Preparing for Severe Allergies at School

If your child suffers from any kind of serious allergies – to foods, insect stings, classroom pets, or other triggers – talk to the school staff to ensure they can deal with an allergic reaction if it happens. Check if the school already has a procedure in place, or make a plan with the principal, teachers, and clinic staff to deal with any situation that may arise. Remember to include the school bus driver and any after-school program supervisors as well. Also, create a plan with your child to help him or her avoid triggers and still take part in school activities.

If a child has a serious allergic reaction (anaphylaxis) this is a medical emergency and it is important it is treated immediately. If your child has been prescribed epinephrine (an Epi-Pen), set up an emergency plan with your child's doctor and the school nurse. This plan should include your child's photo, his or her specific allergy warning signs and symptoms, treatment instructions, and emergency contact information for parents/caregivers and the child's pediatrician or allergist. Copies of this plan should be distributed to the child's teachers, the office, and in the cafeteria. Anyone who supervises your child at school should have access to this plan in case of emergency.

Prescribed epinephrine (Epi-Pen) should be kept with your child at school, not locked away where it is not easily accessible. In an anaphylactic reaction, seconds count. When your child is younger, the epinephrine can be passed between staff from class to class. When your child is old enough, he or she can carry it with them. A doctor may suggest a child has two doses available. Make sure all doses are current and discard expired medications. All staff members need to be trained to use the epinephrine, so make sure they understand doctor's instructions for administration, which may include injecting it at the first signs of anaphylaxis.

Your child needs to know what his or her allergies are, and how to avoid the triggers. If he or she has food allergies, make sure your child understands not to share food, utensils, or containers, and that washing hands before and after eating is important to not be exposed to the allergens.

If your child is allergic to insect stings, make sure he or she knows to wear long sleeves, pants, and closed shoes when outside. Your child should try to eat indoors when possible, and if eating outside to use a straw so as not to swallow any insects if they are in any drinks.

Children with allergies should also be instructed to tell an adult immediately if they think they may have ingested an allergen, or been stung by an insect.

Staff who supervise your child (teachers – even substitutes – lunch monitors, and bus drivers) should be taught the warning signs of severe allergic reactions, including:

• Hives and itching
• Pale or flushed skin
• Swollen lips, throat, or tongue
• Wheezing, shortness of breath, trouble breathing or swallowing
• Dizziness or fainting, or rapid or weak pulse
• Incontinence
• Nausea, vomiting, diarrhea, or stomach cramps

Children should not be expected to administer epinephrine to themselves, even if they know how. In an emergency situation, any school staff member in charge of your child should have an emergency response plan to follow that has been created by the child's doctor. This plan should tell them when epinephrine is needed, how to administer it, to call 911, and to start emergency first aid.

Certain foods such as eggs and peanuts are frequent triggers for allergies. Sometimes these allergens can be hidden in everyday items used at school for crafts or cooking classes. Talk to your child's teachers and ask them to avoid using products that may contain these triggers including: tempera paints that contain eggs, icing made from egg whites, or clay or dough made with peanut butter.

It can be more difficult to prevent insect stings, but there are things the school can do to minimize your child's risk. Ask the school to remove any insect nests on or near school grounds and ensure trash is stored in covered bins away from areas where students play or line up for school. Finally, the school can allow any students at risk for allergic reactions to insect stings to eat inside, especially when insects are most active.

In an anaphylactic emergency, a medical ID bracelet or necklace will remind school staff your child needs epinephrine. Emergency responders are also trained to look for these IDs, which can provide important medical and contact information. There are ID bracelets designed just for kids with cartoon characters or beads.

Packing a lunch is the best way to ensure there are no allergens in what your child is eating (make sure he or she knows not to swap food with classmates!). However, schools are required to make meals for children with special dietary needs at no extra cost.

The cafeteria staff should know your child's food triggers, and be trained to read package labels to identify even the technical or scientific names for foods that may trigger allergies. The food staff should also ensure surfaces and utensils are washed properly to avoid cross contamination.

Schools can also work with families to create an environment where children with food allergies feel safe, and not isolated from classmates.

For example, the school staff can make accommodations such as:

• A separate lunch table where any child whose lunch is nut-free, or dairy-free can eat
• School-wide rules that discourage trading food or sharing utensils or straws
• Create a nut-free or dairy free policy in the classroom, or no food in the classroom
• For celebrations only allow commercially-prepared and packaged foods with the ingredients listed
• Celebrate birthdays or other events with books, music, and games instead of food
• Teach children about allergies and not to tease other children who have allergies.

As a parent, volunteering at your child's school can give you more control over your child's care. You can help plan field trips and class parties and watch what is going on to ensure your child – and any others – are not exposed to allergens. Help the teacher write a letter to send to other class parents to let them know about your child's allergy, and offer to provide kid-friendly allergy information to teach the class. Most schools need extra assistance so you'll be helping your child, as well as the school and the community.