Early Years care is defined as all childcare settings, including childminders, preschools and nurseries, for children from birth to five...
A management plan
A management plan is a written document that informs the person reading it exactly what the problem is and what to do about it. This should include details of signs and symptoms which would alert someone to suspect an allergic reaction, the procedure to be followed in an emergency and details of any medication, which needs to be given. Medication and the management plan should then be kept together in an easily accessible place that all staff are aware of. It is also useful to supply an up-to-date photo so that staff can easily identify your child (this can be useful to add to management plans if school photos are not taken in the first few weeks). Make sure you list all correct and current contact telephone numbers as well as information about what your child needs to avoid. If you are going to be away or out of the area, provide the school with a letter giving alternative contact details for the specified time period.
Advice for schools
Schools can obtain guidance from ‘Managing Medicines in Schools and Early Years settings’ (DFES 2005); this outlines useful information including management of medications, roles of parents/carers and staff training and policy development. It is available online and in hard copy. You can always contact the Allergy UK Helpline for further advice. A Schools Allergy Protocol is available for download, and the school can get more information from the ‘schools’ section of the Allergy UK website.
If there is a possibility that your child needs medical care or the use of medical equipment then specialist input may be required, such as training sessions. Training for adrenaline auto-injector devices may be arranged via your local doctor or school nurse, ask them for further advice on this or discuss with the school how staff get training. Discuss who will be the delegated adult your child should go to, both at break times and during lessons, if there are any problems. Make sure your child and all staff know where the adrenaline auto-injector pen or other medication is kept; this should be in a visible, easy to access area which is unlocked and accessible at all times.
- Always make sure you update new telephone/mobile numbers, addresses, etc.
- Ask about staff training if your child needs an adrenaline auto-injector device
- Find out how supply teachers are informed of your child’s allergy
- Ask the teacher to clarify where all medications such as inhalers, adrenaline devices, antihistamines etc, are kept and make sure your child knows who to ask if they feel any symptoms. Confirm the designated members of staff so your child is familiar with this routine.
These are prescribed for people who suffer with severe allergic symptoms or those that might be at increased risk.
- Consider a medic alert necklace/bracelet/watch for your child (https://www.medicalert.org.uk or https:// www.mediband.com/gb/)
- If your child is also asthmatic, ensure good asthma control is being maintained (your child should be regularly reviewed by your family doctor or specialist for this)
- Keep a note of adrenaline auto-injector expiry dates both at school and at home. EpiPen (www.epipen.co.uk) and Jext (www.jext.co.uk) have an alert system, which you can sign up for. These sites also offer training pens to practise how to give the medication.
- If your child is old enough, reminders about carrying adrenaline auto-injectors or knowing where they are kept will be useful and should be carried out regularly
- Remember to discuss other areas your child may go to around the school or off site for sports and suitable access to the adrenaline auto-injector. This should be stored in a named box with a copy of the management plan, your child’s photo and instructions for use and all staff should be familiar with where this box is kept
- Find out about carrier/protection tubes for adrenaline auto-injector pens, which allow safe carrying of medication if your child is older. (www.yellowcross.co.uk, www.allergylifestyle.com or The Anaphylaxis Campaign www.anaphylaxis.org.uk)
It is important to think of any areas where allowances may need to be made for your child to have extra time, for example, to put on emollient after swimming, or to collect their packed lunch, or to go to have any medication they require. These issues can be dealt with in a non-disruptive way and a routine can soon be established as long as you inform the teacher and check with your child that the plan of action is working.
Remember to consider lessons that your child may take part in and the potential allergens which they may come into contact with. Research has shown that children who have asthma and allergies often have reactions due to triggers in the classroom, so it is not unreasonable to insist that your child’s allergy is taken into account when planning lessons. It will be necessary to ask the teacher to check the suitability of materials used in lessons to make sure they will not affect your child.
When children are at infant school, the class teacher usually has the same children for all lessons and movement around the school may be quite limited as most lessons are in the same area. This makes it easier to assess and control the exposure to allergens.
