Medication Administration & Prevention of Allergy

INTRODUCTIONS

• My name is: Peggy Drussel, MSN, RN
• I work at GBC as a nursing instructor
• Recently moved to Las Vegas and will teach at Pahrump
• WHO ARE YOU?????????

There are two parts to this training:
1- Medication Administration
2- Response to Food and Other Allergies
(Both topics relate to the child care setting)

Part One

OBJECTIVES

• Demonstrate an understanding of the roles and responsibilities of adults involved in a child's health and treatment plan
• Recognize rules and recommendations for administration of over-the-counter and prescription medications in the child care environment

Continued Objectives

• Demonstrate an understanding of training and authorization levels required for administration of various types of medication
• Identify key information to include in a program's medicqtion administration

Continued Objectives:

• Identify safe medication receipt, storage, and handling procedures
• Demonstrate an understanding of the Seven Rights of Medication Administration
• Identify recommended procedures for ensuring safety and efficacy

Continued Objectives:

• Identify and demonstrate an understanding of recommended strategies and best practices for administering medication to children of various ages and abilities Key information to include in a program's medication administration policy
• Identify safe medication receipt, storage, and handling procedures

Continued Objectives:

• Identify and demonstrate an understanding of recommended strategies and best practices for administering medication to children of various ages and abilities
• Identify recommended information to include in a child's medical file

Continued Objectives:

• Identify Key information to include in a program's medication administration policy
• Identify safe medication receipt, storage, and handling procedures
• Demonstrate an understanding of the Seven Rights of Medication Administration
• Demonstrate an understanding of training and authorization levels required for administration of various types of medication

More objectives:

• Identify and demonstrate an understanding of recommended strategies and best practices for administering medication to children of various ages and abilities
• Identify recommended procedures for ensuring safety and efficacy
• Identify recommend information to include in a child's medical file

Resource by the American Academy of Pediatrics

PRETEST

WHY DO WE GIVE MEDICATION IN CHILD CARE?

REASONS WHY MEDICATION IS GIVEN:

• Prevent illness: Barrier cream to prevent diaper rash or sunscreen to prevent sunburn
• Relieve symptoms: Allergies or pain
• Control or cure health problems like: Inhaler for wheezing

Reasons meds are given in Child Care:

• To maintain the health of a child
• To allow the child who is not acutely ill to attend the program
• To comply with laws, regulation, and best practice

When Should Medication Be Given?

• Whenever possible, medication should be given at home by the parent or guardian
• Prescribers should try to minimize the number of doses given at a child care center

State Regulations are used to ensure basic health and safety parameters
AND are minimal standards for a licensed program to operate legally

(Let's review these)

BEST PRACTICES

• There are research based publications that attempt to provide us with best practice standards

Partners in the health of a child

• Parent/Guardian
• Health Care Provider
• Child Care Provider

Parent or Guardian

Responsibilities:

• Regular check-ups and up to date immunizations
• Complete communication about the child's health status including symptoms
• Consulting with the health care professional about diagnosis and care
• Compliance with mediation policies and completion of forms
• Communication with health care professionals about the child care setting

Additional Responsibilites

• Ask the health care professional if medication can be given at home and NOT in child care
• Providing properly labeled medication and providing appropriate measuring devices
• Providing up to date emergency contact phone numbers
• Promptly picking up their child when notified of illness
• Arranging for back-up care
• Working well and in partnership with child care providers to determine the appropriate care for their child

Child Care Provider

Responsibilities

• Careful and periodic monitoring of health records
• Having and communicating clear policies on medication, exclusion, and readmittance
• Maintaining good hygiene practices
• Promptly communication with parents and guardians about their child's symptoms

More Responsibilities

• Using available resources for health consultation
• Obtaining training about medication administration (getting today)
• Provide guidance and education as requested

