Allergy safe child care facilities

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 the Canadian Society of Allergy and Clinical Immunology https://csaci.ca/patient-school-resources/
• Regularly training staff 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?

Symptoms of a severe allergic reaction can start within minutes of eating the food that triggers reactions. They will usually occur within 2 hours. While rare, symptoms can take up to a few hours to develop.

Symptoms can vary from person to person. The same person may experience some differences in their symptoms each time they have an allergic reaction.The most dangerous symptoms include difficulty breathing or a drop in blood pressure. Symptoms of anaphylaxis can include any of the following:

• Breathing: coughing, wheezing, shortness of breath, chest pain or tightness, throat tightness, hoarse voice, nasal congestion or hay fever-like symptoms (such as runny, itchy nose, watery eyes and sneezing), trouble swallowing
• Heart: signs of a drop in blood pressure like weak pulse, feeling faint, dizzy or lightheaded, passing out
• Skin: hives, swelling (tongue, lips or face), itching, warmth, redness, rash, pale or blue-coloured skin
• Stomach: vomiting, nausea, abdominal pain or diarrhea
• Other: anxiety, headache, metallic taste or uterine cramps

How is a severe allergic reaction treated?

When a reaction begins, it is important to respond right away. Do not wait. Give the prescribed medication called epinephrine (eh-puh-NEH-fren) right away. Epinephrine will not cause harm to the child if it is given unnecessarily.

Epinephrine comes in a pre-loaded syringe called an auto-injector. Epinephrine helps reverse the symptoms of an allergic reaction and can save the child’s life.

Steps for treating a severe allergic reaction

The above section has been adapted from: Anaphylaxis in Schools and Other Settings, Copyright 2005-2016 Canadian Society of Allergy and Clinical Immunology.

What training should child care providers have?

Staff 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 how to 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 auto-injector and how to use it

As a child care provider, what can I do to create an allergy safe facility?

Care plans and epinephrine auto-injectors

• 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 auto-injectors 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 auto-injectors for your child. Replace auto-injectors before the expiry date
• Consider having your child wear MedicAlert® identification
• 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 auto-injector with them and how to use it

For more information about food allergies in children, see 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:

• Food Allergy Canada https://foodallergycanada.ca
• Anaphylaxis in Schools and Other Settings https://csaci.ca/wp-content/uploads/2017/11/Anaphylaxis-in-Schools-Other-Settings-3rd-Edition-Revised_a.pdf (PDF 1.68 MB)