Managing Common Childhood Illnesses, Including Food Intolerances and Allergies. Script

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1 Managing Common Childhood Illnesses, Including Food Intolerances and Allergies Introduction Script Welcome to Management of Common Childhood Illnesses, including Food Intolerances and Allergies. This 2-hour course is part of a series of online trainings designed to help you, as child care providers and directors, implement current, research-based best practices in your child care environments. During today s training, we will discuss how to manage common childhood illnesses, food intolerances, and allergies. Learning Objectives When you have completed this course, you should be able to: Explain why it is important for you to be familiar with childhood illnesses, List and describe several types of chronic illnesses that may affect children in your care, Define and describe food intolerances and food allergies, and the differences between them, and Understand what needs to be done to protect children with food allergies while they are in your care. Overview of Childhood Illnesses All children will become ill at some point in time. That s simply a fact of life. Illnesses can be caused by infection, or can be a product of the child s body reacting to something in the environment. Some illnesses are congenital, meaning the child is born with them. Some illnesses are over quickly, and others may be chronic. Some illnesses are contagious, meaning they can be passed from one person to another, and others are not. Obviously, when children are in a group setting, like a child care home or center, the likelihood of becoming exposed to the germs that cause contagious illnesses like the common cold and strep throat increases. Young children tend to get sick more often than older children and adults, because they have not been exposed to as many germs. As child care providers, you will have to deal with illnesses, both contagious and non-contagious, and it s important that you have a working knowledge about the most common childhood illnesses. Throughout the rest of this course, we will explore various types of illnesses that tend to be prevalent among children, including infectious diseases (like the common cold) and chronic conditions (like asthma), with a special emphasis on food intolerance and allergies. Common Infectious Illnesses First, let s look at some common communicable diseases that occur in child care settings. There are lots of different pathogens that can invade our bodies and make us sick, such as bacteria, viruses, fungi, and parasites. Strep throat is an example of a bacterial infection. The flu is an 1

2 example of a viral infection. Ringworm is an example of a fungal infection, and is not actually caused by a worm. Head lice and tapeworms are both parasites that can infest the human body. The most common ways these types of infections spread are through touching, sneezing, coughing, and bleeding (Nemours, 2015). These infectious diseases can be prevented to a large degree by implementing proper infection control procedures, including using best practices in hand washing, cleaning and sanitizing, diapering and toileting, and food handling. Some of the most common types of infections that you might encounter in working with children include: Colds Colds are generally caused by one of more than 100 different rhinoviruses. If a child catches a cold, the first signs might include a scratchy throat, a runny or stuffy nose, and sneezing. Discharge from the child s nose may be thick in consistency, and yellow or green in color. Children can get as many as eight colds a year, and this viral infection is the number one reason children visit the doctor and stay home from school. However, colds do not typically cause serious complications, and more often than not they clear up on their own (National Institute of Allergy and Infectious Diseases, 2015; Nemours, 2015). Gastroenteritis Gastroenteritis is commonly called the stomach flu, but is not actually caused by the influenza virus at all. Gastroenteritis is characterized by vomiting and diarrhea. Gastroenteritis can be caused by viral, bacterial, or parasitic infections. It is usually not serious and generally lasts just a few days, but it is highly contagious. The greatest risk from gastroenteritis is dehydration, with young children being most at risk. Because it is not actually a type of flu, gastroenteritis cannot be prevented by the annual flu vaccine. The flu vaccine helps to prevent infection with the influenza virus, which can cause respiratory symptoms and can lead to serious complications for people with weakened immune systems. The best way to prevent gastroenteritis is through frequent, proper hand washing (National Institute of Diabetes and Digestive and Kidney Diseases; Nemours, 2015). Ear Infections An ear infection, medically known as acute otitis media, is most often a bacterial or viral infection that affects the middle ear. Children are more affected by ear infections than adults. In fact, according to the National Institutes of Health (2015), seventy-five percent of children will have an ear infection before they turn three. Signs of ear infections include ear pain, especially when lying down, tugging or pulling at an ear, difficulty sleeping, crying more than usual, acting more irritable than usual, difficulty hearing or responding to sounds, loss of balance, fever of 100 degrees Fahrenheit or higher, drainage of fluid from the ear, headache, and/or loss of appetite (Mayo Clinic, 2013). It is important to recognize these symptoms, because while ear infections are usually easily treated, long-term problems like hearing loss can occur if no medical treatment is sought. Pink Eye The medical term for pink eye is conjunctivitis, which refers to the fact that pink eye occurs when there is inflammation of the clear membrane that covers the white part of the eye and lines the inner surface of the eyelids, called the conjunctiva. It can be caused by bacterial or viral infections, or by allergic reactions. Symptoms of pink eye 2

