A is for allergies
September 21, 2015 5:12 PM   Subscribe

How can I be (reasonably) sure my child with serious food allergies is safe in daycare? What should I expect of the center staff?

I'm currently checking out local daycare options for my 10 month old daughter who is highly sensitive to peanuts and eggs, with less severe allergies to a few other common culprits as well. I am terrified. Eggs are in everything! What if she eats from another kid's plate, or finds something on the floor? What if she has a reaction that no one notices immediately? She's sensitive enough that she's had reactions after touching something that someone touched after touching eggs. What does that mean for toys? I want to make sure all staff members are trained in what type of symptoms to look for and how to use an epipen, but what else can I expect? A friend in another city said that her kid's daycare will ban foods from certain room if any child in there is allergic. I'm under the impression that that's unrealistic in my town, but that sure would be nice. Also - very reluctantly - considering keeping her home with a sitter until she can talk.
posted by imanastasia to Health & Fitness (12 answers total) 1 user marked this as a favorite
I hate to be a bummer, but in my experience with kids with moderately severe allergies, a lot of parents opt to do a nanny. With the level of sensitivity that your child is exhibiting, I doubt that even an EXCELLENT daycare center could prevent her from accidentally exposing herself. Most daycares and schools in my experience are willing to be nut-free and parents have adjusted, but that asking other families to not use any products even produced in a nut facility is impossible. People (including myself) are too lazy to check that everything that goes in a lunch box is from a nut-free facility. That also excludes all Trader Joe's products. Eggs could be even more of a nightmare. My friends with kids with severe allergies sometimes even opt for one parent to be a stay-at-home because managing all of this is so difficult.
I wonder if there is a forum for other allergy parents that might have more information?
posted by k8t at 5:18 PM on September 21, 2015 [13 favorites]

I'm in the Boston area and people are very allergy-aware here. I would ask the following questions:
- What kind of allergy training do you give to your staff? Are they trained to use Epi-Pens?
- What do you do if a child has an allergic reaction?
- Are children allowed to share food?
- Do children or teachers bring in food for special occasions like birthdays? What about children who have food allergies?
- Are certain foods not allowed?
- How will staff members know about my child's food allergies? What if it's someone who is not her regular teacher, but is caring for her temporarily?

My kid who was allergic to eggs and nuts was fine in daycare, BUT was not as sensitive as your kid. Each year, we brought in Benadryl, Epi-pens, and an allergy action plan that stayed at school in a see-through bag with his picture in it. We stored special snacks at school so if other kids were having a treat, he could have a (different) treat too. We told him not to eat other kids' food. We spoke with his teachers and made sure they understood his allergies. The daycare was nut-free so that was a relief for us. At our local elementary school they're even more strict -- they tell kids not to share food, have a special allergy-sensitive table in the cafeteria, don't allow food for celebrations, and ban nuts from some classrooms.
posted by chickenmagazine at 5:25 PM on September 21, 2015 [2 favorites]

It's really hard. I would be scared too. I've done prac teaching in a preschool and we had a few highly allergic kids but they at least could talk. There were information sheets and action plans (including kiddos pictures) all over and nuts were banned and staff knew how to use epi pens etc but even so, I don't think it would've been safe to assume that there was no cross contamination, especially if she's very sensitive. I mean, parents dropping off kids in the morning could easily have had sticky fingered toddlers with them who touch something etc etc..

There are definitely forums where this sort of thing is discussed. I can't recommend any specifically (though the celiac dot com people are pretty good and might know). I'd ask how others manage it. But I guess too it depends on the margin of error and your tolerance for risk. Child care staff are not highly paid. If I compare it to airline pilots, they get trained throughly and have on going training and aircraft have various fail safes. Child care centres, not so much. If a tiny oversight could lead to tragic consequences, you might want to look at a nanny instead.

