Back to School With Food Allergies – What You Need to Know – Part 2

In Part 1 of this post, I shared with you some important things to consider as you send a child with food allergies to school.

We discussed the three key areas you should address with your child’s caregivers. They must know how to:

• Avoid an allergic reaction
• Recognize an emergency situation if it occurs
• Respond appropriately if an allergic emergency occurs

Now that you have some practical tips to partner with the staff at your child’s school to ensure they avoid allergenic food, we’ll discuss ways you can equip your child’s caregivers to recognize and respond appropriately in an emergency situation.

And remember – the better you communicate, the better the school can accommodate your child’s needs.

Teach Others How to Recognize an Emergency

Many schools offer training for their staff in responding to emergency situations, but staff members can’t respond until they recognize that something serious is happening.

If the building catches fire, it will be obvious. If a tornado threatens destruction, you will know it is happening. But when a child is having a severe allergic reaction, it easily can go unnoticed for some time, and those seconds and minutes that pass are critical.

To ensure they know how to recognize a serious situation, discuss the following with your child’s caregivers:

• Be sure they know the difference between a food intolerance and a true food allergy. Some children may need to avoid foods that give them undesirable symptoms (i.e. bloating and gas when consuming milk or wheat products). This is not the same as a true food allergy that causes an immune response threat, which can be life-threatening.
• Common signs and symptoms associated with an allergic reaction:
  • Hives (red, raised areas of the skin that appear suddenly and can show up anywhere on the body and may cause itching, burning or stinging)
  • Itchy mouth
  • Swelling of the tongue or lips
  • Itching or tightness of the throat
  • Trouble breathing or swallowing
  • Shortness of breath or wheezing
  • Repetitive cough
  • Pale or blue skin color
  • Feeling faint or dizzy
  • Change in alertness or a sense of impending doom
  • Nausea, vomiting, cramps or diarrhea

If you’ve ever been in a situation where your child is experiencing an allergic reaction, you know that often it is not as clear-cut as knowing a list of signs and symptoms.

Reactions present themselves differently in different people, and it’s especially difficult to evaluate when a small child cannot communicate as an adult would.

Explain to your child’s caregivers that instead of a child saying, “I feel tightness in my throat,” they may say things like, “it hurts when I swallow” or “something is stuck in my throat.” Instead of an itchy throat, they may describe something poking them, or instead of saying they feel faint or dizzy, they may simply say that they feel tired.

Equip Others to Respond to an Emergency

This checklist, adapted from the toolkit provided by St. Louis Children’s Hospital, describes what you should do to prepare in case of an emergency.

• Give up-to-date emergency contact information to the school.
• Provide epinephrine auto-injectors for your child’s use. Two doses must be on hand as anaphylaxis often requires a second dose. Medication should be stored at room temperature in a clean, dry, secure location and labeled for your child’s use.
• Make note of the expiration date on the medication provided. Put a reminder on your calendar to replace the medication once expired.
• Provide instructions to all necessary staff members about how to use an epinephrine autoinjector correctly. Use the training device provided with your medication as an example.
  The better you communicate, the better the school can accommodate your child’s needs.
• Ask your allergist or pediatrician to help you develop an emergency response plan specific to your child’s needs.
• Work with school staff members to implement this emergency response plan. If anaphylaxis occurs, staff members should:
  • Inject epinephrine immediately
  • Call 911
  • Place the child in a reclined position with feet raised
  • Keep a second epinephrine dose nearby, if needed
• Consider asking the following questions of school personnel when developing your emergency response plan:
  • Who is responsible for staying with the child, and who will call 911?
  • Who will notify school administration?
  • Who will notify the child’s parents? When will the child’s pediatrician or allergist be contacted?
  • Where will epinephrine be stored, and who will retrieve it?
  • Does the school need written permission from you or your doctor to allow them to administer medication?

After doing each of these things, the school will be well-equipped if your child experiences an allergic reaction. However, sometimes things aren’t quite as clear-cut in real-life emergency situations as we’d like them to be.

The problem we often encounter is this: We see that perhaps a child has begun to have a reaction, but we wonder how bad it has to be before it’s considered an emergency situation.

When Does a Child Need Epinephrine?

Parents, teachers and medical personnel all wrestle with this because often there isn’t a clear answer. Since we aren’t quite sure, sometimes we may decide to wait and see how the situation develops. The American College of Allergy, Asthma and Immunology recently addressed  this topic, and here’s what the experts say: When in doubt, give the dose of epinephrine.

When given in doses available in the auto-injectors, epinephrine is very safe. Delaying the dose of epinephrine may be much more dangerous in the long run. Discuss this topic with your allergist or pediatrician before an emergency occurs. 

If you aren’t sure when epinephrine is needed or what signs and symptoms to look for, talk to your doctor. You can’t prepare your child’s caregivers well if you aren’t prepared, and your doctor’s input is crucial.

Once you’ve addressed each of these issues, you can feel good knowing that you’ve done everything you can to prepare for an emergency. Now, relax and enjoy the school year!