Soon, a number of children with food allergy will be starting school in Australia. When children are transitioning to school with food allergy, parents will be concerned about their child’s safe and inclusive participation in all school activities, increased risks of food allergy via accidental exposure from others, how quickly a child’s allergy can be identified and addressed and importantly, whether a young child has the capacity to stay safe at school (Sanagavarapu, 2012).
Before children start school, parents assume a primary responsibility for their young child’s safety. However, at the time of starting school, it’s imperative that children also assume some responsibility for their safety at school where there will be diminished adult or parental supervision.
But the question is, can a 4 and a half year old (the starting age for schools in New South Wales) understand his or her food allergy and what an allergic reaction is, and alert his or her teacher to the allergic reaction promptly and seek timely help? Can young children resist the temptation to accept unsafe foods when offered by their peers at school? Can they advocate for their own safety, age appropriately? Or is it too much to ask a young child to take responsibility for his or her safety and the management of food allergy at school?
Adolescents are cognitively and emotionally competent to grasp the implications of food allergy (e.g., Fenton et al., 2011) and can manage to stay safe independently. However, it is not known if young children understand their food allergy and its implications and can stay safe at school with limited adult supervision.
Our pilot study on ‘Starting school with food allergy’ (Sanagavarapu, Said, Katelaris & Wainstein, 2014), funded by Allergy & Anaphylaxis Australia, has provided valuable insights into children’s knowledge and understanding of food allergy and safety at school. In this study interviews were conducted with six children affected by food allergy, aged between four and a half to six years old, in Sydney, Australia.
These interviews with children have pointed to the need to scaffold young children’s knowledge of their own food allergy, and of their safety and its self-management, at the time of starting school.
To stay safe, children must be able to recognise foods that they are allergic to and avoid them by all means, essentially by resisting temptations to accept or share such foods with others.
All children in our study named the foods that they can and can’t eat, and most children also recognised those affected foods from photos shown in the interview. Further, all children knew the various symptoms of food allergy, saying things like:
“ I keep coughing and coughing”; “my mouth gets funny”; “sometimes I scratch my mouth when it’s itchy and it takes a while to get unitchy”; “I start to vomit and get spots”.
One child even mentioned the prospect of a fatality from an allergic reaction (commenting, “You will die”), while another child labelled the condition medically (saying, “I also have anaphylaxis”).
Additionally, most children had a range of strategies to prevent the potential risks of food allergy. These included refusing to accept foods from others, checking with teacher or mum, and peer education through to a simple and effective strategy of hand washing. To quote:
“I try my best to not eat”.
“I say stop”.
“Even if they told me it is yummy, I say “I can’t eat them”.
“At big school you don’t share food”.
“I only eat my own food”.
But, not all children seemed to be able to resist temptations to accept foods, and some children trusted their peers’ assurances and risk assessments, which can be potentially risky. To quote:
“if my friend says, it does not have eggs or nuts, I will have it”.
“I would ask if it had nuts and if it did not I would eat it”.
In terms of seeking help, all children knew who to go for help when needed. They said it would be their class teacher in the first instance, and or friends at school. Drawing from their own knowledge and experiences of food allergy, children in our study offered advice to other children which included:
• Tell others you have food allergy;
• Don’t eat foods you are allergic to, and
• Don’t share food with others.
This advice from children implies a preventative approach to safety that corresponds with the preventative approaches that parents generally take in the management of food allergy, because currently there is no known cure for allergy. The most effective way to manage food allergy is to prevent the risks in the first instance, and administer antihistamine and adrenaline autoinjector if needed.
The advice provided by children in this study to other children starting school is simple, yet invaluable in reducing the risks of food allergy at school. Although based on a small sample, our study findings offer valuable implications and suggestions to parents, teachers and children in promoting the safety of children with food allergy at school. They are below.
For parents or caregivers
• Talk to your child age appropriately about his or her food allergy and its symptoms, without alarming them about the consequences of food allergy.
• Help your child to recognise and label foods that he or she is allergic to in various forms and via grocery shopping, books, and through pictures in advertising materials and catalogues.
• Age appropriately, also assist your child to recognise and read food labels.
• Encourage your child to share information on his or her food allergy with teachers and peers at school, and with before and or after school staff.
• Raise the awareness of your child’s classmates on food allergy with the help of the school/class teacher.
• Develop simple scripts with your child that she or he can use to communicate when unwell and to seek help from an adult or peer at school when needed.
• Reinforce the simple message of ‘no sharing or accepting foods’ from others and that they eat their own lunch/tea.
• Scaffold self-control strategies with the child to resist temptations, albeit at varying levels, and age appropriately via reading stories, mock sessions and role plays before children start school and in the transitional periods.
For educators or schools
• Incorporate the simple message of ‘no sharing or accepting of food’ into classroom discussions and promote and implement policy of ‘no sharing of food’.
• Raise the awareness of all children about food allergy through the reading of stories about children starting school with food allergy or other strategies.
• Scaffold self-control strategies to resist temptations, albeit at varying levels, and age appropriately via reading stories, mock sessions and role plays at school.
• Collaborate and communicate with parents or caregivers on matters of the food allergy management to promote child safety.
• Know your food allergy.
• Do not share foods with others.
• Say ‘no’ to food politely when offered from others, even friends.
• Let an adult or peer know when feeling unwell.
Fenton, N.E., J. S. Elliott, L. Cicutto, A. E. Clarke, L. Harada, and E. McPhee. (2011). Illustrating Risk: Anaphylaxis Through the Eyes of the Food-Allergic Child, Risk Analysis, DOI: 10.1111/j.1539-6924.2010.01488.x
Sanagavarpu, P., Said, M., Katelaris, C., Wainstein, B. (2014). Starting school with food allergy: Listening to parents’ and children’s voices. Research Report Commissioned by and prepared for Allergy & Anaphylaxis Australia. University of Western Sydney, Australia.
Sanagavarapu, P. (2012). Don’t forget to pack my EpiPen® please? What issues does food allergy present for children’s starting school? Australasian Journal of Early Childhood, 37 (2), 56-61.
Dr. Prathyusha Sanagavarapu is a senior lecturer in the School of Education at the University of Western Sydney, Australia. Her research interests include the areas of starting school, food allergy and children’s health, and issues around family diversity and parenting.