All the best to you. I really feel for you. I don't have allergies myself but do have a severe gluten intolerance and being around sticky fingered kiddos made me extra cautious to avoid being 'glutened' and gluten won't kill me. A little one who can't speak is a lot more vulnerable.
posted by kitten magic at 5:43 PM on September 21, 2015 [1 favorite]

The advantage of daycare is that kids don't bring their own snacks so the school has much more control over food and allergies. Does your daughter get the reaction after touching something after someone who touched eggs or after someone touched a food containing eggs such as a cookie? If they need to eliminate eggs for everyone then I think limiting eggs by themselves in the daycare is something they can do. Limiting products that contain eggs will be much harder. And actually "cookie" is a bad example because I think daycares tend to have fruits and vegetables instead of cookies as snacks because of allergy issues and they are healthier.

You should definitely talk to the daycare about what level of training the staff have for dealing with the allergies. I think it is common for all of them to know what to do now but it is something you should confirm. My daughter's epipen was kept in a bum bag/fanny pack with her name on it in the office and when she came to daycare then it was given to the staff who were looking after her, so it was at hand at all times.

With our daughter we opted for getting an Allerject instead of an Epipen. The advantage of the Allerject is that it talks and tells you what to do so if the person administering it doesn't know or is panicked it can talk them through it.
posted by any portmanteau in a storm at 6:05 PM on September 21, 2015 [2 favorites]

Food Allergy Research and Education includes the CDC guidelines for managing allergies in school here. In particular, this includes a chart of common accommodations (41-43), a checklist (44) and guidelines for early care and education staff (77-85). This should be a good starting point for setting expectations - for example, staff should prevent children from sharing food, help children wash hands, and clean surfaces where food has been. This site is also useful and includes some planning steps and information about the ADA. This site also addresses allergies in the context of early childhood care.

You should expect the daycare staff to put together a plan that includes daily allergy management as well as emergency procedures. Ideally, the daily plan would include keeping any allergens out of the room altogether. All staff on site should be trained in preventing exposure to allergens, recognizing a reaction, and treating a reaction.

Finally, if you want something between staying home with a sitter and going to daycare, you might consider a nanny share with a few other families who are willing to accommodate your child's allergy.
posted by earth by april at 7:18 PM on September 21, 2015 [1 favorite]

Chickenmagazine's list of questions is great for interviewing potential daycare settings. One I would add is to ask specifically how they have handled similar allergies in the past, and if they've ever had a severe allergic reaction at the school. They may not be able to tell you specifics, for confidentiality reasons, but the tone of their answers will tell you just how seriously they treat food allergies. Your pediatrician's office may also know which daycare centers have experience with allergies.

I teach preschool in the Boston area, and we've dealt with a number of serious allergies at our center, including: peanut, various tree nuts, sesame, egg, dairy, mango, strawberry, and other fruits. Our center is peanut and tree nut free, and was sesame free for a few years. Some classrooms have further restrictions on what snacks they will serve, and in some cases also restrict what food families can send in. We are required to post a list of children with allergies in each classroom. One toddler classroom would have the kids eat lunch in just their diapers, and clean each child individually after lunch, to prevent cross contamination.

At her current age, all the children in her classroom will be eating while buckled into chairs. If they all eat at the same time, the teachers should be able to clean the floor before your daughter gets up to play.

It's scary to think about all the opportunities for her to ingest an allergen, but if you find a school with experience handling food allergies, they should be able to keep her safe. Go out and tour a few centers. You may not find one that works for you, and you may want to wait until your daughter is older and verbal, but it's good data to have. Good luck!
posted by SobaFett at 7:43 PM on September 21, 2015 [1 favorite]

Hi, mother of a severely-allergic-to-peanuts kid here. I sent you MeFi Mail with the name of an online support group that I think might be helpful for you to check out to get advice from a really large community of food allergy parents. But publicly here I also want to let you and other readers know that, as I understand it (I am not a lawyer, just a well-read food allergy mom) life-threatening food allergies are considered a disability under ADA law, and preschools and daycares that are not run by religious organizations are subject to ADA. What this means is that a preschool or daycare technically cannot deny your child access to their program solely on the basis of her food allergies-- and they must provide at the very least such basic accommodations as training their staff on how to read labels, recognize a reaction, and use an epinephrine autoinjector. Look up United States v. La Petite Academy for more information about this.

