Special Health Care Needs in Early Childhood: Food Allergies Colleen Kraft, M.D., FAAP CHSA Annual Conference April 12, 2016
Who s Here Today? Health Managers? Family Services Managers? Other Area Managers? Classroom Staff, Home Visiting Staff, or Family Child Care Providers? Parents or Family Members? Directors or Administrators? Governing Boards/Tribal Council/Policy Council? Community Partners? TA Staff? Federal Staff? Other?
What is a Food Allergy? When the body s immune system mistakenly believes a harmless substance is harmful to the body. It tries to protect the body by releasing histamines and IgE antibodies to attack the substance.
True or False? Food allergies can affect anyone
True or False? Lactose intolerance is a type of food allergy.
True or False? 90% of food allergies fall into one of eight types of food
True or False? It is possible to have a serious reaction to a food, even if a previous reaction was mild.
True or False? Peanut exposure can occur if art materials are stored in an old peanut butter jar.
True or False? Anaphylaxis can occur within seconds to an exposure or a food that triggers allergy.
True or False? To prevent cross-contamination, foods for children with allergies should be prepared last.
True or False? Food manufacturers are required by law to clearly identify ingredients from the eight allergic food groups.
True or False? Eggs are a main ingredient in meringue, divinity, and custard.
True or False? An allergy plan for a child is needed only in the case of severe food allergy.
Food Allergy Response Chemical triggers like histamine and IgE antibodies are released in response to an allergen and can cause allergic reactions with a variety of symptoms Symptoms may vary from person to person and not all reactions appear the same Best to get all allergy information from the child s parents
Histamine Reaction
Symptom Reactions Symptoms can range from mild to severe. Severe, lifethreatening reactions are called anaphylaxis. 40-50% of people diagnosed with food allergies are judged to have a high risk of anaphylaxis.
Symptoms of Anaphylaxis Tingling sensation in the mouth Swelling of the tongue and throat Difficulty breathing Hives Vomiting Abdominal cramps Diarrhea Drop in blood pressure Loss of consciousness Death (in rare cases)
Common Food Allergies Peanuts Tree nuts Wheat Soy Milk Eggs Fish Shellfish
Food Allergy Statistics More than 12 million Americans have food allergies. That s one in 25, or 4 percent of the population. Approximately 2 million school-age children have food allergies in the U.S. The CDC reported an average of 317,000 food allergyrelated ambulatory care visits per year to emergency and outpatient departments and physicians offices for children under the age of 18.
Number of Children In Children, Males Predominate Median age at first episode: 5.8 years 25 20 15 Number of Cases (1994-1996) 10 5 0 Cianferoni A, et al. Ann Allergy Asthma Immunol. 2004;92:464-468. 20
Food Allergy Increasing in the US Food allergy prevalence in children as high as 8.0% 1 39.7% had a history of severe reactions 30.4% had multiple food allergies Prevalence was highest for peanut followed by milk and shellfish 8 major foods are responsible for >90% of serious allergic reactions in the US (fish, shellfish, peanut, tree nuts, milk, egg, wheat, soy) 2 1. Gupta, et al. Pediatrics. 2011;128:e9-e17. 2. Boyce JA, et al. J Allergy Clin Immunol. 2010;126:S1-S58. 21
Patient Factors That Increase Risk of an Event or Potentiate Its Severity History of previous anaphylactic reaction Atopy Asthma Age Adolescents and young adults: risk-taking behaviors Elderly: comorbidities and medications Cardiovascular disease Medications (β-blockers, ACE inhibitors, ARBs, tricyclics, MAO inhibitors) Mast cell activating disorders ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; MAO, monoamine oxidase. Simons FER, et al. J Allergy Clin Immunol. 2010;125:S161-S181. 22
Food Allergy Statistics In two published studies addressing fatal food anaphylactic reactions, more than half (59%) of the individuals were age 19 or younger. In a study of 13 food allergy-induced anaphylactic reactions in school-age children, four of the six fatal reactions occurred in a school-type setting.
Why Should Head Start Be Prepared to Address Food Allergies? Schools and educational programs have a responsibility for the health and safety of children under their care. First food allergy reactions often occur in these settings. Fatalities can result from delaying administration of epinephrine and providing effective emergency care Food allergies could be a complicating factor when dealing with other conditions (i.e. asthma). Children with food allergies have unique social and emotional challenges. NSBA s School Health Programs (2010). Food Allergies and Schools: Keeping students safe and ready to learn. [Powerpoint Slides]. Retrieved from http://static.cdn.esgn.tv/food_allergy_webcast_slides.pdf.