Health Care Provider

Provider Responsibilities

• Complete all child care health forms legibly
• Discuss medication needs with parent/guardian and if needed, with child care providers, if parent permission is obtained
• Adapt medication schedules to meet the needs of children in child care and limit the number of doses given in child care

Cont'd Provider Responsibilities

• Promote disease prevention and good health practices
• Promote disease prevention and good health practices

Cont'd Provider Responsibilities

• Be accessible to child care staff for questions and concerns about their patients with parental permission

Types of Medication

• Prescription
• Over the Counter
• Brand name
• Generic Name
• Oral
• Topical
• Inhaled
• Injectable
• Rectal

Types of Medication

• Prescription
• Over the Counter
• Brand name
• Generic Name
• Oral
• Topical
• Inhaled
• Injectable
• Rectal

Prescription Medications

• Can only be prescribed by an authorized health care professional
• Are dispensed by a pharmacist
• Are considered a "controlled substance" if they are dangerous or addictive
• Controlled substances have special rules
• Sample medications must have a complete and appropriate label

Over the Counter Medications

• These can be purchased without a prescriptions. Examples: Vitamins, Homeopathic medications, Herbal medications, sunscreens, insect repellant, diaper cream and
• Can often have different regulations.

Common OTC Medications

• Fever reducer or pain reliever (Tylenol)
• Antihistamines (Benadryl)
• Cough syrups/cold medicine
• Nasal drops
• Many OTC drugs do not have dosing information and is NOT recommended for under 24 months old.

Forms of medication

• Oral
• Topical
• Inhalation
• Injection
• Rectal

Oral Medications

• Tablets
• Chewable
• Scored
• Swallow
• Sprinkle
• Suspensions
• Syrups
• Elixers
• Sublingual

Types of Topical Meds

• Drops
• Sprays
• Patches
• Creams, ointments, sprays

Let's Discuss

• Prescription vs OTC
• Preventative vs Treatment

Inhalation Meds

• Breathing or inhaling a drug into the respiratory tract such as:
• Inhaler
• Nebulizer
• Powder
• Spray

Types of injection

• EpiPen and EpiPen Jr
• Glucagon
• Insulin
• Special training is required for these meds and will not be covered during this session
• EpiPen training is provided in First Aid

NAC 432A.376
Except in an emergency, only one person designated by the license of a facility may administer medications to children. A person designated by this licensee of a facility pursuant to this subsection must be trained in the administration of medications by a health care professional or the parent of a child cared for in the facility and authorized to administer the medication.

Rectal/Suppository

• These meds require special training and will not be covered in this program

Medication Preparation

• Forms
• Policies
• Confidentiality
• Receiving and storing meds
• Disposing of medication

What Forms Are Needed?

• Child Health Assessment -Could include a care plan
• Medication Administration Form with consent/authorization to give med
• Receiving Medication Form
• Medication Log
• Emergency Contact Form
• Health Care Professional's Order

Child's Health Assessment Form

• Physical examination results
• Immunization record
• Medical conditions
• Preventative health screenings, if required (eyes, hearing)

Children with Special Health Care Needs

• May require and individualized care plan due to the need of the child care provider for detailed specific information
• This type of care plan should be completed by a health care professional and provide information about any ongoing or emergency medication
• The plan should outline needed diet, environment, or activity modifications.

Medication Administration Packet

• Authorization to give medication that is completed by parent or guardian
• Should include child's information, prescriber's information, and permission to give medication

Receiving Medication

• Checklist of steps to take to receive and safely store medication
• Is completed by child care staff, completing steps for medication administration.

Steps for Receiving Medication

• Check labels adn containers
• Ensure that all forms are complete
• Question parent/guardian to gather necessary information
• "Need to know"

Medication Log

• Is completed by the child care staff
• MUST INCLUDE: name of the child; Medication; day, dose, time, route and staff signature
• Comments and observations
• Return or disposal of medication notation
• Prescription and OTC meds. must all be logged
• See NAC 432A.376 (handout)

Emergency Contact Form

• How to contact the family
• Permission to speak with the health care professional regarding a specific child's health needs

Health Care Professional's Order

• Written order required for both OTC and prescription
• Parents should co-sign or instructions should match
• Should include the name of child, name of medication, form of medication, dosage, how often to give, and when
• Toothpaste and non-medicated lotions/creams are not considered meds.