Of course, what the law says your child is entitled to is one thing. What an organization actually can and will provide is something else entirely. In my personal experience it can be very challenging just to convince some school / childcare staff that genuinely life-threatening food allergies actually exist, and are not made up by crazy helicopter parents, let alone to convince them that a child can have a reaction on skin contact with allergen residue (which, trust me, I do know is actually possible, ugh). My advice is to shop around carefully for a daycare that has handled multiple kids with severe food allergies before, so that you won't have to start out at zero by explaining what food allergies are to clueless people.
posted by BlueJae at 7:54 PM on September 21, 2015 [1 favorite]

What is done at child care centres around here (Southern Ontario) and what I would consider reasonable:

Most centres are peanut/nut free. I haven't worked for any that allowed nuts in over 5 years. This might depend on your area.

All of the staff should be trained to use the epi pen and should have the action plan memorized, even if they are never actually in your child's room. For instance at my current job all staff read and sign off on actions plans for every child with an allergy. I work in school age but still have to know what happens if a toddler with an allergy is triggered. The supervisor should receive the trainer training, so that they are qualified to teach new staff how to use an epi pen, how to avoid allergic reactions etc. Allergy lists and plans with photos of the child should be posted in each room.

If you're worried that not all staff will be trained to use the epi pen, there are new ones out that literally talk you through the process and they are very easy to use. Your centre should have two epi pens on site, with different expiry dates, in the event that an ambulance needs to be called and is delayed.

If your child is allergic to eggs, but would be ok touching someone who had touched a food that contains some eggs (like cake, not something such as scrambled eggs). This should be simple for your child care centre to work with. If other children are getting a food with some eggs in it, they should have alternate meals/snacks planned for your child. Some centres will provide these items, others request parents supply all or some of them.

I worked with a child who had a severe allergy to nuts and sesame, and a intolerance for milk. Other children could have milk, staff were very careful that he did not get any from a supply staff, drinking from another child's cup, etc. The entire centre was already peanut/nut free but also went sesame free. It was a bit difficult finding breads, crackers etc that were free of both but they worked it out. Children bringing snacks from home had their snacks checked out before eating. A child that walked in with peanut butter food item, or having eaten one in the car was taken out of the room and had their hands/face etc thoroughly washed.

Good luck finding a child care centre!
posted by Lay Off The Books at 8:00 PM on September 21, 2015 [2 favorites]

We couldn't do daycare due to my son's metabolic disorder, and now at 2.5 years old he's with a nanny and my parents while I'm back at work full time.

Is cost the reason why you're reluctant to keep your child at home with a sitter, or something else? My kid gets lots of playtime with other kids at the playground, and he has a great time with his sitters. I am confident that we've avoided numerous hospitalizations by keeping him home.
posted by Maarika at 8:43 PM on September 21, 2015 [1 favorite]

I'd lean towards keeping her at home until she can talk.

My son's food allergies weren't as severe (hives, not anaphylaxis). We brought all of his food and snacks, and center staff watched him during meals to make sure that he didn't steal anyone else's meals. Twice (between the age of 1 and 2), he got his hands on someone else's sippy cup of milk or a piece of cheese, and they noticed immediately and administered Benadryl.

If you decide to go the center route, you should ask about training for new staff. We had a few instances where new staff tried to give him the center food, but at that point he was talking and could tell them that he only got his own food.
posted by statsgirl at 6:39 AM on September 22, 2015 [1 favorite]

At the centers you look at, do the centers make all the meals or do parents bring in some meals? At a center that makes all meals/snacks in house, this would be a lot easier - your child's room could be nut & egg free and other food wouldn't be brought in. If parents have to bring meals from home I would be very nervous.
posted by medusa at 8:41 AM on September 22, 2015 [1 favorite]

Response by poster: Thank you, all of these answers are so helpful! I feel much more prepared for these visits and more confident that we'll be able to make a good decision. I've been thinking I'm crazy for considering daycare and neurotic for considering a nanny. Thanks again!
posted by imanastasia at 4:42 PM on September 23, 2015

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