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How to stay safe at school with food allergy – Listening to children’s voices! January 27, 2015

Posted by Editor21C in Early Childhood Education, Primary Education, Role of the family.
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from Prathyusha Sanagavarapu

Soon, a number of children with food allergy will be starting school in Australia. When children are transitioning to school with food allergy, parents will be concerned about their child’s safe and inclusive participation in all school activities, increased risks of food allergy via accidental exposure from others, how quickly a child’s allergy can be identified and addressed and importantly, whether a young child has the capacity to stay safe at school (Sanagavarapu, 2012).

Before children start school, parents assume a primary responsibility for their young child’s safety. However, at the time of starting school, it’s imperative that children also assume some responsibility for their safety at school where there will be diminished adult or parental supervision.

But the question is, can a 4 and a half year old (the starting age for schools in New South Wales) understand his or her food allergy and what an allergic reaction is, and alert his or her teacher to the allergic reaction promptly and seek timely help? Can young children resist the temptation to accept unsafe foods when offered by their peers at school? Can they advocate for their own safety, age appropriately? Or is it too much to ask a young child to take responsibility for his or her safety and the management of food allergy at school?

Adolescents are cognitively and emotionally competent to grasp the implications of food allergy (e.g., Fenton et al., 2011) and can manage to stay safe independently. However, it is not known if young children understand their food allergy and its implications and can stay safe at school with limited adult supervision.

Our pilot study on ‘Starting school with food allergy’ (Sanagavarapu, Said, Katelaris & Wainstein, 2014), funded by Allergy & Anaphylaxis Australia, has provided valuable insights into children’s knowledge and understanding of food allergy and safety at school. In this study interviews were conducted with six children affected by food allergy, aged between four and a half to six years old, in Sydney, Australia.

These interviews with children have pointed to the need to scaffold young children’s knowledge of their own food allergy, and of their safety and its self-management, at the time of starting school.

To stay safe, children must be able to recognise foods that they are allergic to and avoid them by all means, essentially by resisting temptations to accept or share such foods with others.

All children in our study named the foods that they can and can’t eat, and most children also recognised those affected foods from photos shown in the interview. Further, all children knew the various symptoms of food allergy, saying things like:

“ I keep coughing and coughing”; “my mouth gets funny”; “sometimes I scratch my mouth when it’s itchy and it takes a while to get unitchy”; “I start to vomit and get spots”.

One child even mentioned the prospect of a fatality from an allergic reaction (commenting, “You will die”), while another child labelled the condition medically (saying, “I also have anaphylaxis”).

Additionally, most children had a range of strategies to prevent the potential risks of food allergy. These included refusing to accept foods from others, checking with teacher or mum, and peer education through to a simple and effective strategy of hand washing. To quote:

“I try my best to not eat”.
“I say stop”.
“Even if they told me it is yummy, I say “I can’t eat them”.
“At big school you don’t share food”.
“I only eat my own food”.

But, not all children seemed to be able to resist temptations to accept foods, and some children trusted their peers’ assurances and risk assessments, which can be potentially risky. To quote:

“if my friend says, it does not have eggs or nuts, I will have it”.
“I would ask if it had nuts and if it did not I would eat it”.

In terms of seeking help, all children knew who to go for help when needed. They said it would be their class teacher in the first instance, and or friends at school. Drawing from their own knowledge and experiences of food allergy, children in our study offered advice to other children which included:

• Tell others you have food allergy;
• Don’t eat foods you are allergic to, and
• Don’t share food with others.

This advice from children implies a preventative approach to safety that corresponds with the preventative approaches that parents generally take in the management of food allergy, because currently there is no known cure for allergy. The most effective way to manage food allergy is to prevent the risks in the first instance, and administer antihistamine and adrenaline autoinjector if needed.

The advice provided by children in this study to other children starting school is simple, yet invaluable in reducing the risks of food allergy at school. Although based on a small sample, our study findings offer valuable implications and suggestions to parents, teachers and children in promoting the safety of children with food allergy at school. They are below.