Medication Orders Continued

• Administration of long-term/ongoing medications, should be paired with a care plan
• Non-prescription sunscreen and insect repellent do not require orders from a Health Care Provider, only parental instructions.

Orders Cont'd

• "As needed" or "prn" orders should have specific information about what symptoms qualify as needing medication
• State regulations vary about telephone orders and should be checked carefully
• Written documentation is required for any telephone orders taken

Important Components of a Health Care Order

• Child's first and last name
• Date of order
• Name of medication
• Amount or dose
• Time, route, and frequency
• Signature or the health care professional
• Expiration date of medication

What a medication Policy Should Include:

• Who will give medication
• What medication will be given
• Where all medication will be given and stored
• When medication will be given
• How confidentiality will be maintained
• What procedures and forms are to be used for permission & documentation

WHO WILL GIVE THE MEDICATION?

• NAC 432A.585
• Include in the policy: Who is designated to give medication, who will serve as alternate if the designated person is not available.
• The designated person should: Have qualifications for the task, be relieved of other dutues when administering meds
• Note that in the regulation it states, "Only trained persons in administration of medication by a health care professional or a parent of a child cared for in a facility and authorized...may administer medication to the child."

What Medications Will be Given?

• The policy should say why medications are given and what types of medications are given in child care
• The policy should apply to prescription and OTC medications
• Facilities should not administer folk or home remedy medications, homeopathic or herbal medications, UNLESS an order from a health care provider is present and these meds are proper labeled and unopened with package intact

Policy on Procedures

• Step-by-step procedures: 6 rights
• Which forms are necessary prior to administering medication
• How health care professional's orders will be handled
• First dose of any med. should be given at home by parent/guardian
• Procedures for errors or incidents

Medication Policy Cont'd

• What procedures are used when giving medication (6 Rights)
• What procedure should take place in the event of a medication error or incident

Confidentiality

• The parents/guardian may not want this information to be shared and should only be shared on a need to know basis.
• Establish and follow a written policy on confidentiality of the records of children
• Permission to share confidential information should be written and not just oral
• Health records should be kept in a locked cabinet for confidentiality

Federal Regulations

• All medical records MUST be kept confidential
• Secure transfer of medical records
• Permission is required for electronic transfer of medical records
• HIPPA covers confidentiality in health care settings, while FERPA applies to school settings, but not particularly child care settings.

Receiving Medication

• Prescription: Pharmacy name and number, prescriber's name and number, prescription number, date med was filled, child's first and last name, name of medication, refills, quantity, manufacturer, expiration date, instructions for administration, & instructions for storage.

Receiving OTC Meds

• Verify that the strength of the medication is appropriate for child's age
• Original medication packaging should have: Product name, active ingredients, purpose, uses, and warnings
• Make sure that nothing blocks information on the label

Process for Receiving Medication

• Receive medication
• Match the label with permission form and instructions
• Log medication when receiving
• Ask parent/guardian questions: When was the last time the med was taken?; How do you give your child the medication?; What kinds of side effets may be caused by this medication?; What successful techniques do parent's use?
• THEN store medication
• Make sure medication has a child-proof lid (NAC 432A.376).

Receiving Medication Form

• Should include: child's name, name of medication, date medication received, safety check, controlled substances require special tracking.
• IF THE NECESSARY INFORMATION IS NOT PRESENT OR DOESN'T MATCH, DO NOT ACCEPT OR GIVE THE MEDICATION UNTIL ISSUE IS RESOLVED.