3 include redness, itchiness, a gritty feeling, or a discharge that forms a crust during the night that may prevent one or both eyes from opening in the morning, and tearing or watering of the eye (Mayo Clinic, 2015). Pink eye can be irritating, but it does not typically harm a child s vision in the long-term. However, pink eye can be very contagious, so be aware of your program s policies regarding excluding sick children from care, which we will discuss later in this course. Sore throat Most sore throats are caused by viruses, but about 15 percent of children s sore throats are caused by streptococci, the bacteria that causes strep throat. Other bacterial infections can cause tonsillitis. If a child in your care has a sore throat accompanied by breathing difficulty, difficulty swallowing, or he cannot tolerate liquids, seek immediate emergency care. Contact a child s parent and request medical attention if he has a sore throat for longer than a week, or has a fever, swollen tonsils, white patches or pus on the back of his throat, swollen lymph nodes, or signs of dehydration (Mayo Clinic, 2015). Human Parainfluenza Viruses Infections with human parainfluenza viruses (also called HPIVs) tend to cause upper and/or lower respiratory symptoms. According to the Centers for Disease Control and Prevention (2012), the symptoms of HPIVs include fever, runny noses, coughing, pneumonia, ear infection, irritability, decreased appetite, and/or croup, bronchitis, or bronchiolitis, which are all terms for swelling in different parts of the passage through which air travels in and around the lungs. It spreads through contact with infected people or contaminated surfaces, and through droplets in the air released when an infected person coughs or sneezes. Tinea Infections Tinea infections include ringworm, athlete s foot, and jock itch. While these conditions sound like separate categories, they are actually all referring to the same type of infection on different parts of the body. They are all caused by certain types of fungi, sometimes called dermatophytes, which thrive on the skin, hair, and nails, especially in warm, moist conditions. They spread through contact with the skin of an infected person or animal, or with objects that have come into contact with an infected individual, like clothing or hair brushes (Mayo Clinic, 2015; CDC, 2014). Head lice Head lice are tiny insects that infest the hair of the scalp and sometimes eyebrows and eyelashes, resulting in intense itching and sometimes in red bumps that can become crusty and ooze, especially when children scratch and cause their scalps to become infected. Lice can easily pass from person to person in child care settings, because children are prone to sharing items like hats, hair brushes, bedding, and stuffed animals that can harbor these parasites (Nemours Foundation, 2015), and Impetigo This is a skin disorder caused by bacterial infection and characterized by crusty skin lesions. Typically, the infection begins as a cluster of tiny blisters, followed by oozing and the formation of a thick, yellow- or brown-colored crust that is firmly stuck to the skin. Impetigo can spread through skin-to-skin contact, or through contact with items that have been contaminated through contact with infected areas of skin (Nemours, 2015). While this list contains some of the most common types of infections found in child care, these 3

4 are just a small sample of the various infections you might see. Some other types of infectious disease are less common, but can lead to very serious complications. These include: Meningitis Meningitis is a viral or bacterial infection that causes inflammation of the membranes covering the brain and spinal cord. Symptoms may include fever and chills, nausea and vomiting, stiff neck, sensitivity to light, and mental status changes. Some forms of meningitis can be highly contagious, and the impact of meningitis can be lifethreatening in some instances if not treated properly. Hepatitis A Hepatitis A is a liver disease caused by a virus. It spreads through the ingestion of fecal matter from an infected individual. This can happen through close contact with others or by contaminated food or drinks, which can happen, for example, if food service personnel do not practice proper hand washing. Hepatitis A is a vaccinepreventable disease. Hepatitis B Hepatitis B is also a liver disease caused by a virus. It spreads through contact with blood and body fluids from an infected individual. Infants can be born with Hepatitis B if the mother is infected prior to giving birth. Hepatitis B is also a vaccinepreventable disease. Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome Human Immunodeficiency Virus (also called HIV) is a viral infection that damages the body s ability to fight infections. HIV can cause a serious chronic medical condition called Acquired Immunodeficiency Syndrome (or AIDS). While HIV is most commonly thought of as a sexually transmitted infection, it can also be passed from mother to child at birth or through breast milk, and through contact with the blood of an infected individual (especially through blood transfusions or injections with contaminated needles) (Mayo Clinic, 2015), and Methicillin-Resistant Staphylococcus Aureus Methicillin-resistant Staphylococcus aureus, also called MRSA (or MER-sah) is an infection caused by a particular strain of bacteria that resists treatment with the most common antibiotics used to treat staph infections. MRSA can spread in child care settings because there is a lot of skin-to-skin contact among children and between children and caregivers during normal routines and play activities. MRSA tends to start as a painful red sore on the skin that might look like a spider bite. Without proper treatment, MRSA can spread from the skin to other body systems, affecting the bones, joints, blood, heart, and/or lungs (Mayo Clinic, 2015). There may also be times when a child exhibits symptoms of having a contagious illness, but you might not know exactly what that illness is. Some of the symptoms you might see include: Fever Fever is a sign that a person s immune system is reacting to some sort of infection. A fever by itself is not usually dangerous. A child with a fever may have less appetite and energy than usual, and may have chills. Unless you have documentation from a medical provider that states that a child is not contagious, you should always assume that a fever is a potential sign of a communicable disease, and follow your program s procedures for excluding the child from care (Texas A&M AgriLife Extension, 2015). 4

