Anaphylactic Policy (9 min read)

Name of Child Care Centre: Kinder Learning Centres

Date Policy and Procedures Established: June 2, 2023

Date Policy and Procedures Updated: June 2, 2023.

Purpose

Anaphylaxis is a serious allergic reaction that can be life-threatening. It requires avoidance strategies and immediate response in the event of an emergency. These policies and procedures are intended to help meet the needs and save the lives of children with severe allergies and provide relevant and important information on anaphylaxis to parents, staff, students, volunteers and visitors at the childcare centre.

This policy is intended to fulfill the obligations set out under Ontario Regulation 137/15 for an anaphylactic policy for childcare centres. The requirements set out in this policy align with Sabrina’s Law, 2005.

Note: definitions for terms used throughout this policy are provided in a Glossary at the end of the document.

Policy

Individualized Plans and Emergency Procedures for Children with Life-Threatening/Anaphylactic Allergies

Before attending the childcare centre, the supervisor/designate will meet with the parent of a child to obtain information about any medical conditions, including whether the child is at risk of having or has anaphylaxis.
Before a child attends the child care centre or upon discovering that a child has an anaphylactic allergy, an individualized plan and emergency procedures will be developed for each child with anaphylaxis in consultation and collaboration with the child’s parent, and any regulated health professional who is involved in the child’s care that the parent believes should be included in the consultation.
All individualized plans and emergency procedures will include a description of symptoms of an anaphylactic reaction that are specific to the child and the procedures to be followed in the event of an allergic reaction or other medical emergency based on the severity of the child’s symptoms.
The individualized plan and emergency procedures for each child will include information for those who are in direct contact with the child on a regular basis about the type of allergy, monitoring and avoidance strategies and appropriate treatment.
All individualized plans and emergency procedures will be always made readily accessible to all staff, students and volunteers at the childcare centre and will be kept in the child’s classroom.
All individualized plans and emergency procedures will be reviewed with a parent of the child as required or annually to ensure the information is current and up to date.
Every child’s epinephrine auto-injector must be carried everywhere the child goes.

Strategies to Reduce the Risk of Exposure to Anaphylactic Allergens

The following strategies to reduce the risk of exposure to anaphylactic causative agents must be followed at all times by employees, students and volunteers at the child care centre.

Do not serve foods where the ingredients are not known.
Do not serve items with ‘may contain’ warnings on the label in a room where there is a child who has an individualized plan and emergency procedures specifying those allergens.
Ask the caterer or cook to provide the known ingredients for all food provided. The ingredients will be reviewed before food is served to children to verify that causative agents are not served to children with anaphylactic allergies.
In cases where a child has food allergies and the meals and snacks provided by the child care centre cannot meet the child’s needs, ask the child’s parent to supply snacks/meals for their child. All written instructions for diet provided by a parent will be implemented.
Where food is provided from home for children, ensure that appropriate supervision of children is maintained so that food is not shared or exchanged.
Encourage parents who serve foods containing allergens at home to ensure their child has been rid of the allergens prior to attending the child care centre (e.g. by thoroughly washing hands, brushing teeth, etc.)
Do not use craft/sensory materials and toys that have known allergens on the labels.
Share information about anaphylaxis, strategies to reduce the risk of exposure to known allergens and treatment with all families enrolled in the child care centre.
Make sure each child’s individual plan and emergency procedure are kept-up-to-date and that all staff, students, and volunteers are trained on the plans.
Refer to the allergy list and ensure that it is up to date and implemented.
Update staff, students, and volunteers when changes to a child’s allergies, signs and symptoms, and treatment occur and review all updates to individualized plans and emergency procedures.
Update families when changes to allergies occur while maintaining the confidentiality of children.
Update or revise and implement the strategies in this policy depending on the allergies of children enrolled at the child care centre.

Parents Who Send Food with their Child

Ensure that parents label food brought to the child care centre with the child’s full name and if applicable, the date the food arrived at the child care centre.
Parents must advise the teacher of the child how to properly store the food.
Parents must advise the child care centre of all ingredients in food supplied by the parent or any ingredients to which children may be allergic.
Parents must also provide any changes in writing to the manager as they occur. This is sent to the manager of the centre by email and then it is reviewed with the staff of the centre. This information is then uploaded to the child’s profile on Kindertales.

Communication Plan

The following is our communication plan for sharing information on life-threatening and anaphylactic allergies with staff, students, volunteers, parents and families.