For parents or caregivers
• Talk to your child age appropriately about his or her food allergy and its symptoms, without alarming them about the consequences of food allergy.
• Help your child to recognise and label foods that he or she is allergic to in various forms and via grocery shopping, books, and through pictures in advertising materials and catalogues.
• Age appropriately, also assist your child to recognise and read food labels.
• Encourage your child to share information on his or her food allergy with teachers and peers at school, and with before and or after school staff.
• Raise the awareness of your child’s classmates on food allergy with the help of the school/class teacher.
• Develop simple scripts with your child that she or he can use to communicate when unwell and to seek help from an adult or peer at school when needed.
• Reinforce the simple message of ‘no sharing or accepting foods’ from others and that they eat their own lunch/tea.
• Scaffold self-control strategies with the child to resist temptations, albeit at varying levels, and age appropriately via reading stories, mock sessions and role plays before children start school and in the transitional periods.

For educators or schools
• Incorporate the simple message of ‘no sharing or accepting of food’ into classroom discussions and promote and implement policy of ‘no sharing of food’.
• Raise the awareness of all children about food allergy through the reading of stories about children starting school with food allergy or other strategies.
• Scaffold self-control strategies to resist temptations, albeit at varying levels, and age appropriately via reading stories, mock sessions and role plays at school.
• Collaborate and communicate with parents or caregivers on matters of the food allergy management to promote child safety.

For children
• Know your food allergy.
• Do not share foods with others.
• Say ‘no’ to food politely when offered from others, even friends.
• Let an adult or peer know when feeling unwell.

References:
Fenton, N.E., J. S. Elliott, L. Cicutto, A. E. Clarke, L. Harada, and E. McPhee. (2011). Illustrating Risk: Anaphylaxis Through the Eyes of the Food-Allergic Child, Risk Analysis, DOI: 10.1111/j.1539-6924.2010.01488.x

Sanagavarpu, P., Said, M., Katelaris, C., Wainstein, B. (2014). Starting school with food allergy: Listening to parents’ and children’s voices. Research Report Commissioned by and prepared for Allergy & Anaphylaxis Australia. University of Western Sydney, Australia.

Sanagavarapu, P. (2012). Don’t forget to pack my EpiPen® please? What issues does food allergy present for children’s starting school? Australasian Journal of Early Childhood, 37 (2), 56-61.

 

Dr. Prathyusha Sanagavarapu is a senior lecturer in the School of Education at the University of Western Sydney, Australia. Her research interests include the areas of starting school, food allergy and children’s health, and issues around family diversity and parenting.

Psychosocial affects of food allergy: What do they mean for educators’ practice in early childhood settings? December 11, 2011

Posted by Editor21C in Community Engagement, Early Childhood Education, Primary Education, Social Justice and Equity through Education.
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from Dr Prathyusha Sanagavarapu

In her first post, Prathyusha explores the role that educators can play in understanding the impact of food allergies on children and their families, and how they can provide support when allergies are identified.

Food allergy in young children is a growing health issue in the 21st century. It is widely known as a medical issue with significant impacts on affected children’s safety and wellbeing.  However, it is also a social issue with implications for children’s and their caregivers’ socio-emotional wellbeing, as indicated in recent medical research. In this context, it is timely to understand and consider the socio-emotional impacts of food allergy for educators’ practice, as the attendance of affected children is on the rise in early childhood settings.

Currently, one in 10 Australian children has food allergy (Osborne, Koplin, Martin, Gurrin, Lowe, Matheson, Ponsonby, Wake, Tang, Dharmage, Allen, 2011), whereas previously, one in 20 were reported to have this medical condition (Anaphylaxis Australia Inc: AAI).  The attendance of young children with a diagnosed food allergy is also on the increase in Australian early childhood settings. For example, in the ACT alone, one in 30 children had nut allergy at the time of starting school (Kljakovic, Gatenby, Hawkins, Attewell, Ciszek, Kratochvil, Moreira & Ponsonby, 2009). Consequently, the management of food allergy has become an important issue for Australian educators in recent times.