5 Inflammation Inflammation is another general sign that a child s body is fighting some kind of infection, injury, or irritation. The term inflammation refers to tissue that is swollen, red, hot, and/or painful. Inflammation can occur in any area of the body, and types of inflammation are usually named based on where they occur. For example, croup, bronchitis, bronchiolitis, and pneumonia, which we discussed briefly earlier in this course, are all examples of inflammation in the respiratory system (Texas A&M AgriLife Extension, 2014), and, Coughs According to the National Institutes of Health (2015), Coughing is a reflex that keeps the throat and airways clear. Although it can be annoying, coughing helps our bodies heal or protect themselves. There are many different types of coughs dry coughs and productive coughs, acute (or short-term) and chronic (or long-term) coughs, and so forth. While some coughs are caused by infectious diseases, others may be indicators of non-contagious conditions like allergies or asthma. If a child has a cough along with any other signs of infectious illness, follow your program s policies and procedures regarding excluding sick children from care. Excluding Sick Children from Care With the large variety of symptoms and conditions that children can experience, it can be confusing to determine when to send a child home and when to keep him or her in your care. The Texas Department of Family and Protective Services Child Care Licensing division gives specific requirements for child care providers operating in the State of Texas regarding when to exclude children from care. If you are a child care provider operating outside of Texas, contact the regulatory agency in your area to find out the requirements that apply to your program. In general, if the child is suffering from a contagious illness or if his or her condition requires more care and attention than a caregiver can reasonably provide in the context of a group, then the child s family should be contacted to remove the child from the program until he or she has been treated. The Texas Minimum Standards for Child Care (2015) states that unless you are licensed to provide get-well care, you must not admit an ill child for care if one or more of the following exists: The illness prevents the child from participating comfortably in child-care center activities including outdoor play, The illness results in a greater need for care than caregivers can provide without compromising the health, safety, and supervision of the other children in care, The child has one of the following, unless medical evaluation by a healthcare professional indicates that you can include the child in the child-care center s activities: o Oral temperature of above 101 degrees and accompanied by behavior changes or other signs and symptoms of illness, o Rectal temperature of above 102 degrees and accompanied by behavior changes or other signs or symptoms of illness, o Armpit temperature of above 100 degrees and accompanied by behavior changes or other signs or symptoms of illness, or 5

6 o Symptoms and signs of possible severe illness such as lethargy, abnormal breathing, uncontrolled diarrhea, two or more vomiting episodes in 24 hours, rash with fever, mouth sores with drooling, behavior changes, or other signs that the child may be severely ill, or A healthcare professional has diagnosed the child with a communicable disease, and the child does not have medical documentation to indicate that the child is no longer contagious. The Texas Department of State Health Services provides a concise chart summarizing many of the major communicable diseases that affect children in schools and child care facilities. It is called the Communicable Disease Chart and Notes for Schools and Childcare Centers, and we have provided a copy among the materials for this course. The Communicable Disease Chart lists: The name of the condition, Information about how it is passed from person to person, The incubation period, which means the amount of time that typically passes between when a person comes into contact with the illness and when he or she starts to show symptoms, Signs and symptoms associated with the illness, Guidelines for excluding children with the condition from schools and child care programs, Guidelines for when children can come back to the school or child care program after they have been diagnosed with a particular condition, Whether or not schools and child care programs are required to report the illness to the Department of State Health Services, and Information about how to prevent infection, how infections are treated, and other important notes pertaining to each condition listed on the chart. Take a few moments to familiarize yourself with the Communicable Disease Chart. [HANDOUT: Communicable Disease Chart and Notes for Schools and Childcare Centers] Non-Contagious Conditions There are some common illnesses that affect children which are not contagious, but may require special procedures or preventative measures to keep the child healthy in the child care setting. These conditions include things like: Eczema Eczema is a red, itchy rash that can cause the skin to be very dry and/or to break out with small red bumps. Eczema is not an allergic reaction, but many children with eczema have allergy problems, so researchers believe the two conditions are related. While eczema is not contagious, any unidentified rash should be considered contagious until you have documentation from a healthcare provider stating that the child can safely remain in care (Nemours Foundation, 2015), 6

