Children's Allergy and Anaphylaxis Protocols for Schools and Child Care Organisations

This protocol can be used by anyone caring for a child who may be at risk of allergic symptoms or Anaphylaxis.

The protocol is to ensure that everyone caring for the child is aware of their allergies, symptoms and to promote better understanding of the child's needs and medical requirements. This should help to allow for better management of symptoms and recognition of how to deal with emergency situations if they arise. It should also allow for effective communication between parents, childcare organisations and medical professionals which should help both the allergic child and anyone involved in their care.

Regular updates of this document should be made (it is recommended that this document is read by those caring for the child between 3-6 monthly periods to ensure familiarity and up to date appropriate care. An annual review is recommended (unless changes need to be made as suggested by the treating Doctor before this date).

The information below is given for guidance purposes only and should be used as an example to help with drawing up of an individual named protocol in conjunction with the clinical judgement of the patient's GP or Consultant, the parents the childminder/ nursery /playschool /carer who is looking after that child.

Staff Indemnity

"The Employer and themselves if self employed fully indemnifies its staff and itself against claims for alleged negligence, providing they are acting within the scope of their employment, having been provided with adequate training, and are following the Employer's guidelines. For the purposes of indemnity, the administration of medicines falls within this definition and hence the staff can be reassured about the protection their employer provides. The indemnity should cover the consequences that might arise where an incorrect dose is inadvertently given or where the administration is overlooked. In practice indemnity means that Employer and not the employee will meet the costs of damages should a claim for alleged negligence be successful."

This protocol should be read, checked and signed by the parents/carers, your treating Medical Practitioner/Doctor or GP, the Head teacher (if used in a school setting), the Nursery/playgroup manager if used in a childcare setting or the Childminder if used in a childminding facility.

Copies should be kept in accessible places to ensure that everybody who is responsible for the child is aware of the allergic triggers and has good knowledge of how to deal with the child should symptoms occur Copies should be given to the parents, GP, Local Education Authority / Independent School / Education Departments i.e. School/ Nursery, LEA or childcare facility i.e. Nursery/ childminder.

Medication

The Medication often prescribed for a child at risk of anaphylaxis is Epinephrine. (Commonly known as Adrenaline) This may be injectable epinephrine (The EpiPen or Anapen).

It is important that the parent explains what medication his or her child has been prescribed, what symptoms may occur and when and how to use the emergency pack. ALL staff will need to know where the medication is stored. This should be out of reach of children but readily accessible. It should be clearly labelled with the child's name and instructions for use.
Responsibility for ensuring the medication is "In Date" rests with the parent. Make sure insurance arrangements provide full cover for staff within the scope of their employment.

Allergic Reactions

• These reactions can be mild, moderate or severe and in some cases life threatening - this is known as Anaphylaxis. Prompt treatment is necessary and follow up by medical staff may be required.
• It is essential each child follows their own individual protocol and that this is updated if any changes occur.
• It is important that strict attention is paid to any allergic triggers which could cause an allergic reaction and risk of coming into contact with these allergic triggers is minimised. (These are detailed below in precautionary measures).
• Emergency medication must be accessible at all times and a plan of action should be drawn up to ensure everyone knows what to do in such an event to ensure safety of the child.
• It is important that children with allergies are treated sympathetically but also that they are able to be included in as many activities with precautionary measures in place which do not place the child at risk. Therefore allowing them to take part in school and out of school activities and feel they can be included in a supportive environment.

Symptoms of allergic reactions:

Ear/Nose/Throat Symptoms:
runny or blocked nose, itchy nose, sneezing, painful sinuses, headaches, post nasal drip, loss of sense of smell/taste, sore throat/swollen larynx (voice box), itchy mouth and/or throat and blocked ears.

Eye Symptoms:
watery, itchy, prickly, red, swollen eyes. Allergic 'shiners' (dark areas under the eyes due to blocked sinuses).

Airway Symptoms:
wheezy breathing, difficulty in breathing and or coughing (especially at night time).

Digestion:
swollen lips, tongue, itchy tongue, stomach ache, feeling sick, vomiting, constipation and or diarrhoea.

Skin:
Urticaria - wheals or hives-bumpy, itchy raised areas and or rashes.
Eczema -cracked, dry, weepy or broken skin. Red cheeks.
Angiodema - painful swelling of the deep layers of the skin.

Symptoms of Severe Reaction/ Anaphylaxis:

These could include any of the above together with:

• Difficulty in swallowing or speaking.
• Difficulty in breathing -severe asthma
• Swelling of the throat and mouth
• Hives anywhere on the body or generalized flushing of the skin
• Abdominal cramps, nausea and vomiting
• Sudden feeling of weakness (drop in blood pressure)
• Alterations in heart rate (fast Pulse)
• Sense of Impending doom (anxiety/panic)
• Collapse and unconsciousness

If you are in any doubt about the severity of any symptoms always seek urgent medical attention (Call 999 for an ambulance and state Anaphylaxis. The first line treatment of anaphylaxis is Adrenaline (epinephrine) given by injection.

THE ABOVE ONLY INCLUDES PART OF THE PROTOCOLS DOCUMENTATION. PLEASE USE THE BUTTON BELOW TO DOWNLOAD THIS AS A PDF WHICH INCLUDES SUPPLEMENTAL FORMS.

Updated 4/2009