Care Plan for Food Allergies Define food allergy Child s symptoms When to call Parents Care Team 911 Epinephrine injection Epi-Pen Audi-Q
Treating Anaphylaxis
Once an Epi-Pen has been used. Child should lie down for 15-20 minutes Care plan should be followed Family should definitely be called and child taken from school For many children, 911 should be called if child is serious enough to be treated with an Epi-Pen. NSBA s School Health Programs (2010). Food Allergies and Schools: Keeping students safe and ready to learn. [Powerpoint Slides]. Retrieved from http://static.cdn.esgn.tv/food_allergy_webcast_slides.pdf.
What can you do? Lead your school s planning for managing food allergies Coordinate planning and implementation of your classroom s Food Allergy Management and Prevention Plan (FAMPP). Identify a team leader. 28
Food Allergy Management and Prevention Plan Priorities 1. Ensure the daily management of food allergies for individual children. 2. Prepare for food allergy emergencies. 3. Provide professional development on food allergies for staff members. 4. Educate all students and their family members about food allergies. 5. Create and maintain a healthy and safe educational environment. 29
What can you do? Support professional development on food allergies for school staff: Provide training for all HS staff. Ensure staff understands the HS legal responsibilities under federal law. Communicate policies and HS plan to all school staff, volunteers and families. 30
What can you do? Oversee the daily management of food allergies for students Ensure implementation of District food allergy policies, HS Food Allergy Management and Prevention Plan Student emergency care plans. 31
What can you do? Support practices that protect and promote the health of students with food allergies across the HS environment. Ensure that students with food allergies have an equal opportunity to participate in all HS activities and events. 32
What can you do? Prepare your school to be ready to respond to food allergy emergencies: Ensure that responding to food allergy emergencies is a part of your HS emergency plan. Set up an easy-to-use communication system for staff who may need to respond to food allergy reactions and emergencies. 33
What can you do? Communicate food allergy management and policies to parents and families. Ensure that staff who are trained and delegated to administer epinephrine autoinjectors can get to them quickly and easily. Plan and prepare for field trips. Practice responding to food allergy emergencies with emergency response drills. 34
Steps to Take Within 24 Hours of a Nonfatal Food Allergy Reaction Call parent or guardian to follow up on student condition. Review anaphylactic or allergic episode with parent or guardian and student. Discuss family role with parent or guardian to improve outcomes. Discuss school and home concerns to improve prevention, response and student outcomes. Ask parent or guardian to replace the epinephrine dose that was given, if needed. Ask parent or guardian to follow up with health care provider. Source: National Association of School Nurses, 2011 35
What can you do? Take the lead to create and maintain a healthy school environment: Establish policies that address competitive foods. Teach children, parents, and families about food allergies. 36
True or False? Food allergies can affect anyone TRUE
True or False? Lactose intolerance is a type of food allergy. FALSE
True or False? 90% of food allergies fall into one of eight types of food TRUE
True or False? It is possible to have a serious reaction to a food, even if a previous reaction was mild. TRUE
True or False? Peanut exposure can occur if art materials are stored in an old peanut butter jar. TRUE
True or False? Anaphylaxis can occur within seconds to an exposure or a food that triggers allergy. TRUE
True or False? To prevent cross-contamination, foods for children with allergies should be prepared last. FALSE
True or False? Food manufacturers are required by law to clearly identify ingredients from the eight allergic food groups. TRUE
True or False? Eggs are a main ingredient in meringue, divinity, and custard. TRUE
True or False? An allergy plan for a child is needed only in the case of severe food allergy. FALSE
Where can you find more information? Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs. Available at www.cdc.gov/healthyyouth/foodallergies/ Food Allergy Resource and Education (FARE). Available at http://www.foodallergy.org/resources/schools National Association of School Nurse (NASN), Food Allergy and Anaphylaxis Tool Kit. Available at http://www.nasn.org/toolsresources/foodallergyandanaphyla xis National School Boards Association, Safe at School and Ready to Learn Policy Guide. Available at http://www.nsba.org/services/school-board-leadershipservices/food-allergiesschool-health 47
AAP Resources Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide Includes more than 35 quick-access fact sheets that describes specific conditions, like: Allergies Asthma Autism Diabetes Also includes: Care plans Emergency planning recommendations Ready-to-use sample letters & forms Medication administration issues http://tinyurl.aap.org/pub92742 Heart conditions & defects Seizures
Questions?
For More Information Phone: 888-227-5125 Email: nchinfo@aap.org Web site: http://eclkc.ohs.acf.hhs.gov/hslc /tta-system/health Phone: 888-227-5409 Email: childcare@aap.org Web site: www.healthychildcare.org
Thank You! Head Start Support + Allergy Knowledge = Success