7 Psoriasis Psoriasis is a skin condition that causes thick, itchy patches of skin, which are often red, and may have silvery, scaly flakes that come off the affected areas. A child with psoriasis may go long periods without showing any symptoms at all, and then break out with the telltale rash again. There are many different types of psoriasis, and a healthcare provider will work with the child s family to find the appropriate course of treatment to reduce the frequency and severity of outbreaks, and relieve the symptoms when one occurs (Nemours Foundation, 2015), Seizures Seizures can be triggered by many different causes, and are essentially a disruption of the electrical signals that carry information throughout the brain. Some very young children experience febrile seizures, which occur when the child has a high fever. Other children may have chronic, recurrent episodes of seizure activity, which may be diagnosed as a condition called epilepsy. Seizures can be very scary, but most are over quickly and do not do any lasting harm to the affected person. If a child in your care has a history of seizures, his or her healthcare provider may have specific recommendations for how to minimize the risk of a seizure occurring, and for how to keep the child safe in the event he or she experiences a seizure while in your care, Diabetes Diabetes is a condition in which a person s body cannot properly use glucose, a type of sugar, from the food he or she eats. For most people a hormone called insulin allows cells to use glucose to produce energy, but for people with diabetes, their bodies either do not make insulin properly (called Type 1 Diabetes), or do not respond to it in the right way to allow them to use the glucose (called Type 2 Diabetes). This can cause glucose to build up in the blood. High blood sugar can be dangerous and affect a person s health in many ways, so it is important that you carefully follow any instructions from the healthcare team when working with a child with diabetes (Nemours Foundation, 2012), Asthma Asthma is a condition in which the passages that carry air within a person s lungs are over-reactive to certain irritants, like smoke, exercise, or allergens the person inhales. The small tubes throughout the lungs of a person with asthma tend to be inflamed and produce more mucus than the lungs of a person without asthma, which makes it hard to breathe. A child with asthma may be able to breathe fairly normally most of the time, but may have a flare-up, also called an asthma attack, when his or her lungs become irritated for some reason. In most cases, a child with asthma will have an inhaler. You will have instructions from the child s healthcare provider on how to use the inhaler, what symptoms to look for, and how to help prevent an asthma attack. Be sure to read and understand these directions before an attack occurs, and ask questions if you need help learning how to use the inhaler or other equipment (Nemours Foundation, 2014), and Allergies An allergy is a condition where the body s immune system overreacts when it is exposed to a certain substance, reacting as though the substance is a threat to the body when it is really harmless. The substance the body mistakes for a hazard is called an allergen. Some people are allergic to many different substances, while others only react to one or two allergens. Some allergens are things we inhale, like dust mites, pollen, mold, and pet dander. Some people are allergic to certain types of insect bites or stings, 7

8 medications, or household chemicals. It is also not uncommon for an individual to be allergic to particular foods. Shortly in this course we will discuss food allergies in much more detail. Allergies can cause a wide range of symptoms, including sneezing, stuffy nose, coughing, difficulty breathing, digestive problems like vomiting or diarrhea, itchy, watery, or swollen eyes, hives, swelling, or tightness in the throat. For children with allergies who require specialized care, you will need a plan on file from the child s healthcare provider specifying which allergy triggers they need to avoid, what symptoms to look for in the event the child has an allergic reaction, and how to respond when a reaction occurs (Nemours Foundation, 2014). Food allergies, and other issues with food called intolerances, are of particular concern for child care providers because young children may be exposed to many new foods throughout the first few years of their lives, and because group settings can be particularly risky for children with severe food allergies. Throughout the remainder of this course, we will look at food allergies and intolerances in greater depth discussing how they affect children s bodies and what you can do to help keep children safe and healthy in your care. Food Intolerances and Allergies There are two main categories of adverse reactions to foods intolerances and allergies. In order to keep children with these conditions safe and healthy, you need to understand what each of these terms means, and the differences between them. Let s start by talking about intolerances. Unlike an allergy, a food intolerance does not usually involve the body s immune system. Intolerances, which are also sometimes called food sensitivities, occur when the digestive system has trouble breaking down a certain type of food for one reason or another. Food allergies, on the other hand, involve the immune response we discussed earlier in which the body mistakenly treats some foods as if they are dangerous invaders, and responds by releasing chemicals such as histamine in an attempt to protect itself. Because the immune system is not reacting when a child has a food intolerance, intolerances are unlikely to cause serious complications. When a child eats or drinks something that his or her body cannot digest properly, he or she may experience symptoms like: Belching, Passing gas, Bloating, Indigestion, Diarrhea, Headaches, Feeling nervous, and/or Feeling flushed. While these symptoms can make a child very uncomfortable, they are not life-threatening like certain serious symptoms that can occur in an allergic reaction (Nemours Foundation, 2012). Common Food Intolerances 8