SAFE STORAGE AND HANDLING

• Have child resistant caps
• Store in an out of reach place
• Observe for signs of tampering
• Check for special storage instructions (Refridgeration)
• NAC 432A.376 "Medication that requires refrigeration must be kept separate from food and inaccessible to children"
• Be aware of products that look alike or sound alike

Med/Candy Look Alikes

Look Alikes

Look Alikes

Tips for Parents

• Ask pharmacist to divide medication into 2 bottles, each with their own label (1 for home and 1 for school)
• Ask if medication can be taken at an alternate time if needed

Medication Storage

• "All medications must be locked and inaccessible to children" NAC 432A.376
• The area should be cool and dark with limited access.
• If refridgeration is needed should be kept seperate from food, in a spill proof container, and stored at 36-46 degrees F.

According to NAC 432A.585 there

• are no exceptions for creams or emergency meds.

Medication Administration Area

• A safe medication area is a place: Where the person administering the medication can concentrate on administering the medication; stocked with medication and supplies within easy reach; is clean and well lit; free of clutter; confidential and quiet

Disposing of Medication

• If medication is left over or out of date, return to the parent for disposal and record that on the permission or intake form
• If medication cannot be returned to the parents follow proper disposal procedures. Controlled medications require special disposal procedures.
• Contaminated meds should be disposed of and replaced promptly.

Let's practice

• Nick is 24 months old and has an ear infection. Nick needs a noon time dose of amoxicillin suspension for this week and part of next week. The medication requires refrigeration and it must be shaken before being given. Nick has already received several doses of the amoxicillin at home.
• What's the best protocol for accepting this med?

Scenario 2 Practice

• Maria is 3-years-old and has eczema. She needs hydrocortisone cream applied to her arms at noon time. This is an OTC medication with a brand name of Aveeno®. Aveeno also makes other non-medicated skin moisturizers as well, but the medication that is being requested is an OTC hydrocortisone cream. Maria has had this medication before.
• Group Two- Go through the procedure

Common Errors in Medication Administration

• According to statistics, a child is subject to a medication error every 8 minutes in the US. Research and statistics show that the Poison Control statistics show gathered show 696,937 children under 8 years of age were reported for medication errors and that this is under reported.
• (THE PHARMACEUTICAL JOURNAL, 2014)

COMMON ERRORS

• Took medication twice
• Wrong medicine
• Incorrect dose
• Missed dose

COMMON CAUSES

• No understanding the medication label
• Not understanding how to give medication
• Poor communication between parents/guardians and health care professinals

MOST COMMON MEDICATION ERRORS

• Errors are most commonly made with analgesics, which is the class of medication which includes Tylenol (acetaminophen) or Motrin (ibuprofen)
• Reasons include: Meds are given frequently; there are many different concentrations (infant/child doses); They are often mixed with other meds in cough and other oral preparations; Dosing charts are unique to the type and form of the medication.

7 Rights of Medication Administration

• Right Child/Patient
• Right Medication
• Right Dose
• Right Time
• Right Route
• Right Reason
• Right Documentation

Right Child

• Check the name on the medication label and the child's name
• If any questions arises, chec a second identifier such as date of birth

Right Medication

• Read the label to make sure you have the correct medication
• Check to see that the medication is in the original labeled container & that the med. is not expired
• Especially important for children who are taking more that one medication

Right Dose

• Check dose on label and authorization form each time
• Use the proper measuring device
• Check measuring device carefully

Right Time

• Check the permission form to match the time with the label
• Check that medication is being given within 30 minutes before or after prescribed time
• The right time includes both time and date
• In an emergency, "now" is the right time to give medication

Right Route

• Check the label and Authorization to Give Medication form
• HOW is the medication to be given?

Right Reason

• Is the medication the right medication for the problem? Has the right medication been ordered?

