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Dina DiMaggio, MD, and Anthony F. Porto, MD, MPH

Top 5 Tips for Keeping Kids With Food Allergies Safe

A food allergy can be a scary thing. Here’s how to plan ahead to protect your little one in and out of the home.

As a parent, life is never totally without worry—especially if your child happens to have a severe food allergy. About 1 in every 25 school-age kids has a food allergy. Whether they’re away at school or on a playdate, it can be nerve-racking not to have them under your close supervision. What if something happens? Will they or their caregivers know what to do? Here are our top five tips for keeping kids with allergies safe while away from home.

1. Know the Signs of an Allergic Reaction (And What to Do)

Talk to your pediatrician if you think your child has had an allergic reaction or has a known allergy and come up with a plan for how to avoid or treat the allergy. Any food can cause an allergy, but the top nine allergic foods are peanuts, tree nuts (such as almonds, cashews, walnuts, etc.), cow’s milk, fish, shellfish (such as clams, lobster, etc.), egg, soy, wheat and sesame. If your child is having an allergic reaction, they may be experiencing any of the following symptoms:

Skin reactions: Swelling of the lips, tongue or mouth, eyelid swelling, itchiness all over, skin redness, a few hives or hives all over the body, or a worsening eczema rash

Digestive reactions: Vomiting or diarrhea

Respiratory reactions: Coughing, choking, wheezing, hoarseness, short of breath or labored breathing (breathing very quickly or barely taking a breath, or sucking in all the muscles on the chest so you can see the outline of the ribs)

Cardiovascular reactions: Pale skin; bluish lips, mouth or fingers; rapid or weak pulse

Nervous system reactions: Fainting or passing out, acting confused

Make sure your pediatrician goes over what medicines to use, when to use them and when to call 911. Always have children’s Benadryl (diphenhydramine) on hand and ask your pediatrician for your child’s correct dosage at every well visit, since it will change based on your child’s weight. The bottle of Benadryl says it’s for children 6 years old and older, but the dose is based on weight and can be given to younger kids under a doctor’s recommendation.

If your child needs an EpiPen, which contains epinephrine, make sure you’re given refills and extras to have in multiple places (to be kept at home, school, grandparents house, etc.). If you aren’t sure how to use the EpiPen, your pediatrician would be happy to go over the instructions with you! If your child is having severe symptoms, such as trouble breathing or symptoms from two body systems, then a dose of Benadryl wouldn’t be enough—an EpiPen should be given while you call 911. If you aren’t sure what to do, it’s always better to call 911 and seek immediate help.

2. Talk to Your Child’s School Ahead of Time

Schools are often open before the official first day of school. We always encourage parents of children with severe food allergies to talk to their child’s teacher or school nurse before the start of the school year and provide them with a written “emergency action plan” or “food-allergy action plan” that describes a child’s allergy, what medicines to administer and who to call in case a reaction occurs or an allergic food is ingested. A form for the plan (such as this) is typically provided by the school or your pediatrician’s office and filled out by your pediatrician specifically for your child. Many schools are now peanut- and tree nut-free zones, but other parents who aren’t familiar with allergies may not know what type of snacks should be avoided and what to look for on a package label. It would be helpful to talk to the teacher and educate other families on what’s safe for your child during lunch, special school parties or birthday celebrations.

3. Keep Medicines Up-to-Date

If your child has had an episode of anaphylaxis or a severe allergy, it’s important to have a non-expired epinephrine pen at school as well as home. For older children, the EpiPen can be carried in a dedicated backpack the child can carry with them; for younger children it should be given to the supervising adult or kept in the health office. Due to a recent temporary shortage of EpiPens, the FDA has extended the expiration date for EpiPens, so speak to your pediatrician about whether your EpiPen can still be used.

4. Teach Your Child About Their Allergy

We encourage parents to talk to their kids about their allergy as soon as it’s developmentally appropriate. Talk to them about what foods to avoid, not to share food with other kids, how their body might react if they’re having an allergic reaction and how to seek help if they’re having any allergy symptoms. For younger kids, we recommend getting medical identification jewelry to alert others of a child’s allergy, such as a bracelet with their allergy listed on it.

5. Educate Other Adults About Your Child’s Allergy

When your little one is on a playdate or with a babysitter, grandparent or other caregiver, it’s important to let the other adults know of your child’s allergy, signs to look out for if an allergy occurs and what medications to have on hand. It’s also important to leave a list of numbers to have readily available, such as parents’ cell or work phones and the pediatrician’s office number. If your child is playing at the park or in other areas where kids may be sharing toys or playground equipment, caregivers should look out for and avoid potential places for an allergen encounter—so if your child has a peanut allergy, look for and avoid other kids eating a peanut butter and jelly sandwich, who may then go on playground equipment or play with shared toys with their peanut butter-y hands.

Meet Dina DiMaggio, MD, and Anthony F. Porto, MD, MPH, official spokespeople for the American Academy of Pediatrics and the co-authors of The Pediatrician’s Guide to Feeding Babies and Toddlers. They write about the latest AAP guidelines, studies and seasonal issues affecting babies and toddlers. Follow them on Instagram @pediatriciansguide.

Published September 2018

Plus, more from The Bump:

Baby Allergies: A Primer on What You Need to Know

Children’s Benadryl Dosage Chart

You Need to Know About This New Machine if Your Child Has a Peanut Allergy

PHOTO: Crystal Marie Sing