House CallAug/Sep 2012 Issue

Pediactric Allergies Q & A - Peanuts in the Cafeteria, Safe Sleepover, and More!

Medical experts answer your questions about allergies and sensitivities

Photo © Thinkstock 2012/Purestock

Safe Sleepover

My 4th grade daughter has severe food allergies. She wants to stay overnight at her friend’s house but I’m just not comfortable with it. I hate to always say no. What should I do?

Lee & Pistiner Getting dropped off at a friend’s house is not only fun, it helps foster independence and lasting friendships. Yet it’s understandable that you feel uneasy about leaving your daughter with someone else. A sleepover can be safe if the adults in charge understand allergen avoidance and know how to respond in an emergency. Planning, teaching and good communication make this possible. Well before the sleepover, tell the caregivers about your daughter’s food allergies and let them make an informed choice about taking on the responsibility. Training the adult caregivers about food allergies should take place when they have time to give you their full attention. If you rush, important details may be left off.

To prevent a reaction, discuss label reading, hidden ingredients, cross contact and the importance of communication. Ask about foods being served and ensure that the necessary steps are followed to provide a safe meal. If there’s any doubt, provide safe foods that your child can bring with her to eat there.

To prepare for an emergency, teach how to recognize an allergic reaction and when to give epinephrine. Demonstrate how to use an autoinjector with a training device. Review your child’s allergy action plan and leave a copy with an epinephrine autoinjector. Provide the phone number for emergency services and your contact information. Remind the caregivers to call you only after the appropriate steps are followed.

Review avoidance strategies with your daughter in a way that’s developmentally appropriate. Remind her to report any allergic symptoms and accidents and emphasize that it’s absolutely okay to say, “No, thank you,” if she is offered foods that may not be safe. Talk with your physician about how to teach your daughter other appropriate self management.

If you sense the caregivers aren’t comfortable with allergy management, don’t force it. It may take a few supervised get-togethers—or sleepovers at your house—before you and the other family feel ready handing over responsibility.

Back to School

My son, who has a severe milk allergy, is starting school this fall. How can I prepare to send him off?

Lee & Pistiner Schools are generally more aware of food allergies and sensitivities than in the past and many have developed comprehensive and effective policies to care for their students. That said, depending on your district, your child’s school may have less experience and you may need to work in close cooperation with school officials and staff to put safe strategies into place. With multiple staff members, different settings and other students and their families to take into account, the key to success is creating a close working partnership with a team of well-informed people who are watching out for your child’s welfare.

Don’t recreate the wheel. Use trusted resources and become familiar with local, state and national policies and guidelines that provide the groundwork. Involve your healthcare provider and maintain open communication with the school, especially your child’s teacher and the school’s point person (in most cases, the school nurse). Get familiar with regulations that may affect your child. In some cases, the creation of a 504 plan in collaboration with your school team and allergist may be necessary.

It’s best to discuss your child’s food allergy well before the start of the school year. Set up an appointment to talk to your school team about how food allergies will be managed in different settings (classroom, cafeteria, school bus, field trips, etc). Ask about policies regarding snacks, birthdays and outside food. Request that you be alerted in advance when food is brought in or used for educational curriculum; this way you can provide input and institute measures to keep your child safe.

Food allergy management must be implemented at all times. An important part of this is to provide the school with unexpired epinephrine auto-injectors, as well as an updated Food Allergy Action Plan (a document created by your healthcare provider that outlines your child’s emergency allergy treatment). The start of the school year is a busy period for doctor’s offices, so allow plenty of time to obtain necessary prescriptions and completed health forms.

Peanuts in the Cafeteria

My daughter has a peanut allergy. The school allows children to eat peanut butter near her in the cafeteria. Should I be worried?

Lee & Pistiner Age and developmental level are very important when considering proper food allergy management. Strategies should be tailored to the developmental age of your child.

Young children explore their environment with their hands, touching their face and eyes and putting their fingers in their mouth and nose. In addition, they may not understand the importance of not sharing food, may be messy eaters and may not be very effective at washing their hands. It stands to reason that policies restricting the allergen from the classroom and play areas or close adult supervision and thorough cleaning strategies may be required.

Older children and teenagers are better able to self manage, understand the potential risks of food allergy exposures and, in most cases, are responsible enough to eat near others who are consuming a food to which they’re allergic.

Studies in children with peanut allergies demonstrate that it’s highly unlikely that an allergic reaction will occur just from the smell of peanut butter. However, certain precautions need to be in place to prevent exposure, since an anaphylactic reaction can happen if a food allergen is accidentally ingested or rubbed into the eyes or nose. Policies such as washing hands before and after eating and cleaning tables and chairs after each meal will help to prevent these exposures.

Consult with your child’s allergist to formulate a strategy to keep your daughter safe while eating at school.

John Lee, MD, a board-certified pediatric allergist, is clinical instructor of pediatrics at Children's Hospital Boston, Harvard Medical School, where he also serves as co-director of the Eosinophilic Gastrointestinal Diseases Program.
Michael Pistiner, MD, a board-certified pediatric allergist, works at Harvard Vanguard Medical Associates and is instructor of pediatrics at Children’s Hospital Boston, Harvard Medical School.
Lee and Pistiner are creators of Visit for free reference tools and educational modules that can be used to raise community awareness of food allergies.

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