Things that people working/volunteering with children/young people who have allergies and anaphylaxis should be aware of

This is the first out of 3 blogs which I hope will help people who work with and/or volunteer with children and/or young people who live with allergies as well as anaphylaxis. I feel that oftentimes people can be somewhat clueless about allergies and anaphylaxis if they've never come across someone with it before. I hope these blogs can be somewhat helpful and educational about the things people working with children and/or young people with allergies and anaphylaxis can look out for and ways to best help include children with these conditions. *Please note that I've answered these questions using my personal experiences with allergies and anaphylaxis since being diagnosed at the age of 15/16, I am in no way a professional and every child/young person should be assessed differently.*

This particular blog will be focusing on different aspects of things that people looking after children/young people with allergies and anaphylaxis should be aware of and different things that should be taken note of.

1. What information should be given regarding a child/young person's allergies?

• What allergies do they have?
• If they are prescribed any medications for this allergy? If so what?
• How severe is/are their allergic reaction/s?
• If any special measures need to be carried out to keep the child/young person safe, i.e. do they need to be seated at an allergen free table, do they need to be kept away from other children/young people with that particular allergen etc.?
• If the child/young person needs to be given safe snacks so they are not left out when other children/young people have snacks?
• If they suffer a reaction what should happen, i.e. should medication be given, should their parent/guardian be called to collect them, should medical attention be sought etc.?

2. What should the child/young person tell adults looking after them?

• If the child/young person is self-carrying their medication where they keep their medication
• The adults should be alerted as soon as possible if the child/young person is feeling unwell due to an allergic reaction and procedures should be followed 
• If it is age appropriate the child/young person should let the adult know about what their allergen/s is/are
• If the child/young person feels unwell they should alert and adult looking after them so appropriate help can be sought 

3. How can the particular allergen the child/young person is allergic to be limited?

• Having an allergen-free table if the child/young person is for example eating lunch where no children/young people with foods containing their allergen can sit 
• If the child/young person is airborne allergic to their allergen it may be worth considering if a rule can be implemented where nothing containing their allergen is brought into the environment, a way around this would be issuing letters to other parents/guardians requesting when packing a child/young person's lunch they try to exclude foods with that allergen
• If the child/young person has food allergies allowing their parent/guardian to supply a box of safe treats so the child/young person with the allergy is not left out

4. Should the child/young person be in charge of their own medication?

This usually depends on the institution as well as the age of the child/young person. If there are rules surrounding the child/young person not being allowed to carry their own medication the adults in charge of said child/young person should be alerted to where their medication is kept and if the child/young person is age appropriate then they should also be told where their medication is kept. Preferably medication should not be kept too far away from the child/young person and should not be kept in a locked room/box to allow for quick and easy access if and when the medication is needed

5. What are the signs/symptoms of an anaphylactic reaction?

Anaphylaxis is a severe and life-threatening allergic reaction. It is classed as multiple mild symptoms or at least one severe sign/symptom occurring 

• Itching (mild)
• Flushing of the skin (mild)
• Hives (looks similar to a nettle rash) (a few hives, mild, lots of hives, severe)
• Swelling of the face/tongue/extremities/abdomen (severe)
• Nausea (mild)
• Cough (mild)
• Sneezing (mild)
• Runny nose (mild)
• Stomach pain (mild but excruciating pain is severe)
• Vomiting (one episode, mild, recurrent vomiting, severe)
• Dizziness (severe)
• Low blood pressure (severe)
• Shortness of breath (severe)
• Difficulty breathing (severe)
• Difficulty speaking (severe)
• Difficulty swallowing (severe)
• Increased or decreased heart rate (severe)
• Wheezing (a high pitched whistling sound) (severe)
• Stridor (sounds similar to snoring) (severe)
• Fainting (severe)
• Feeling weak (severe)
• Diarrhea (severe)
• A sense of impending doom (the feeling like something bad is going to happen to you) (severe)
• Anxiety (severe)
• Confusion (severe)
• Hoarse voice (severe)
• Pale of bluish skin (severe)
• Unconsciousness (severe)

7. What is the first thing that should be done if an anaphylactic reaction is suspected?

The most important thing is to remain as calm as possible, try not panic. Get the child/young person into a comfortable position, if they're struggling to breathe sit them upright however if they're feeling dizzy or have become unconscious then lying down is a better option. If they have medication (an adrenaline auto-injector) this should be used, if the medication is not with the child/young person someone should stay with the child/young person and someone else should get the medication. An ambulance should be called before contacting the child/young person's parent/guardian