Right Documentation

• Documentation MUST be done at the time that the med. is given.
• Complete all the documentation that is required on the medication log
• Documentation should be done in blue or black ink.
• No pencil or white out can be used.
• Never cross out or write over documentation
• If you make a mistake when you are documentating on the medication log, circle your mistake and write a note on the log to explain what happened.
• Double check your documentation for accuracy and if possible have a second person go over the documentation to make sure it is complete.

AS NEEDED OR PRN

• Some medication, such as an EpiPen is only given in an emergency and "as needed."
• Health care professionals and other prescribers should not write "as needed" or "prn" without more specific instructions. (Ex: Albuterol inhaler is given for wheezing, increased coughing, or breathing difficulty.)
• OTC medication for pain and fever should be kept to a minimum and should be as specific as possible. (Should not be at child center if there is fever)
• The order should state the maximum number of times the dose can be repeated before seeking further medical care.

STANDARD PRECAUTIONS IN CHILD CARE SETTING

• The term for infection control measures that all health and child care providers should follow in order to protect themselves from infectious diseases to those in their care.
• Sometimes call universal precautions

WHAT STANDARD PRECAUTIONS INCLUDE

• Proper handwashing with soap and water both before and after medication administration and and individual towel should be available for each handwashing.
• Hand sanitizers should be kept out of reach of children and their use should be supervised
• Wear disposable gloves
• Dispose properly of gloves and other materials
• Make sure to clean the area where meds are given and prepared before and after

ACTIVITY TO PREPARE AND ADMINISTER MEDICATION

• Wash hands
• Prepare work area
• Take out the medication
• Check the label and the tiems on the forms to see that they match
• Get proper measuring device
• Check the time
• Find appropriate measuring device
• Measure the amount on the label
• Change the form of the medication only if label states for you to do so

Medication and Food

• It is usually best practice not to mix medication with food, but it may be necessary
• Ask the prescriber or pharmacist before mixing medication with food or liquid
• If medication is mixed with food or liquid, All of the mixture must be taken
• Give the child something to drink immediately afterward to help with the taste

PREPARE THE CHILD

• Communicate with the child in a manner that they understand for developmental level
• Explain the procedure to the child
• Never call medication candy or tastes like candy
• If child will handle the med. wash their hands
• Position the child in sitting or standing position

Prepare the Child: Infants

• Support the infant's head
• Hold the baby semi-upright
• Keep the infant's arms and hands away from her face
• Gently press the chin to open the mouth
• Rock the baby before and after
• If using a dropper or syringe position on one side of the mouth along the gum and squirt slowly to allow the swallowing
• Special dosing nipples may work best when the baby is hungry
• Give oral medication before feeding unless instructed otherwise

PREPARE THE CHILD: TODDLER

• Ask parents what techniques they use
• Give toddlers some control, like sitting or standing, but do not give veto power over taking the medication
• Be honest about bad taste and allow the child to drink afterwards
• Use age-appropriate language to explain what you are doing
• Maintain an attitude that you expect cooperation
• Thank the child for their cooperation and praise them

PREPARE THE CHILD: OLDER CHILDREN

• Explain why we take the medication and why they help us to get better
• Use the opportunity to teach about time, body parts, health, and illness
• Involving the child in the process helps to prepare him to take his own medication as he gets older.
• Books that talk about medication are helpful to read with the child.

Medication Administration Procedure

• Check 6 rights: child, medication, dose, time, route, and documentation
• Note any special instructions
• Take the med. from the container and prepare
• Check the label again
• Give the medication. NEVER give more or less, accuracy is very important.

Finishing up with meds

• Praise the child
• Check the label again
• Return the medication to storage immediately and never leave it unattended
• Record the medication, date, time, dose, route and your signature in the medication log.
• Clean the measuring device
• Wash your hands
• Observe the child for side effects

AFTER GIVING MEDICATION

• Allow the child the opportunity to express his or her feelings
• Acknowledge that some medication is difficult to take
• Encourage the child that next time will be easier
• Offer to spend time with the child

Video

• How to give medication to children

How to Give Oral Medication

• Oral measuring devices include a dropper, syringes, dosing spoon, or medication cup
• NO KITCHEN TEASPOONS OR TABLESPOONS!