Some simple steps to discuss with your child and school, to help reduce allergen exposure at school include:
- Prevent a child with asthma, eczema or house dust mite allergy sitting on dusty carpets www.allergyhouse.co.uk
- Prevent a child with hay fever sitting near an open window in the summer, especially when grass is being cut. Ensure they are taking regular medication also to reduce symptoms (see Factsheet on allergic rhinitis and hay fever)
- Minimise exposure to heat sources for children with eczema
- Prevent exposure to allergens when considering art and craft and sensory play. (This includes glues, paints and old food cartons that may include food allergens i.e. for crafts and models and washing up liquid and highly perfumed products i.e. shaving foam and detergents)
- Take care when creating nature tables or pet corners with animal foods and touching of pets
- Take care with the choice of class snacks or treats, if children have a food allergy
- Inform cookery, science or other teachers when working with food in class with food allergic children
Remember to discuss with teachers any potential allergens, both inside and outside the classroom, such as activity lessons, school trips, games and physical education. If your child has an asthma inhaler or an adrenaline auto-injector device, ensure that these are taken to any sporting area or fixture.
As your child gets older, they will want to take more control of their own allergic condition and may find it easier to discuss their needs with individual teachers themselves. However, it is important that your child always has a written management plan as a back-up, since even the most confident child or young person can sometimes forget to pass on a vital piece of information. You may find your child is being taught by different teachers for a number of subjects and it would help to ensure that all these are aware of your child’s allergies. It may also be helpful for supply teachers or helpers to be given this information.
Studies have shown that allergic children may be more prone to sleep disturbance, which could affect their concentration levels and behaviour. If tiredness is a problem it may be a good idea to discuss your child’s medication with your healthcare professional to see if there are any alternatives that can be used eg non-sedating antihistamines. Make sure teaching staff are aware of any issues with exacerbation of allergic conditions that can lead to irritation or disturbed sleep which can make your child feel more agitated or lacking in concentration, so that any alterations in behaviour etc can be noted and acknowledged. This will also limit the child being labelled as ‘difficult’ when physical symptoms could be a factor to consider.
Make sure your child knows that it is important to tell someone if they feel any symptoms are starting even if they have been given a ‘forbidden’ food by a friend or eaten something by mistake. Sometimes children do not want to get their friends or themselves into trouble, and the importance of telling someone quickly is forgotten. This can lead to a more serious situation so it needs to be handled delicately.
School meals / catering Food allergy is increasingly understood by those working in schools, so most schools have processes in place to minimise risk to children with food allergy. A common approach is to have:
- A no food-sharing policy – this means that all children, not just those with allergy, only eat their own food. In this way there can be no confusion or need for decisions to be made about whether a child with a food allergy can or cannot have some of their friend’s food.
- We do not recommend a ‘no nuts’ policy in schools as this can lead to the children having a false sense of security and stop checking whether foods are safe for them to eat. It will not cover other allergies.
- In the first instance, arrange to meet with the head teacher once you know your child has a school place; you can then raise your concerns and make suggestions about how your child, and any others with food allergies, can be kept as safe from risk as possible. The head teacher of a school does not usually have any managing role regarding the school catering, but should be able to put you in touch with the people who do the school’s catering.
Some schools encourage children with food allergy to bring a packed meal, and this provides an easy solution to ensure that your child is eating safely. However, your child is entitled to a school meal, and many schools are now beginning to take food allergies into consideration when providing their food. You can help this process by:
- Giving the catering staff a copy of a picture of your child and their management plan. Whilst schools no longer routinely want sensitive information with pictures on display, the picture can be kept in a file so that new staff can have a child with food allergy pointed out to them.
- Approach the school early so that it does not come as a shock to the catering staff that they are to cater for a child with a food allergy. You will probably know that you have a place at a school before the end of the previous school year; this would be a good time to visit and start taking steps to talk to the school caterers.
- If you are given prescription foods (such as gluten-free pasta), you may wish to let the school caterers have a store of this. Give the caterers your phone number so that they can contact you directly if more information is required.
- Ask if there is a specific member of the catering staff who will help your child each day and give them the required ‘safe’ prepared meal.
Special treat days
Supply any special snacks or birthday treats in a labelled tin (the teacher can then give these out if other children bring in treats for birthdays). Try to send in “extras” each half term so your child does not run out and supply your child’s own allergen-free cake if you know in advance the birthdays of classmates who may take in cakes to school.