6. Should an ambulance be called whenever an anaphylactic reaction is suspected?

If any of the severe symptoms mentioned in question 5 are exhibited by the child an ambulance should be called. If the child has medication in the form of an adrenaline auto-injector this should be given before calling for an ambulance. An ambulance should be phoned before the parent/guardian is contacted as the quicker the emergency services are contacted the quicker the child/young people will get help

8. Should other children be told about the child/young person's allergies?

My personal opinion is that yes, other children/young people should be told about the person having allergies. In particular where younger children are concerned it can better help keep the child safe. Having people surrounding the child/young person know about the allergies can mean that more people are looking out for the welfare of the child/young person with the allergies/anaphylaxis and can in turn reduce the likelihood that the child/young person may be accidentally exposed to the allergen. If the child/young person is exposed to the allergen it can also help in making sure they get help as quickly as possible from an adult surrounding them.

9. If a surface has come into contact with a particular allergen is there anything in particular that should be used to attempt to remove the allergen from the surface?

If possible the child/young person should be seated at an area away from the surface which has had contact with the allergen in question, if there's any doubt about if a surface has had contact with the allergen the steps below can be followed to minimise the likelihood that an allergic reaction will follow:

• Soap and warm water could be used with a clean cloth to throughly wash the surface which has come into contact with the particular allergen
• Baby wipes can also be used to wipe the surface when it's come into contact with a particular allergen 
• Anti-bacterial wipes (i.e. Dettol wipes) can be used to wipe the surface if it's had said allergen on it 

10. What advice would you give to friends of the child/young person with allergies?

This depends on the age of the child/young person and their peers. Examples of things you could tell a child who's quite young and may not fully understand allergies and anaphylaxis are:

• "*insert allergen* makes *insert child's name* really poorly so they can't have it"
• "Please don't share your food with *insert child's name* as it could make them really poorly"
• "*insert child's name* has a box of food they can have so if they'd like some ask an adult if they can have some safe food"
• "If *insert child's name* says they feel bad come tell an adult"
• "If *insert child's name* gets *insert symptom/s* please tell an adult"
• "If you see *insert child's name* with *insert allergen* tell them to stop and get help from an adult"
• "If you want to share your food with *insert child's name* ask an adult if it's okay first as some foods can make *insert child's name* poorly if they have it"

Examples of things you could say to an older child/young person who may have a better understanding of allergies and anaphylaxis is: 

• "*insert allergen* causes *insert child/young person's name* to become really unwell due to them having an allergy to it so they aren't allowed it"
• "Ask *insert child/young person's name* where the medications which help when they're having an allergic reaction are kept"
• "If *insert child/young person's name* says they feel unwell come and alert an adult"
• "If *insert child/young person's name* gets *insert symptom/s* come tell an adult"
• "If you see *insert child/young person's name* with *insert allergen* come and get help from an adult"

11. What are some ways of ensuring that staff/volunteers are aware of every child/young person who suffers from allergies and anaphylaxis?

• Having a note of children/young people who have allergies and anaphylaxis. If this is in an educational setting having a note beside their name in the register. For example my high school had a system where if there was a yellow square beside a student's name it meant they suffered with allergies and if there was a red square it meant they suffered with anaphylaxis 
• Having care plans for every child/young person who has allergies/anaphylaxis and having a photo of the child with the care plan so people volunteering/working with them can recognise the child/young person in question

12. Are there ways in which staff/volunteers can be trained on allergies and anaphylaxis?

• First aid courses. If these are not automatically offered by the organisation/place of work individual first aid training that is specific to allergies can be sought out at organisations such as: St Andrew's First Aid (https://www.firstaid.org.uk/), St John's First Aid (http://www.sja.org.uk/sja/default.aspx), AllergyWise UK (https://allergywise.org.uk/)
• Contacting organisations which deal specifically with allergies and anaphylaxis, 2 such examples are The Anaphylaxis Campaign (https://www.anaphylaxis.org.uk/) as well as Allergy UK (https://www.allergyuk.org/)
• Learning how to administer an adrenaline auto-injector. I have written a previous blog about this which features the 3 current auto-injectors available in the UK (epipen, jext pen and emerade) and I have included details on how to administer each of these, details on where to find a trainer pen as well as videos showing how to administer them. That blog can be found at this link: http://adifferentsortoflife.blogspot.co.uk/2017/12/how-to-use-epipen-jext-pens-and-emerade.html