VIDEO ON MEDICATION ROUTES

TOPICAL MEDICATION INCLUDE

• Skin Creams, ointments, patches
• Eye drops, ointments
• Ear drops

INHALED MEDICATION

• Nasal sprays and drops
• Metered dose inhalers and nebulizers

Practice

• Go to each station and practice administering medications of each form to a child in pairs. Total of 6 stations.

DOCUMENTATION

MEDICATION ADMINISTRATION PACKET

• Authorization to Give Medicine
• Receiving Medication
• Medication Log

Medication Log

• Is completed by the staff who administer the medication
• The log should include:Name of child, medication, day, time, dose, route, staff signature, any reported errors and return or disposal of medication
• For "as needed" medication, write the reason the medication was given

MORE ABOUT MEDICATION LOG

• Each child should have his or her own log
• Every dose of medication must be recorded to prevent dosing errors
• Recording takes place right af the med. is given
• Having a record helps to track and prove your actions
• Record unusual circumstances
• The log is a permanent and legal record

PROPER DOCUMENTATION

• Is always legible and in INK
• Has no white out or eraser marks
• To document an error, cross out with single line, make correction and initial
• Fill in ALL blanks on the form and write N/A if not applicable
• Sign with a witness if necessary
• Records need to be kept for as long as your state requires them to be kept
• Parents should be able to get a record of medications given

OBSERVATIONS

• Make notations of possible side effects in the log
• Record incidents, such as child refusing to take medication
• Note successful techniques that helped the child to cooperate
• We will discuss side effects and incidents in the next section.

Activity

Let's Problem Solve

PROBLEMS THAT CAN OCCUR

• Medication errors
• Medication side effects
• Medication incidents
• What to do for problems and how to document them
• Field trips
• Self administration
• Problems with requests

COMMUNICATION AND CARE

• Preventing errors begins with good communication at drop-off and pick up of the medication.

What is a Medication Error?

• Giving the medication to the wrong child
• Giving the wrong medication
• Giving the wrong dose
• Giving the medication at the wrong time
• Giving the medicaiton by the wrong route

Preventing Medication Errors

• Look at the pattern of errors
• Make changes based on the patterns seen to prevent further errors of that type (Ex: forgetting to give the med-set an alarm as reminder)
• What other ways can we prevent errors?

SIDE EFFECTS OF MEDICATIONS

• An adverse effect of taking a medication
• There are common side effects

Common Side Effects

• Upset stomach
• Diarrhea
• Dry mouth
• Drowsiness
• Change in activity or mood
• Dizziness
• Flushing, sweating
• Rashes
• Rapid heartbeat
• Nausea

Side Effects

• Can vary from child to child (sleepy/hyperactive)
• Side effects that could be normal for one medication maybe abnormal for another (Rapid heart rate would be expected after use of an albuterol inhaler, but not for a medication such as acetaminophen.

Sources for Information Regarding Side Effect

• Package inserts/labels
• Information from pharmacy
• Informatin from the prescribing health care professional
• Reliable reference materials like the PDR (Physician Desk Reference)
• www.consumermedsafety.org

Allergic Reactions to Medication

• An adverse effect is any undesirable experience associated with the use of a medical product in a patient
• Allergic reactions can involve many different types of symptoms and are difficult to predict.
• Most common: Skin disturbances, may be mild to severe.
• Mild-itch, rash
• Severe- life threatening: Can't breath, tongue swelling, or complaint of tongue itching.

OBSERVING

• Young children can't always verbalize side effects, adverse effects or allergic reactions, so careful observation is essential!

