UW-Whitewater 38 th Annual Early Childhood Conference Saturday April 9, 2016 Session 4035 Kathleen K. Shanovich, Nurse Practitioner Valerie Schend, Pharmacist 1 2 3 1
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Do not wash the tubing! Disinfect weekly when used: soak in a vinegar solution (1 part vinegar:2 parts water) for ½ to 2 hours Clean or change the compressor filter at least once per year 19 Care of Spacer Spacer Care Wash the spacer once a week with dish soap and warm water Rinse well and air dry (24 hours) Replace once a year 20 Asthma Action Plan Required for childcare in Wisconsin Individualized emergency childcare asthma plan developed between the parent & the childcare provider Best practice is a written plan from a health care provider 21 7
22 Asthma Action Plan Green zone: child doing well Yellow zone: worsening asthma symptoms or cold symptoms Red zone: severe asthma symptoms 23 Early Warning Signs of an Asthma Attack Increased work of breathing Cough, wheezing Breathing fast Nasal flaring (nostrils enlarging with each breath) Working hard to breathe using neck & chest muscles Difficulty walking or talking Child becomes sleepy/tired Child is not looking or acting like normal self 24 8
How can you tell a child is having an asthma attack? Cough Wheezing whistling sound coming from the chest Shortness of Breath with or without exercise with or without exposure to triggers Breathing fast Increased fussiness/irritability 25 Emergency Signs of an Asthma Attack Unusual sleepiness Anxious, fussy Child appears worried, afraid Chest tugging, head bobbing Child appears confused Child sits in tripod position Child s lips, fingernails appear blue 26 27 9
Treatment of an Asthma Attack Stay calm & positive Talk quietly & reassure child Provide privacy if possible Comfort the child: Have child sit up (not lie down) An adult should be with the child at all times 28 Treatment of an Asthma Attack Give full dose of rescue medication (albuterol) as prescribed If no rescue medication available, call 911 If child is still having trouble breathing 15 minutes after rescue medication, call 911 You may repeat rescue medication every 20 minutes until support arrives Call parent or guardian 29 30 10
31 32 What to do if... Weather extremes Wisconsin Childcare Regulations * if < 2 years old, cannot go outside if T is < 32 or > 90 (with wind chill, heat index) * if > 2 years old, cannot go outside if T is < 0 or > 90... Approaches: turtle furs, discourage vigorous activity, play in sheltered area (avoid open, windy areas) 33 11
Food Allergies 34 Food Allergies Food Allergy statistics: 11 million Americans, including adults 6% of US children 2% of adults have shellfish allergy True Prevalence of Food Allergy Patient/Parent Self Report = 12-14% Based upon History & Testing = 3% 35 Why are Food Allergies Increasing? Hygiene hypothesis? oaffluence owestern culture Food genetics/chemicals/processing? Decreased Vit D, fatty diets, obesity? Timing of exposure to foods? Human genetics? Unknown 12
Definition of Food Allergy Food allergy is an adverse immune system reaction that occurs soon after exposure to a certain food. Even a small amount of food can result in an adverse reaction. Food Allergies Common food allergens: Cow s milk Egg white Soy Peanut Tree nuts Shellfish Fish 38 Wheat Natural History of Food Allergy Dependent on allergen - Most children outgrow milk, egg, soy & wheat allergy - Less common to outgrow peanut or tree nuts - Seafood allergies often develop in adults & persist Age - Food allergy that starts in adults is unlikely to resolve 39 13
Food Allergy Hypersensitivity or allergic reaction that occurs quickly (seconds/minutes to 1-2 hrs) after eating the food Can be life-threatening Occurs every time the food is eaten Can occur with tiny amounts of food (250 mcg) Positive testing for the food: either by skin or blood Food Allergies Symptoms of an allergic reaction: Skin Gastrointestinal Respiratory Neurological 41 Symptoms of Severe Food Allergic Reaction or Anaphylaxis Skin Hives (raised itchy bumps) Swelling of lips/eyes Gastrointestinal Nausea, vomiting, diarrhea Breathing Throat tightening (swelling) Cough, wheezing Cardiac or heart Fast heart beat, low blood pressure 14
Symptoms of Severe Food Allergic Reaction or Anaphylaxis Neurological Worry, fear Change in behavior (active listless/quiet) Sense of impending dome Kids express fear of something bad I am going to die. Food Allergies What happens: type of reaction can vary based on: Amount ingested Type of food Previous reactions Age of child timing treatment 44 Food Allergies Treatment: Education, education, education Anaphylaxis Specific food avoidance/nutrition support Medications: injectable epinephrine Epi Pen Auvi-Q Food allergy action plan Adjusting to daycare and/or school 15
Treatment of Reactions For reactions isolated to the skin ( mild reactions ): Antihistamine (cetirizine or diphenhydramine syrup preferred) Close monitoring for additional symptoms For signs of anaphylaxis: Epinephrine IM Switch to 0.3 mg at 66 # or 30 kg (due to underdosing: ~60#) Seek immediate care/call 911 Late phase reactions occur up to 20% of the time at least 4 hours observation recommended in ED *Jarvinen, JACI 2008 Injectable Epinephrine Epi Pen Auvi-Q Adrenaclick generic Treatment of Reactions The only treatment for anaphylaxis is injectable epinephrine! *Jarvinen, JACI 2008 16
Management in Schools* 25% of anaphylaxis occurs in schools in child without previous diagnosis Unassigned Epi should be considered Emergency action plans: Provider Parent School Health School Staff Antihistamines: adjunctive therapy not to treat anaphylaxis Epinephrine safe: when in doubt, inject. Medical alert ID (young children) *Clinical Report Management of Food Allergy in the School Setting, AAP 2010 49 Management in Schools* Peanut butter vapors protein Foods can be vaporized through heating respiratory symptoms Cleaning in classroom: soap/water; NOT antibacterial gels standard cleaning & lack of visible contamination should suffice Care not to ostracize/physically separate FA child *Clinical Report Management of Food Allergy in the School Setting, AAP 2010 50 Management in Schools* Reducing risk of accidental exposure: No food sharing Education of parents/staff (injectable epi use, when to call EMS) Plans for field trips Label-reading No eating on school bus Harassment/bullying *Clinical Report Management of Food Allergy in the School Setting, AAP 2010 51 17
Food Allergy Action Plans Food Allergy Action Plans a Impact on Quality of Life Children & caregivers with significant anxiety due to risk 50% alter social activities & 10% homeschooled due to food allergy 1 60% food prep altered Children s self report of quality of life similar to Type I diabetes 2 1 Bollinger, Annals of Allergy 2006 2 Avery, Pediatric Allergy 2003 54 18
Food Allergies Additional Facts: Only 20% of fatal reactions had experienced a prior severe reaction* Patients ill prepared for reaction* < 20% have injectable epinephrine available < 20% pediatricians know how to administer epinephrine correctly* * Dr. Hugh Sampson, oral presentation, Wisconsin Allergy Society Meeting, October 2006 55 Online Resources Food Allergy & Anaphylaxis Network (FAAN) www.foodallergy.org American Academy of Allergy Asthma & Immunology (AAAAI) www.aaaai.org Guidelines for the Diagnosis & Management of Food Allergy in the US: Report of the NIAID-Sponsored Expert Panel. Dec. 2010 Clinical Report Management of Food Allergy in the School Setting. AAP. 2010 56 19