9 Some foods tend to be associated with food sensitivities more frequently than others. A few of the most common intolerances you might encounter among children in your care include: Lactose The National Institute of Allergy and Infectious Diseases (2010) states that, Lactose is a sugar found in milk and most milk products. Lactase is an enzyme in the lining of the gut that breaks down or digests lactose. Lactose intolerance occurs when lactase is missing. Instead of the enzyme breaking down the sugar, bacteria in the gut break it down, which forms gas, which in turn causes symptoms of bloating, abdominal pain, and sometimes diarrhea. Lactose intolerance is less common in babies and young children under the age of five years. Because lactase levels decline as people get older, lactose intolerance becomes more common with age. Lactose intolerance also varies widely based on racial and ethnic background. Food Additives According to the U.S. Food and Drug Administration (2010), In its broadest sense, a food additive is any substance added to food. Legally, the term refers to any substance the intended use of which results or may be reasonably expected to result directly or indirectly in its becoming a component or otherwise affecting the characteristics of any food. This definition includes any substance used in the production, processing, treatment, packaging, transportation, or storage of food. It is not unusual for substances to be added to foods to preserve them longer, enhance taste, or add color. Some people s bodies react badly to eating certain food additives, such as monosodium glutamate (commonly called MSG) and sulfites. These reactions can be confused with food allergies, because they can include symptoms like chest discomfort and respiratory symptoms (National Institute of Allergy and Infectious Diseases, 2010), and Gluten Gluten is a protein found in several grains, such as wheat, barley, and rye. Many people can eat foods containing gluten without experiencing any adverse reactions. However, some people have an intolerance or sensitivity to gluten, which can cause diarrhea, bloating, and abdominal pain. Others have a condition called celiac disease, in which consuming gluten leads to damage in the lining of the intestines, which makes it more difficult for the body to absorb nutrients from food. Unlike other intolerances, celiac disease involves the immune system, but not in the same way as a traditional allergy. When a person with celiac disease consumes a food containing gluten, he or she will experience symptoms that resemble a gluten sensitivity diarrhea, bloating, and abdominal pain. There are other people who actually are allergic to wheat. When a person with a wheat allergy consumes a food containing wheat, he or she could break out in hives, experience nasal congestion, have trouble breathing, or have eye irritation (National Institutes of Health, 2015; University of California Los Angeles, n.d.). This list is not exhaustive. Children in your care could have trouble tolerating all sorts of foods. It is crucial that you maintain open communication with each child s family in order to ensure that every child s needs are met. As we stated before, food intolerances can cause a lot of discomfort, but they are generally not dangerous. Food allergies, on the other hand, can cause severe reactions that, in extreme cases, 9

10 can even be life-threatening. Let s talk about food allergies and how you can protect the children enrolled in your program. Facts about Food Allergies According to the Centers for Disease Control and Prevention (2015), A food allergy occurs when the body has a specific and reproducible immune response to certain foods. The body s immune response can be severe and life-threatening, such as anaphylaxis. Although the immune system normally protects people from germs, in people with food allergies, the immune system mistakenly responds to food as if it were harmful. It is important that child care providers educate themselves about food allergies because food allergies are fairly common, and the number of children who have been diagnosed with food allergies is on the rise. To emphasize the impact of food allergies, let s take a look at some statistics and facts. These are compiled from the Centers for Disease Control and Prevention, also called the CDC (2015), the Asthma and Allergy Foundation of America, also called AAFA, and Food Allergy Research and Education, also called FARE (2015): Food allergies affect between 4 and 6 percent of children in the United States (CDC, 2015), There may be as many as 6 million children in the U.S. with food allergies, and young children tend to be the most affected (AAFA, 2015), Between 1997 and 2011, the number of children diagnosed with food allergies increased by about 50% (FARE, 2015), Food allergies cause more cases of anaphylaxis in non-hospital settings than any other cause (FARE, 2015), In 2006, there were one or more students with a known food allergy in roughly 88% of American schools (FARE, 2015), About 1 in every 13 children 18 years old or younger has some form of food allergy (FARE, 2015), Someone seeks emergency medical treatment for an allergic reaction to food every three minutes, which equates to over 200,000 emergency room visits each year that are attributed to food allergies (FARE, 2015), Among children who have food allergies, more than 38% have a history of severe allergic reactions, and more than 30% are allergic to more than one type of food (AAFA, 2015), and While it is clear that the incidence of food allergies is increasing, no one is really sure why this is the case (FARE, 2015). With increasing numbers of food allergies being diagnosed among children, it is very likely that at some point you will be called upon to care for a child who is allergic to one or more foods. In order to provide high quality care for children with food allergies, you need to know where food allergies come from, what foods are most likely to trigger an allergic reaction, what kinds of symptoms a child might exhibit during an allergic reaction, what steps you can take to help prevent an allergic reaction to food in your child care program, and how to develop a plan for responding to an allergic reaction if one should occur. 10