Parents are not to bring foods that contain ingredients to which children may be allergic.
Parents and families will be informed about anaphylactic allergies at the childcare centre through our Kindertales parent portal. Anaphylactic allergies will posted with our menus at the front entrance of the childcare centre. This board will be updated as required by the centre manager.
A list of all children’s allergies including food and other causative agents will be posted in all cooking and serving areas, in each play activity room, and made available in any other areas where children may be present.
Each child with an anaphylactic allergy will have an individualized plan and emergency procedures that detail signs and symptoms specific to the child describing how to identify that they are having an allergic reaction and what to do if they experience a reaction.
Each child’s individualized plan and emergency procedures will be made available and accessible wherever the child may be present while receiving child care.
The caterer, cook or individuals who purchase groceries on behalf of the child care centre and/or other food handling staff, where applicable, will be informed of all the allergies at the child care centre, including those of children, staff, students and volunteers. An updated list of allergies will be provided to the caterer or cook as soon as new allergies are identified. The supervisor or designate will communicate with the caterer/cook about which foods are not to be used in food prepared for the child care centre and will work together on food substitutions to be provided.
The child care centre will communicate with the Ministry of Education by reporting serious occurrences where an anaphylactic reaction occurs in accordance with the established serious occurrence policy and procedures.
This communication plan will be continually reviewed to ensure it is meeting the needs of the child care centre and that it is effectively achieving its intended result.

Drug and Medication Requirements

Where drugs or medications will need to be administered to a child in response to an anaphylactic reaction, the drug and medication administration policy will be followed including the completion of a parental authorization form on Kindertales to administer drugs or medications.
Emergency allergy medication (e.g. oral allergy medications, puffers and epinephrine auto-injectors) will be allowed to remain unlocked or carried by children with parental authorization so that they can be administered quickly when needed.

Training

The centre manager will ensure that the supervisor and/or all staff, students and volunteers receive training from their CPR/First aid course or a parent of a child with anaphylaxis on the procedures to follow in the event of a child having an anaphylactic reaction, including how to recognize the signs and symptoms of anaphylaxis and administer emergency allergy medication.
Where only the supervisor/designate has been trained by a parent, the supervisor/designate will ensure training is provided to all other staff, students and volunteers at the child care centre.
Training will be repeated annually, and any time there are changes to any child’s individualized plan and emergency procedures.
A written record of training for staff, students and volunteers on procedures to be followed for each child who has an anaphylactic allergy will be kept, including the names of individuals who have not yet been trained. This will ensure that training is tracked and follow-up is completed where an individual has missed or not received training.

Confidentiality

Information about a child’s allergies and medical needs will be treated confidentially and every effort will be made to protect the privacy of the child, except when information must be disclosed for the purpose of implementing the procedures in this policy and for legal reasons (e.g. to the Ministry of Education, College of Early Childhood Educators, law enforcement authorities or a Children’s Aid Society).

Additional Policy Statements

Expired Epi-pens must be returned to the parent and a new a one must be replaced prior to the child returning to the centre for care.
It is the responsibility of the centre manager and the classroom teacher with the anaphylactic child to ensure the medications are not expired.

Procedures to be followed in the circumstances described below:

Circumstance	Roles and Responsibilities
A child exhibits an anaphylactic reaction to an allergen	The person who becomes aware of the child’s anaphylactic reaction must immediately: implement the child’s individualized plan and emergency procedures; contact emergency services and a parent/guardian of the child, or have another person do so where possible; and ensure that where an epinephrine auto-injector has been used, it is properly discarded (i.e. given to emergency services, or in accordance with the drug and medication administration policy). Once the child’s condition has stabilized or the child has been taken to hospital, staff must: follow the child care centre’s serious occurrence policies and procedures; document the incident in the daily written record; and document the child’s symptoms of ill health in the child’s records.
A child is authorized to carry his/her own emergency allergy medication.	Staff must: ensure that written parental authorization is obtained to allow the child to carry their own emergency allergy medication; ensure that the medication remains on the child (e.g., fanny pack, holster) and is not kept or left unattended (e.g. in the child’s cubby or backpack); ensure that appropriate supervision is maintained of the child while carrying the medication and of children in their close proximity so that other children do not have access to the medication; and Where there are safety concerns relating to the child carrying his/her own medication (e.g. exposure to other children), notify the centre supervisor/designate and the child’s parent of these concerns, and discuss and implement mitigating strategies. Document the concerns and resulting actions in the daily written record.