Medication Incidents (not errors)

• Child refuses medication
• Spits out medication
• Vomited up dose
• Spilled medication

What to Do

• Always call 911 if the child is in distress
• Notify the center director
• Notify parent or guardian
• Fill out a Medication Incident Report
• If needed call Poison Control
• Contact the Health Care Professional
• (In most instances the director will make needed calls, but you must fill out the incident report and contact the director immediately)

You may also want to:

• Develop and document follow-up plan to prevent the same error/incident
• NEVER repeat a dose that the child does not keep down, unless told to by the health care professional

WHEN TO CALL 911

• When you see signs of distress in the child
• When there is a loss of or change in consciousness
• Blue color or difficulty breathing
• Swelling of lips, tongue, or face, or drooling
• Seizure activity
• Rapidly spreading rash or hives
• Impaired speech or mobility
• Getting worse quickly
• When in doubt

When to Call Poison Control

• When medication is given to the wrong child
• When the wrong medication is given to a child
• When the wrong dose is given (overdose)
• When a medication is given the wrong route
• When a medication is given at the wrong time and it results in an extra dose

When you call Poison Control

• Have the medication container
• The child's medication packet
• Child's emergency contact form
• Child's current weight if possible

Medication Incident Report

Documentation of an Error or Incident

• Make notation on the Medication Log for that dose
• Complete Medication Incident Report
• Follow up according to the child care facility policy

Scenario

• You gave Nick a dose of amoxicillin at noon and recorded it. At 12:30, you note he is scratching his arms and he is developing a rash on his arms. He is happy and playful and is not having any breathing difficulties. You notify his parent who call his health care professional. Nick is picked up at 1300 and is brought to the health care professional's officee where he is given Benadryl. His amoxicillin is discontinued and he is given a new scenariol
• Let's fill out the incident report

Maria refuses her medication saying it burn her. What should you do?

Transport Provided by Child Care & Field Trip

• A staff person authorized to administer medication should be present
• Medication should be properly secured and labeled
• The proper temperature adn conditions for the medication should be maintained
• Copies of emergency contact information and the child's medical forms should be carried
• The dose of medication given outside of the facility must be properly logged and any side effects should be noted
• Hand hygiene must be maintained
• Emergency contact methods (cell phone) must be available

Independent Administration

• For older children, it may be appropriate for them to carry and take medications on their own, but not for preschool children

Refusal Reasons

• There may be an occasion when you must refuse to give medication because: Special training is required before administering, Missing documentation/authorization, parent makes an inappropriate request, It's against facility policy

Inappropriate Requests

• Non-essential medication
• Medication not authorized by a health care provider
• Off-label use
• Cough and cold medications for young children

Responding to Parents

• "I do undeerstand, but for the safety of your child and the other children in our setting...."
• "I'm sorry, but according to our policy...."

What to do?

• Call your supervisor
• Ask the parent to make alternative arrangements
• Record the situation and document the response

Post Test

PART TWO

OBJECTIVES

• Identify the Eight Major Food Allergies
• Define contact sensitive and airborne sensitive as they relate to food allergies
• Identify strict avoidance as the only effective way to prevent allergic reactions
• Identify causes of cross contamination as it relates to food allergies
• Identify proper policies and procedures for storing foods in the center

Objectives Continued

• Identify causes of non-typical contact with allergens
• Identify safe practices for staff, children, and parents to follow in order to minimize the risk of allergic reactionsj
• Identify signs, symptoms, and recommended medical procedures for responding to allergic reactions

Three categories of allergens

• Ingested/eaten allergies
• Contact sensitivities/allergies
• Inhaled/airborne sensitivities MOST COMMON

What is a Food Allergy?