Food allergy is the body’s adverse immune response to  protein in some naturally occurring and nutritious foods such as milk, eggs, peanut, tree nuts (e.g. walnuts, cashews), sesame, fish, shell fish (e.g. prawn, lobster), wheat and soy.  These nine foods are regarded as being responsible for 90% of allergic reactions in Australian children. An allergic reaction usually occurs immediately or with a delay after eating a food and in some cases, a reaction could possibly result in a fatality or a near fatality situation.  Ingestion of affected foods even in very small amounts can result in either a mild, moderate or a very severe allergic reaction, known as anaphylaxis (AAI).  A child needs immediate administration of the lifesaving adrenaline auto-injector (known as Epipen® or Anapen® in Australia) into the thigh muscle, in the case of anaphylaxis. The instructions on how to handle food allergy and anaphylaxis in a child are set out in an Action Plan for Anaphylaxis, prepared by a doctor. Currently, there is no cure for food allergy or anaphylaxis.  Therefore, it needs to be managed by avoiding potentially dangerous food/s and by administering the adrenaline auto injector when needed (Bertine, Block & Dubois, 2009).

As food is integrated with peoples’ everyday activities, parents of young children have to be highly vigilant to totally eliminate affected foods, which requires them to scrutinise food labels to choose safe foods, avoid cross-contamination of foods in all meals served, and to prepare and carry home cooked or special meals while attending social events to prevent risks (e.g.,  Avery, King, Knight &    Hourihane, 2003). A few parents also tend to restrict social activities and even travelling to avoid potential risks in out of home contexts, where risks may be unknown and the safety of children cannot be guaranteed (e.g., Primeau, Kagan, Joseph, Lim,  Dufresne, Duffy, Prhcal & Clarke, 2000).  The fear and anxiety around children’s health and safety are so predominant that some parents opt to home school their children (Bollinger, Dahiquist, Mudd,  Sonntag, Dillinger & McKenna, 2006) and others may refuse to send their children to birthday parties or school excursions (Primeau, et al., 2000).

Other daily concerns of parents are related to children’s poor nutritional intake, sleep difficulties, and management of other health conditions and illnesses (diarrhoea; asthma, eczema and dermatitis and allergic rhinitis, eating problems and gastric disorders: Bertine et al., 2009; Bollinger, et al., 2006).  These burdens further tend to intensify for mothers when they lack support from extended families and communities (Sanagavarapu, 2004).

Children were also noted to feel insecure, apprehensive, and fearful because of the safety risks (Lyons & Forde, 2004), and had other issues in regards to normalising their lives (e.g., Marklund, Wilde-Larsson, Ahlstedt  &  Nordström, 2007). Literature also suggested that children “may be at an increased risk of socio-emotional developmental difficulties” (Bollinger at al, 2006, p.15).

To put it simply, normal chores of sending children to school or child care, for a sleep over, or going to a beach or a restaurant, can be quite challenging and emotionally demanding for some parents, given the unique risks of food allergy. The anxieties around children’s safety, social restrictions, and adaptations were noted to have a significant impact on both parents’ and their children’s emotional wellbeing or quality of life (Cohen, Noone, Munoz-Furlong, & Sicherer 2004).

As research confirms the socio-emotional impacts of food allergy for children and their parents, it is imperative that educators understand and address the social issues of food allergy to manage it holistically. While the management of food allergy from a medical perspective requires educators to identify children with risks of food allergy and anaphylaxis, know the causes and symptoms of food allergy, identify allergic reactions and respond effectively to allergic reactions (as per the instructions in the Action Plan for Anaphylaxis, and the state education departments’ guidelines), the management of food allergy from a social perspective requires educators to:

  • acknowledge the socio-emotional issues and minimise children’s and their parents’  anxiety by offering the support needed, providing information on support services such as Anaphylaxis Australia Inc (the only national organisation for people affected by food allergy and anaphylaxis) and/or assisting families and children  to find coping strategies;
  •  ease their anxiety and provide reassurance through  the  development, communication, and implementation of the safety guidelines and policies at school or child care;
  •  work collaboratively with parents and children to know how food allergies are managed at home and develop specific strategies to prevent risks at school or child care and for specific situations and events such as meal times, field trips, school camps and so on, where adult supervision may be minimal and risks may be unknown;
  • address the issues of inclusion and self-esteem that may arise when children cannot participate in curricular and extra-curricular activities involving affected foods;
  •  educate peers and other families about the seriousness of food allergies to elicit their cooperation in keeping affected children safe and to address their negative perceptions of and attitudes to food allergy, and  negative labelling of affected parents as paranoid and overprotective;
  • keep strategies in place to prevent possible peer pressure and victimisation of children with food allergy; and
  • advocate for the rights of affected children and their families and so on-just to name a few.