If your child has a seasonal allergy, make sure that you visit your GP prior to the season for adequate medication and advise the teacher about difficulties such as games lessons outside, wearing of sunglasses, etc. Try avoidance techniques or measures to eliminate exposure to allergens, such as showering hair after games lessons or at home to remove pollens.
Check ingredients and offer to provide alternatives if possible for cookery etc, ask the school if they could adapt a recipe (for example nut-free ingredients, etc) so your child is included and the other children all use the same products if possible. However, there may be children with different allergies who are not able to use the same ingredients as your child, so it may be easier just to supply your own child’s ingredients.
Check activities such as play dough, art lessons, nature tables and care of the class pets. Be especially aware of any contact allergies, such as eczema, which could be made worse by some activities. Ask the teacher about alternative activities which they could provide, or may already be available, that your child could take part in with a small group of other children so that they do not feel left out. Discuss distraction techniques to prevent focusing on factors such as itchy eczema (The National Eczema Society have more guidance on these issues – https://eczema. org 0207 561 8230 and EOS https://www.eos.org.uk/ healthcare-professionals/education/). For older children, lessons such as science should be discussed with regard to chemicals etc.
For PE and games, make sure staff are aware of children who have asthma. Reminders from staff may be necessary about taking inhalers/ adrenaline auto-injectors to sports fields (especially off site). Emphasise the need for additional ‘swim’ time which will allow for children who may require emollients or showering if they have eczema.
It is important that your child is included in all outings where possible and it is also important to make sure that they are enjoyable for your child without any, or minimal, risk of allergic reactions.
- Day trips and school journeys will need careful forward planning – ensure you are given all the details of the trip and meet with the teacher to offer suggestions or discuss any points may concern you. Try and do this several days in advance so that you are not trying to explain to busy trip leaders on the morning of the departure, as it may be that additional medications are needed, such as two adrenaline auto-injector pens.
- Ensure that the management plan is taken on the trip by the teacher and a mobile telephone is available (in case of emergency)
- Provision of extra packed lunch items, drinks etc and spare adrenaline devices may be useful
- Eating/drinking outdoors should be avoided where possible, especially drinking from open cans if your child is wasp/bee-allergic
- Overseas translation cards will be useful if going abroad. Contact Allergy UK to order these.
Explaining to other children about your child’s allergy can be done by the child, parent, teacher or the school nurse if requested. Children are naturally inquisitive and will want to know why your child has to avoid certain things, so it is easier to be open and discuss any issues surrounding the allergy that the children should be aware of. Always make sure that any information is age-appropriate; the class teacher or school nurse may be able to advise upon this.
Circle time is a good environment in early years to introduce the subject of allergies to other children and to talk about how to help an allergic child deal with their allergy. It can be useful to explain about situations where your child can and cannot take part, for instance, other children can often think that they are being kind by offering sweets etc to an allergic child so that they are not left out. They may also not understand why some children cannot take part in activities, such as sport, and it can be helpful for teachers to explain this simply to classmates, before starting an activity where one child cannot take part for medical reasons.
There are various books available to help explain allergy to children, and further information on these can be obtained from Allergy UK. The most important thing is that your child feels included and secure, and that other children do not feel they have to be kept apart from your child. It is easier if these situations are dealt with from an early age then, as the child grows up, their confidence should increase and they can find it easier to cope as they get older.
As your child gets older, you may find that their friends will be able to offer a great deal of support to them, so it is important that they understand your child’s condition as soon as possible.
Remember that all children need extra reassurance when starting/going back to school and flare-ups of allergic conditions, such as asthma or eczema, can occur at any time. Tiredness, due to lost sleep, if the child has allergic symptoms at night, may be a problem, so always take this into account. Always advise the teacher the next day if there has been a problem, so your child’s needs are fully understood. And ask the teacher to notify you of any problems encountered during the school day so you are aware of any potential triggers or problems which could continue after home time. Try to manage any flare-ups but, if things do seem to be worsening, then contact your GP/ allergist for advice to ensure that the condition is controlled and stabilised quickly.