• An allergy is or allergic response is when the immune system reacts to a common substance in the enviroment. This exposure causes and inflammatory response that

The 8 MOST Common Food Allergies

• Egg, milk, peanut, tree nuts (e.g. cashews, almond), fish, shellfish (such as prawn and lobster), sesame, soy and wheat. The remaining 10% of food allergic reactions are triggered by many other foods such as kiwi fruit, banana and mustard.
• MORE COMMON for children to have food allergies that adults

Routes of Exposure

• Oral
• Contact with allergens on food or surfaces
• Exposure by mouth or mucus membranes
• Cross contact

An Interesting Fact

• According to the CDC there can also be significant allergans in saliva

SERIOUS

• FOOD ALLERGIES ARE VERY SERIOUS
• FOOD ALLERGIES HAVE NO CURE

BEST

• The best way to avoid allergic reactions is strict avoidance to the allergen
• Even the smallest amount of allergen can cause a reaction

Symptoms to an allergen can be mild to severe

• When exposed to an allergen a histamine is released which causes :
• Red, itchy, inflammed skin (hives/rash)
• Swelling of the lips and eyes
• Anaphylaxis, a sudden extreme reaction that causes swelling of the tongue or throat and could result in death
• There may also be behavioral signs like crying, irritability, refusal to eat/drink

How a child might describe a reaction:

• "This food is too spicy"
• "My tongue is itchy"
• "My tongue is hot"
• "My mouth is tingling"
• "My lips feel funny"
• "There's a frog in my throat"
• "It feels like there are bugs in my ears"

Accidental Exposures

• Label reading errors
• Unintentional ingestion
• Cross contamination/contact

Challenges

• Difficult to monitor outside foods, especially if not labeled
• Time and training to read labels carefully to avoid allergy triggers
• Celebrations are a common source of unlabeled food and cross contact
• Majority of allergic reactions to food occur in the classroom
• Providing close supervision during snack times
• Sharing of food by other children
• Sharing of saliva on surfaces, toys, or personal contact

Practical Interventions

• Develop a written allergy management and prevention plan
• Train staff in that plan
• Management of food allergies for individual children

Written Plan

• Information from the health care provider to include diagnosis, child's allergens, reaction history
• Strategies to prevent exposure to allergens while in the classroom, while eating, play areas
• Emergency Action Plan

Reducing Exposure to Allergens

• Give non-food incentives for prizes, gifts, and awards
• Prevent cross-contact when storing food
• Wash hands before and after consuming/handling food
• Avoid use of allergens in class projects, parties, holidays and celebrations, arts, crafts, science, experiements, cooking, snacks or rewards
• Consider designed seating

Prepare for Food Allergy Emergencies

• Set up communication system
• Quick and easy access to EpiPen/epinephrine
• Use epinephrine immediately and then call EMS/911
• Identify role of each staff member in an emergency
• Document response to emergency in detail after emergency has been dealt with

Staff Training

• General training on food allergies to all staff (Getting that now)
• More training/Frequent training for those staff who are dealing with children with food allergie

Make sure to read food labels

Know how to use EpiPen/Epinephrine

Create a Positive Climate

• Make children feel safe and secure
• Address bullying
• Avoid isolation
• Teach it's OK not to share food
• Review and practice developed strategies to reduce exposure to allergens

Role of the Parent

• Notify school of the child's allergies
• Bring required medications to school
• Provide Emergency Care Plan from the child's pediatrician
• Make required accommodations with provider for the plan
• Provide support to staff
• Keep open dialogue, share information, and resources
• Encourage child to use medical id

Continued Prevention of Cross Contamination

• Wash tables, chairs and any other eathing area with approved cleaner before and after meal or snack
• Keep eating area separate from learning/playing area
• Avoid ordering food from restaurants/stores
• Keep lunches and snacks in separate sealed containers in assigned cubicles or area of refridgerations to prvent cross contamination.

Take Away Points

Resources

• Food Allergy Research and Education-www.foodallergy.org (FARE)
• www.healthline.com
• Center for Disease Control at https://www.cdc.gov/healthyschools/foodallergies/
• Neveda Registry @ www.nevada registry.org
• www.childcarelaw.org
• American Academy of Pediatrics

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