By recognising food allergy as a significant socio-emotional issue, educators also need to approach the management of food allergy sensitively. As is evident, “sensitivity involves empathy and is built upon knowledge and understanding” (Royal Children’s Hospital, 2007, p.2). To this end, it is essential that educators have the knowledge and understanding of the lived experiences of food allergy to address children’s and their parents’ concerns and support needs, with an overall aim of promoting their psychosocial wellbeing, consequently their quality of life.

*Disclaimer: The information presented in this article on the management of food allergy does not replace medical advice from doctors and the training, guidelines or policy information on the management of food allergy in early childhood settings.

References:  Anaphylaxis Australia Incorporated.  Available from http://www.allergyfacts.org.au.   Avery, N.J., King, R.M., Knight, S., Hourihane, J.O.B. (2003).  Assessment of quality of life in children with peanut allergy.  Paediatric Allergy Immunology, 14, 378-382.   Bertine, M. J., Block, F.,  & Dubois, A.E.J. (2009).  Quality of life in food allergy: valid scales for children and adults. Current Opinion in Clinical Immunology, 9 (3) 214-221.   Bollinger, M. E., Dahiquist, L. M., Mudd, K., Sonntag,  C., Dillinger , L., & McKenna , K. (2006). The impact of food allergy on the daily activities of children and their families. Annals of Allergy, Asthma and Immunology, 96 (3), 415-421.   British Columbia ( 2005).  Life threatening food allergies in school and child care settings. Avialble from www.gov.bc/mcf/.   Cohen, B. L., Noone, S., Munoz-Furlong, A., Sicherer, S.H. (2004).  Development of a questionnaire to measure quality of life in families with a child with food allergy. Journal of Allergy Clinical Immunology, 114(5), 1159-1163.   Kljakovic, M., Gatenby, P., Hawkins, C., Attewell, R.G., Ciszek, K., Kratochvil, G., Moreira, A., Ponsonby, A. (2009). Theparent-reported prevalence and management of peanut and nut allergyin school children in the Australian Capital Territory.Journal of Paediatrics and Child Health, 45(3), 98-103.   Lyons, A.C., & Forde, E.M.E. ( 2004).  Food allergy in young adults: perceptions and psychological effects.  Journal of Health Psychology, 9, 497-504.   Marklund,B., Wilde-Larsson,  B.M., Ahlstedt, S.,  &  Nordström, G. (2007).  Adolescents’ experiences of being food hypersentisitve: a qualitative study. BMC Nursing, 6:8.Available from http://www.biomedcentral.com/1472-6955-6-8.   Osborne, N.J., Koplin, J.J., Martin, P.E., Gurrin, L.C., Lowe, A.J., Matheson, M.C., Ponsonby, A., Wake, M., Tang, M.L.K., Dhramage, S.C., & Allen, K.J. (2011).  Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants.  Journal of Allergy and Clinical Immunology, 127 (3), 668-676.   Royal Children’s Hospital (2007).  Working with culturally and linguistically and diverse families.  Child Care and Children’s health, 10 (1), 1-6. Date accessed on 12/09/11 from http://www.rch.org.au/emplibrary/ecconnections/CCH_Vol10_No1Mar2007.pdf.   Primeau, M.N., Kagan, R., Joseph, L., Lim, H., Dufresne, C., Duffy, C., Prhcal, D., & Clarke, A. (2000).  The psychological burden of peanut allergy as perceived by adults with peanut allergy and the parents of peanut allergic children . Clinical and Experimental Allergy, 30, 1135-1143.   Sanagavarapu, P.  (2004). Socio-cultural matrix of raising a child with food allergies: Experiences of a migrant mother. Australian Journal of Early Childhood, 12 (1), 45-49.

Prathyusha Sanagavarapu is a Lecturer in early childhood education in the School of Education at the University of Western Sydney, Australia. She has a particular research interest in the management of food allergies in young children.

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