Last reviewed 8 November 2019
With almost 1 in 12 young children now suffering from a food allergy, it is essential that early years practitioners can recognise the symptoms and know how to manage allergic conditions in their nursery.
Common food allergies in children
Almost any food can cause an allergic reaction, but in children the foods that most commonly trigger an allergic response are:
Food allergies occur when the immune system mistakenly treats proteins found in food as a threat. This causes a reaction which leads to the release of a chemical called histamine in the body that results in allergy symptoms.
Early years providers are required to obtain information about children’s special dietary requirements, including food allergies and intolerances, before they attend, and record and act on the information provided about children’s dietary needs. A Food Preferences and Allergies Record is available here.
What are the symptoms of food allergies in babies and children?
Mild to moderate symptoms of immediate food allergies typically affect the skin, respiratory system and the gut. These include:
a flushed face, hives, a red and itchy rash around the mouth, tongue or eyes; this can spread across the entire body
mild swelling, particularly of the lips, eyes and face
a runny or blocked nose, sneezing and watery eyes
nausea and vomiting, tummy cramps and diarrhoea
a scratchy or itchy mouth and throat.
Severe symptoms, or anaphylaxis, occur rapidly and can be life threatening. These include:
wheezing or chest tightness, similar to a severe asthma attack
swelling of the tongue and throat, restricting the airways; this can cause noisy breathing (especially on breathing in), a cough or a change in voice
a sudden drop in blood pressure (hypotension) leading to shock
dizziness, confusion, collapse, loss of consciousness and sometimes coma.
How to treat food allergy reactions
The best way of preventing an allergic reaction is to identify the food that causes the allergy and avoid it. However, allergic reactions will happen at times in both diagnosed children as well as in first-time reactors. It is therefore essential that early years practitioners have an awareness of the common food allergens and know how to recognise the symptoms of an allergic reaction in young children.
Oral antihistamines can be given to relieve the symptoms of a mild or moderate allergic reaction. Adrenaline is an effective treatment for more severe allergic symptoms, such as anaphylaxis, which requires urgent medical treatment. Children with food allergies are often prescribed an auto-injector pen, which contains a dose of adrenaline that can be used in emergencies. Auto-injector pens, such as EpiPens, are easy to administer but early years staff will need training in how to use one in the event of an emergency.
Once the auto-injector has been used, early years staff must call an ambulance immediately as all patients receiving emergency adrenaline should be taken to hospital for further care. Adrenaline is a short-acting drug, so if there is no response to the initial injection, current recommendations are to give a further dose after five minutes.
Parents will need to sign a permission to administer medication form before early years staff can administer medicine and ensure all medication they provide is within its use-by date.
Read more about emergency treatment of allergies here.
What do the food allergen regulations mean for early years providers?
The EU Food Information for Consumers Regulation 1169/2011 requires food businesses, including early years provisions, to provide information on the allergens in the food that they serve. Early years providers need to be able to explain which of the main 14 allergens are included as an ingredient in both freshly cooked meals and pre-packaged food. This information helps to ensure that appropriate meals and snacks can be provided for children with food allergies.
Allergen information that needs to be easily accessible for staff, parents and carers are as follows.
Written allergen information can be provided on a menu, chalkboard, website or information pack/folder.
Providers can signpost parents to where allergen information can be accessed in written or verbal format.
There must be a process in place to ensure the information given is correct, consistent and verifiable.
The Food Standards Agency has created an allergen menu matrix that can be filled in to show which allergens are present in meals. This will help kitchen staff to log and check allergen information for the food they provide.
All staff should:
know the procedures and policies when asked to provide allergen information
receive training on handling allergy information requests
know the risks of allergen cross-contamination when handling and preparing foods.
Best practice and action points
Early years providers should develop an effective allergy management policy which must be made available to all staff, parents and carers. The policy could include the following best practice regarding food allergies.
Ensure all staff have relevant training in common food allergies, including recognising allergic reactions and what to do in an emergency.
Obtain and record all relevant information about food allergies and intolerances before a child is admitted to the provision.
Work in partnership with parents and healthcare professionals to write an individual allergy management plan for each child.
Ensure staff are aware of all prescribed medication and it is stored safely while being easily accessible.
Ensure staff receive training in administering adrenaline auto-injectors, such as EpiPens.
Establish a clear policy on food sharing between children.
Establish whether the provision will be a nut-free environment.
Keep an allergy register in the kitchen and in the room where children are based.
Ensure cross-contamination is avoided by maintaining good food hygiene standards at all times.
Ensure clear separation and labelling of ingredients.
Ensure all staff and children maintain effective handwashing.
Check all new recipes and labelling for allergens when trying new foods or meals.
Ensure the allergen information on the food and drinks you offer is available to parents and staff and is accurate, consistent and verifiable.
Ensure children are not excluded from activities or trips due to a food allergy. Extra care must be taken with cooking, baking and craft activities to ensure all children can participate.
You can find a template Allergy Management Policy here.
Allergy UK is the leading national charity dedicated to supporting allergy sufferers in the UK.
Anaphylaxis Campaign is a UK charity supporting people with severe allergies.
Guidance on catering for children with food allergies is included in Catering for Special Dietary Requirements: A Guide for Early Years Settings in England.
Food Standards Agency is an independent government department responsible for food safety and hygiene across the UK.
Further information about food allergies is available on the NHS website.