately (by an ambulance if possible) even if symptoms are mild or have stopped. The reaction could get worse or come back, even after proper treatment. Stay in the hospital for observation for as long as the doctor suggests (generally about 4 to 6 hours)
- Call emergency contact person (for example, a parent or a guardian)
Other important information about epinephrine devices
Epinephrine devices expire on the last day of the month indicated on the product packaging. For example, if the product is marked as expiring in January, it remains valid (not expired) until January 31.
- You are advised to have more than one device in case two doses are needed
- If you are experiencing an anaphylactic reaction and only have an expired device, use the expired product and immediately contact 9-1-1
- Whether the product is expired or not, go to the nearest hospital as soon as possible after using the product, as instructed in the product labelling
What training should child care providers have?
Child care providers should have the knowledge and skills to respond to and care for a child who is having a severe allergic reaction. A child care provider with this training and knowledge should be immediately available for every child with food allergy.
Every child care provider should know:
- The signs and symptoms of anaphylaxis
- How to respond to a child who is having a severe allergic reaction
- How to call 9-1-1 or local emergency number and communicate the health concern
- Each child’s allergy and how to help the child avoid their allergens
- Where to find each child’s care plan, including their Anaphylaxis Emergency Plan
- Where to find each child’s epinephrine device and how to use it
As a child care provider, what can I do to create an allergy safe facility?
Care plans and epinephrine devices
- Create a care plan together with the parent of every child with food allergy. Include a copy of the child’s Anaphylaxis Emergency Plan
- Keep each child’s care plan and Anaphylaxis Emergency Plan handy, while respecting the child’s privacy
- Keep each child’s epinephrine device near them at all times, in a secure unlocked place that is easy for all staff to access
Meal and snack time
Even tiny amounts of a food allergen can cause an allergic reaction.
- Have all children and staff wash their hands with soap and water before and after eating. This helps prevent food from getting on toys, clothing and other surfaces
- Clean all tables and surfaces well before and after eating
- Place dishes and utensils on a napkin, not directly on the table
- Supervise children while they are eating
- Do not allow children to trade or share food, utensils, napkins or food containers
- Ask parents of children with food allergy to approve all foods offered to their child
- Do not offer a food to a child with food allergy if you are not sure it is safe. Ask parents to provide a substitute
- Store food out of reach of young children
- Talk to parents about activities that involve food
Buying and preparing foods
- Learn how to recognize food allergens on product labels. For more information on allergen labelling, visit the Canadian Food Inspection Agency https://inspection.canada.ca/en/food-labels/labelling/consumers/food-allergies
- Read the ingredient list each time you buy a food or receive a food delivery. Ingredients in packaged foods can change without notice. Do not assume that a food served before is safe
- Ensure all foods prepared or stored on site are clearly labelled with a list of ingredients. This includes leftovers, foods made from scratch and any foods brought in by parents and staff
- Wash hands, utensils and surfaces well between preparing different foods. This prevents cross-contamination with food allergens
- When appropriate, ask parents, visitors and older children to help keep the facility allergy safe by not bringing in foods that cause allergic reactions in children who attend the facility. Some food allergens are important sources of nutrients for children who can eat them. These should not be restricted from the facility unnecessarily. The best plan for managing a food allergy in a facility may differ between facilities
As a parent, how can I help make a child care facility allergy safe for my child?
- Give the facility a copy of your child’s Anaphylaxis Emergency Plan completed by your child’s health care provider
- Provide written consent for staff to give your child epinephrine when needed. Do not sign anything that releases the facility of responsibility if epinephrine is not given
- Supply the facility with epinephrine devices for your child. Replace devices before the expiry date
- Consider having your child wear medical identification jewelry, such as MedicAlert
- Provide the facility with foods for your child that do not spoil in case they are needed
As your child matures, they can learn to take some responsibility for their safety. When your child is ready, teach them:
- How to avoid their food allergens. This includes teaching your child not to put objects like pencils or toys in their mouth and to only eat foods approved by you
- To tell someone if they think they are having an allergic reaction
- To carry their epinephrine device with them in a fanny pack or carrier
- How to use their epinephrine device
For more information about food allergies in children, visit HealthLinkBC File #100a Severe allergic reactions to food: Children and teens.
For more information
If you have questions about food allergies, call 8-1-1 to speak with a registered dietitian.
For more information about understanding and managing anaphylaxis, visit:
The B.C. Government provides safety planning resources for severe allergic reactions in schools. To learn about promoting awareness, developing policies and creating safety plans in schools, visit Anaphylaxis.