11 Where Do Food Allergies Come From? Like other types of allergies, food allergies can run in families. So, if a child s sibling or parent has a known food allergy, child care providers should carefully watch for signs of food allergies in the child in their care. According to the American College of Allergy, Asthma, and Immunology, or ACAAI, (2014), children can develop a food allergy at any age. A child can even develop an allergy to a food that they have eaten many times in the past without having any reaction. Therefore, if a child starts to manifest symptoms that could be a food allergy, it s important that you take the situation seriously and consider the possibility that the child may have developed a new allergy, rather than dismissing the situation by saying that the child has never had a reaction before. Food allergies tend to be more prevalent among infants and young children, and children with certain types of food allergies can grow out of the condition at some point in their lives (ACAAI, 2014; FARE, 2015). Children are far more likely to outgrow allergies to eggs and milk, and far less likely to outgrow allergies to peanuts, tree nuts, and shellfish (CDC, 2015). Most Common Food Allergens According to FARE (2015), Although nearly any food is capable of causing an allergic reaction, only eight foods account for 90 percent of all food-allergic reactions in the United States. These foods are: Peanuts, Tree nuts, Milk, Eggs, Wheat, Soy, Fish, and Shellfish. While these are the most common food allergens across the lifespan, children tend to have more reactions to eggs, milk, peanuts, tree nuts, soy, and wheat, while adults tend to have reactions most commonly in response to contact with fish, shellfish, peanuts, and tree nuts (such as walnuts) (NIH, 2015). According to the ACAAI (2015), people who are allergic to a specific food may also potentially have a reaction to related foods. This is called cross-reactivity, and it happens because different foods may contain similar types of proteins, so the body reacts as if the two types of proteins are related. So someone who is allergic to one type of tree nut might react to other types of tree nuts, and someone who is allergic to one type of shellfish might react to other types of shellfish. A person who is allergic to ragweed, an allergen that people typically inhale rather than eating, may even develop an allergy to foods like bananas or melons (ACAAI, 2015). Food allergies are a complex phenomenon. In most cases, individuals with food allergies need to completely avoid the foods that trigger their allergic reactions. However, some people have a 11

12 condition called oral allergy syndrome. These people show allergy symptoms like itching of the mouth or throat after eating fruits or vegetables that have not been cooked. In oral allergy syndrome, the body is reacting to pollen from the plant the food came from, not to the food itself. Heating the fruit or vegetable destroys the allergen, meaning children and adults with oral allergy syndrome can safely eat cooked foods that they cannot eat raw (ACAAI, 2015). Symptoms of a Food Allergy The symptoms of an allergic reaction to food can affect the skin, digestive system, respiratory system, and/or cardiovascular system (Nemours Foundation, 2012). As with other allergies, when someone has an allergic reaction to a food, his or her symptoms can be range from mild to potentially fatal. During a mild allergic reaction to food, an individual might experience: Hives, which are itchy, inflamed areas on the skin, Eczema, which is a dry, itchy rash, Redness of the skin or around the eyes, Itching of the mouth or lips, Itching of the ear canal, Nausea, Vomiting, Diarrhea, Abdominal pain, Stomach cramps, Nasal congestion, Runny nose, Sneezing, A slight, dry cough, An odd taste in the mouth, and/or Uterine contractions (FARE, 2015; NIH, 2015; ACAAI, 2014; AAFA, 2005). In more serious cases, a person who has an allergic reaction to food may experience a lifethreatening condition called anaphylaxis. Signs of a severe allergic reaction include: Swelling of the lips and tongue, Tightening of the throat, Itching of the palms and soles of the feet, Hoarseness, Difficulty swallowing, Shortness of breath, Wheezing, Turning blue, A drop in blood pressure, Feeling faint, Mental confusion, Feeling weak, Becoming pale or flushing, 12