Circumstance

Roles and Responsibilities

A child exhibits an anaphylactic reaction to an allergen

The person who becomes aware of the child’s anaphylactic reaction must immediately:

implement the child’s individualized plan and emergency procedures;
contact emergency services and a parent/guardian of the child, or have another person do so where possible; and
ensure that where an epinephrine auto-injector has been used, it is properly discarded (i.e. given to emergency services, or in accordance with the drug and medication administration policy).
Once the child’s condition has stabilized or the child has been taken to hospital, staff must:
1. follow the child care centre’s serious occurrence policies and procedures;
2. document the incident in the daily written record; and
3. document the child’s symptoms of ill health in the child’s records.

A child is authorized to carry his/her own emergency allergy medication.

Staff must:

ensure that written parental authorization is obtained to allow the child to carry their own emergency allergy medication;
ensure that the medication remains on the child (e.g., fanny pack, holster) and is not kept or left unattended (e.g. in the child’s cubby or backpack);
ensure that appropriate supervision is maintained of the child while carrying the medication and of children in their close proximity so that other children do not have access to the medication; and
Where there are safety concerns relating to the child carrying his/her own medication (e.g. exposure to other children), notify the centre supervisor/designate and the child’s parent of these concerns, and discuss and implement mitigating strategies. Document the concerns and resulting actions in the daily written record.

Glossary

Anaphylaxis: a severe systemic allergic reaction which can be fatal, resulting in circulatory collapse or shock. Symptoms can vary for different people, and can be different from one reaction to the next, including:

Skin: hives, swelling, itching, warmth, redness, rash
Breathing (respiratory): coughing, wheezing, shortness of breath, chest pain/tightness, throat tightness/swelling, hoarse voice, nasal congestion or hay fever-like symptoms (runny nose and watery eyes, sneezing), trouble swallowing
Stomach (gastrointestinal): nausea, pain/cramps, vomiting, diarrhea
Heart (cardiovascular): pale/blue colour, weak pulse, passing out, dizzy/lightheaded, shock
Other: anxiety, feeling of “impending doom”, headache, uterine cramps, metallic taste in mouth

(Source: http://foodallergycanada.ca/about-allergies/anaphylaxis/ )

Causative Agent (allergen/trigger): a substance that causes an allergic reaction. Common allergens include, but are not limited to:

eggs
milk
mustard
peanuts
seafood including fish, shellfish, and crustaceans
sesame
soy
sulphites which are food additives
tree nuts
wheat
latex
insect stings

Epinephrine: A drug used to treat allergic reactions, particularly anaphylaxis. This drug is often delivered through an auto-injector (e.g. EpiPen or Allerject).

Staff (Employee): Individual employed by the licensee (e.g. program room staff).

Licensee: The individual or corporation named on the license issued by the Ministry of Education responsible for the operation and management of the child care centre.

Parent: A person having lawful custody of a child or a person who has demonstrated a settled intention to treat a child as a child of his or her family (all references to parent include legal guardians, but will be referred to as “parent” in the policy).

Regulatory Requirements: Ontario Regulation 137/15

Anaphylactic policy

39.

Every licensee shall ensure that each child care centre it operates and each premises where it oversees the provision of home child care or in-home services has an anaphylactic policy that includes the following:
1. A strategy to reduce the risk of exposure to anaphylactic causative agents, including rules for parents who send food with their child to the centre or premises.
2. A communication plan for the dissemination of information on life-threatening allergies, including anaphylactic allergies.
3. Development of an individualized plan for each child with an anaphylactic allergy who,
  1. receives child care at a child care centre the licensee operates, or
  2. is enrolled with a home child care agency and receives child care at a premises where it oversees the provision of home child care or in-home services.
4. Training on procedures to be followed in the event of a child having an anaphylactic reaction.
The individualized plan referred to in paragraph 3 of subsection (1) shall,
1. be developed in consultation with a parent of the child and with any regulated health professional who is involved in the child’s health care and who, in the parent’s opinion, should be included in the consultation; and
2. include a description of the procedures to be followed in the event of an allergic reaction or other medical emergency.

Disclaimer: This document is a sample of a policy and procedures that have been prepared to assist licensees in understanding their obligations under the CCEYA and O. Reg. 137/15. It is the responsibility of the licensee to ensure that the information included in this document is appropriately modified to reflect the individual circumstances and needs of each child care centre it operates.

Please be advised that this document does not constitute legal advice and should not be relied on as such. The information provided in this document does not impact the Ministry’s authority to enforce the CCEYA and its regulations. Ministry staff will continue to enforce such legislation based on the facts as they may find them at the time of any inspection or investigation.

It is the responsibility of the licensee to ensure compliance with all applicable legislation. If the licensee requires assistance with respect to the interpretation of the legislation and its application, the licensee may wish to consult legal counsel.