Monday, 11 February 2013

Health care plan for kids going back to school

This very useful health care plan was sent in by Kimberley Madden-Snoad who is the Allergy New Zealand South & East Auckland Support Group Coordinator.

I hold regular meetings for parents and children, including school holiday activities. I was inspired by the ‘Friends for Life’ programme that all the Allergy New Zealand National Support Coordinators were introduced to at a workshop.

Kimberley, whose daughter has food allergies, is also a secondary school teacher. In 2008 Kimberley and her husband organised and ran activities for our teen camp.

Health Care Plan


The M.O.E. document “Health Conditions In Education Settings: Supporting children and young people” states that “Many children and young people identified as having health conditions will need a health care plan.” (p15) It particularly identifies children who have “allergies that can result in anaphylactic shock” as needing a “detailed health care plan.” (p 15)

The document explains that the health care plan is written by “Principals … with input from a child’s wider support team.” (p 16) This can include the parents, relevant teachers, management and the Public Health Nurse. (p 17)

Below are some areas of concern for children with food allergies. They need to be addressed in their health care plan. Solutions will depend on the child’s particular allergies.

Risk Analysis

Issue: Relieving teachers
·         Can they identify the allergic children in the class?
·         Are they trained to recognise the signs of an allergic                       reaction/anaphylaxis?
·         Do they know what to do if a child is having an allergic reaction?
·         Who is responsible for relieving teachers’ education?
Ø    A copy of the action plan could be inside the roll and on the wall in the classroom.

Issue: Extra teachers
·         Assuming that the main teacher is properly trained, are the other teachers (eg art, computer) trained and do they know which are the allergic children in the class?
·         Who is responsible for making sure they are prepared?
·         Do they use any equipment that would put the child at extra risk?
Ø    All staff should have an annual refresher on dealing with food allergies. The Public Health Nurse is responsible for delivering this.

Issue: Duty teachers
·         Can they identify the allergic children in the playground?
·         Are they trained to recognise the signs of an allergic reaction/anaphylaxis?
·         Do they know the emergency procedures?
·         Who is responsible for making sure they are prepared?
Ø    All the allergic children’s photos should be in the staff room with a list of their allergies so that all staff are familiar with them.
Ø    In some schools the duty teacher has a small laminated photo of each of the  allergy, or other health problem, kids on a key ring, which they carry round in their duty bag, so they can readily identify any children in the playground if they are unwell. 
Ø    Some schools have purchased an Epipen which the duty teacher carries around.
Ø    If staff have regular first aid updates the school could request that anaphylaxis is part of this.
Duty teachers could carry a “red card” that they could give to a child to take to the office if they need help in the playground.

Issue: Morning tea
·         Who is responsible for making sure that the children are safe?
Ø    The teacher aid could supervise and then have some extra free time later on.
Ø    The duty teacher could make a point of checking on the at-risk children.

Issue: Lunchtime
·         Who is responsible for making sure that the children are safe?
Ø    The duty teacher could check the children sitting around the allergic child to see if anyone had dangerous food.

Issue: Wet lunch time
·         Who is responsible for making sure that the children are safe?
·         What procedures are in place to ensure adult supervision of eating times?
·         How will the food be contained (eg food dropped on the carpet)?
·         Is the child kept safe in a way that doesn’t ostracise them or set them up for bullying?
·         Who is responsible for training wet day monitors?
Ø    The children could sit on a big plastic mat which is taken out and cleaned after lunchtime. The allergic child would sit on the edge of the mat or on a chair.
Ø    The children sit at their table which are cleaned down at the end. There is no wandering around with food. The allergic child sits at a table with others who have “safe” food.
Ø    If the classroom teacher is unavailable a teacher aid could supervise eating time and then have some extra lunch time in the afternoon.
Ø    The class could all eat in another room so that their classroom is kept clean and safe. They would still need to be supervised.
Ø    Wet-lunchtime monitors could watch the Alexander DVD so that they have some awareness of allergies.

Issue: Responding to a reaction in the classroom
·         Is there a procedure for dealing with a reaction in the classroom?
·         If the child is sent to the sickbay who will go with them?
·         If a child is too sick to go to the sick bay what will happen?
Ø    The Public Health Nurse could help write this procedure.

Issue: Responding to a reaction in the playground
·         Is there a procedure for dealing with a reaction in the playground?
Ø    The Public Health Nurse could help write this procedure.

Issue: Handwashing
·         Is food residue being spread by unclean hands?
Ø    Children can be encouraged by their teachers to wash their hands after eating.
Ø    All children have to wash their hands before they come back in the room after lunch or morning tea. If there is a sink in the classroom they could do it there.

Issue: School Trips
·         Who is responsible for carrying the medicine and supervising the child?
·         Are they trained in administering the Epipen?
·         Are there policies and procedures for keeping allergic children safe on a school trip?
Ø    If travel is by bus there should also be a car available in case of emergencies.
Ø    If the parent is available they will be included as parent help.

Issue: After School Care
·         If a parent is unavoidably late is there a safe place for the child to wait?
·         Who will make sure they are sent to the right place?
Concern: If they got sent to Wakacare would they be given food?
Ø    They could wait in the staffroom or at the office.

Issue: Food in lessons
·         Is food used in lessons?
·         Who is responsible for making sure that food is used in a safe way?
Ø    The parent should be included in planning this kind of activity. They are more likely to identify risks and may be able to think of alternatives.

Issue: Contaminated Equipment
·         Are food containers used in lessons? Eg yoghurt containers, egg cartons
·         Who is responsible for making sure that unsafe equipment is not used?
Ø    Check with the parents.
Ø    NB: Egg cartons are not safe unless they are straight from the factory and have never been used. Diary containers can be safe if they have been through the dishwasher.

Issue: Cooking in Class
·         How can cooking be done so that the allergic child is included and safe?
·         Who is responsible for making sure that all ingredients are safe and there is no cross-contamination?
Ø    Ask the parents for recipe ideas and to check ingredients. They might be able to come and help.
Ø    NB: It’s easy to bake without milk or eggs if you know how.
Ø    Note 2: All ingredients must be checked. Bulk bins are not safe. Raisins can have nut traces.

Issue: Shared Food
·         Is there any shared food? (eg birthday cakes)
·         Who is responsible for making sure the allergic child doesn’t eat the unsafe food?
·         How can the allergic child be made to feel included?
Ø    If advanced warning is given to the parent they may be able to provide a safe alternative.
Ø    The parents can have a “treat” box kept in the classroom so that the allergic child always has something nice to eat when the others are eating.

Issue: Picking up rubbish
·         Children with food allergies can’t do this.

Issue: Educating classmates
·         Who is responsible for making sure that classmates are educated about allergies?
·         Do they know how to help keep their classmate safe?
·         Do they know when and how to get help if their classmate has a reaction?
Ø    A note can be sent home informing the families of the other children about the child’s condition.
Ø    Allergy NZ has a range of DVDs and books for children that can be used in class.
Ø    Allergy NZ has a new poster about keeping your food-allergic friend safe which should be on the wall.
Ø    Some schools have run allergy drills – this could be part of general first aid education.
Ø    Some parents would be willing to help with this.

Helpful resources:

“Allergy Education Guide for Schools and Pre-Schools”, from Allergy New Zealand

ASCIA (Australasian Society of Clinical Immunology and Allergy Inc) “Guidelines for prevention of food anaphylactic reactions in schools, pre-schools and childcare centres.”

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