13 Chest pain, A rapid pulse, A weak pulse, A sense of impending doom, and/or Loss of consciousness (FARE, 2015; NIH, 2015; ACAAI, 2014; AAFA, 2005). If not treated immediately, anaphylaxis can lead to death. If you notice any of the severe symptoms we just listed, with or without more mild symptoms of an allergic reaction, seek emergency medical assistance and follow emergency allergy procedures laid out by your program and the child s allergy action plan (FARE, 2015). We will discuss procedures to respond to allergic reactions more thoroughly in a few moments. First, though, it is important to note that children may describe their symptoms in ways that may not immediately make sense to adults. A child who is having an allergic reaction might say things like: This food is too spicy, My tongue feels hot, It feels like something is poking my tongue, My tongue or mouth is tingling, My tongue or mouth is burning, My tongue or mouth itches, My tongue feels like there is hair on it, There s a frog in my throat, There s something stuck in my throat, My tongue feels full or heavy, My lips feel tight, It feels like there are bugs in my ears, My throat feels thick, or It feels like there is a bump on the back of my tongue or in my throat (FARE, 2015; Nemours Foundation, 2012). Very young children may scratch or pull at their mouths and tongues when having an allergic reaction. During a reaction, a child s voice may become hoarse or squeaky, and his or her words may sound slurred. Be on the lookout for these signs. Prompt treatment is the best way to protect a child from serious complications, especially in the event the child develops anaphylaxis. Valuable time can be lost when adults miss warning signs and children are unable to communicate their distress (FARE, 2015). Symptoms of an allergic reaction usually start within two hours of eating the food, but some can start within a matter of minutes. It s unusual, but sometimes symptoms (generally eczema) can appear as late as four to six hours after eating the food (ACAAI, 2014). A child who has had a serious reaction to an allergen at one time may have more mild symptoms during another exposure. More importantly, a child who has mild symptoms after one exposure could have a serious reaction at a later time if he or she is exposed to the allergen again. The best way to protect the child from the possibility of a life-threatening allergic reaction is to help him or her avoid all contact with known allergens (ACAAI, 2014). Managing Food Allergies Prevention 13

14 Now that we have explored what food allergies look like in action, it is time to think about how to ensure that children with food allergies can enjoy the same experiences as their peers without allergies. The Centers for Disease Control and Prevention (2013) has developed a set of recommendations related to managing food allergies in schools and child care programs, called the Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs. As stated in the title, the guidelines in this document are not requirements. However, they represent the highest standard of safety precautions and response planning for children with food allergies in group settings, so they are a powerful resource for child care providers with a commitment to maintaining the safety and health of children with food allergies. Helping children with allergies avoid exposure to substances they are allergic to is the most important step in managing food allergies within your child care program. Young children are generally not capable of managing their own food allergies, and even school-age children require guidance and supervision from adults to keep them from coming into contact with known allergens (CDC, 2013). As a child care provider, your responsibilities include making sure to: Identify - Discuss any known food allergies a child may have and your program s response plan at enrollment. Ask the child s parent or guardian questions about when the allergy was first identified what kinds of signs the child is likely to exhibit in the event of an allergic reaction, and how sensitive the child has been to the food in the past. Request an allergy action plan from the child s healthcare provider. This documentation is required by the Texas Department of Family and Protective Services Child Care Licensing if the child s allergy necessitates a special diet in the child care setting, Inform - Ensure that all the adults who might work with a child with food allergies know who the child is and what types of food or foods the child needs to avoid. This includes administrators, caregivers, assistants, and volunteers, many of whom may move from group to group throughout the program day. It may be useful to have a list of children with food allergies posted in the food preparation area (which should be off-limits to children and families) and to have a copy in each classroom or group area. These lists typically include the name of each child with a food allergy, the group or class to which the child is assigned, and a description of the foods to which the child is allergic. Some programs include a recent photo of each child as well, to help staff and volunteers who might not be familiar with every child in the program. Remember that information about children s allergies should be treated as confidential, so these lists need to be stored in a way that protects the children s privacy (CDC, 2013; extension, 2010), Investigate - Be aware of the ingredients of foods served in the child care facility in order to minimize the risk of a child being exposed to a substance that is likely to cause a child to have an allergic reaction. According to the ACAAI, The Food Allergy Labeling and Consumer Protection Act of 2004 (FALCPA) mandates that manufacturers of packaged foods produced in the United States identify, in simple, clear language, the presence of any of the eight most common food allergens - milk, egg, wheat, soy, peanut, tree nut, fish and crustacean shellfish - in their products. The presence of the allergen must be stated even if it is only an incidental ingredient, as in an additive or flavoring. Some goods also may be labeled with precautionary statements, such as may contain, might contain, made on shared equipment, made in a shared facility or some other indication of potential allergen contamination. Unfortunately, there are no laws or regulations that require these advisory warnings and no standardized definitions for each 14

15 of these terms. However, by being aware of both the required labeling and the precautionary statements, child care providers can identify the ingredients in foods being served, and make substitutions as needed. Ingredients in a packaged food can change from time to time, so individuals purchasing food for child care programs should check the ingredients and warnings every time. Be aware that these labeling requirements do not extend to products regulated by the U.S. Department of Agriculture, such as meat and poultry. Reading labels and understanding them is a very important part of making certain that children are not exposed to their allergens, but it is not a foolproof method. Even non-food products, including cosmetics like certain shampoos and school supplies like clay and paste, can contain traces of allergens traditionally associated with food. These products may or may not have warnings on their labels, so it is critical that you communicate with the child s parent and review the child s allergy action plan for information about products the child needs to avoid (CDC, 2013; ACAAI, 2014), and Intervene Actively work to reduce or eliminate the presence of allergens in your program facility. Institute policies to ensure that foods brought in from outside sources do not represent a risk to a child with food allergies. You can do this by creating allergysafe zones in the areas where children eat, so that children with food allergies can socialize with other children who are eating foods that do not pose a threat to them. You can also use assigned seating at meal times to help protect children with food allergies, and emphasize to children that while sharing toys is a friendly thing to do, sharing food is not safe and could make them sick. Another important step is to educate parents about the risks of food allergies. Without identifying the specific child who is affected, you can notify parents that someone in the group or in the program has an allergy to a particular food, and ask them to avoid bringing in foods containing that ingredient. Best practice is to require that all foods parents bring that will be shared among the children, such as treats for birthday celebrations, be store-bought rather than homemade. This allows caregivers to double-check the food labels and ensure that a child does not inadvertently eat something he or she is allergic to. Some programs have gone so far as to ban specific types of foods, such as peanuts and peanut products, which are commonly associated with severe allergic reactions. Even if a ban is in place, it is virtually impossible to guarantee that the ingredient will never be found in the program facility, so it is crucial that you have a response plan in place in case an emergency arises (CDC, 2013). Managing Food Allergies Response Plan Throughout the last few segments of this course, we ve discussed the importance of having an action plan in place to respond to food allergies. Now it s time to take a closer look at what we mean when we talk about allergy action plans. Allergy action plans go by many different names, including food allergy and anaphylaxis emergency care plans, emergency action plans, food allergy emergency plans, individual food allergy management plans, allergy and asthma action plans, emergency care plans, and many more. No matter what terminology your program uses, it is crucial that each child with a known food allergy have a written plan in place regarding how to manage the allergy, how to recognize an allergic reaction, and, most importantly, what to do if a reaction occurs (CDC, 2013). The response plan should be created by the child s healthcare provider, especially if the plan includes provisions for administering medications, including over-the-counter or prescription 15

16 antihistamines and epinephrine injections, in the event of an allergic reaction (DFPS, 2015). The ACAAI (2014) recommends that, The plan should provide instructions on preventing, recognizing and managing food allergies and should be available in the school and during activities such as sporting events and field trips. As mentioned earlier in this course, anaphylaxis can be fatal if not treated immediately. The only effective treatment for anaphylaxis is an injection of epinephrine, so children with known food allergies will sometimes have epinephrine auto-injectors such as EpiPens. The allergy response plan from the child s healthcare provider should contain information about exactly what types of symptoms would warrant an epinephrine injection, as well as instructions for how to use the auto-injector. It is also possible for a child to experience anaphylaxis the first time he or she ever has an allergic reaction to a specific food, which could take place in the child care setting. Recent changes in federal law have led to some states adopting statutes requiring or allowing schools and early care and education programs to keep a supply of epinephrine on-hand for instances in which a child unexpectedly goes into anaphylaxis. Currently, this law has not been universally adopted. Check with your licensing agency to find out about requirements and recommendations for keeping unassigned epinephrine in your child care facility (ACAAI, 2014). Be sure you know how to use the auto-injector before you find yourself in an emergency situation where a child s life is potentially at stake. Epinephrine needs to be administered as quickly as possible after the onset of a serious allergic reaction, and then the child needs to be seen by emergency medical personnel to ensure the allergic reaction has been adequately controlled. If you have questions about how to operate the auto-injector, ask the child s parent for more information. Conclusion This course outlined a brief introduction to children s common illnesses, both contagious and non-contagious, as well as information about food intolerances and allergies. Here are some key points we would like you to take with you in your professional interactions with children and families: All children become ill at some point. Most common childhood illnesses are not serious and resolve themselves fairly easily, but it is important that you know the signs and symptoms of serious and/or contagious illnesses so you can keep children safe and healthy to the best of your ability, Infection control procedures such as practicing proper hand washing and knowing when to exclude sick children from care can go a long way toward preventing the spread of communicable diseases, For children with chronic health conditions like asthma, diabetes, epilepsy, and allergies, you should request a written plan from the child s healthcare provider which outlines any special considerations that might affect how you care for the child, Food intolerances occur when a person reacts unpleasantly to digesting a certain food product, but since the immune system is not involved, intolerances are almost never lifethreatening, and 16

17 A food allergy is a condition in which the body reacts to a food as if it were a toxin. Symptoms can range from mild to severe. In the most severe cases, children can suffer anaphylaxis a life-threatening systemic allergic reaction. For all children with food allergies, you need to have a written care plan that outlines how to prevent exposure to allergens, how to recognize an allergic reaction, and what to do if an allergic reaction occurs. Thank you for your participation and for your commitment to the health and safety of the children in your care. This course was developed and produced by the Texas A&M AgriLife Extension Service of the Texas A&M University System in cooperation with the Texas Department of Family and Protective Services, Child Care Licensing Division, and using funds provided by the Texas Workforce Commission. 17