POLICY CONTENT

The Education and Care Services National Regulations requires approved providers to ensure services have policies and procedures in place for medical conditions including anaphylaxis. Anaphylaxis is a severe and sometimes sudden allergic reaction which is potentially life threatening. It can occur when a person is exposed to an allergen (such as food or an insect sting). Reactions usually begin within minutes of exposure and can progress rapidly over a period of up to two hours or more. Anaphylaxis should always be treated as a medical emergency, requiring immediate treatment. Most cases of anaphylaxis occur after a person is exposed to the allergen to which they are allergic, usually a food, insect sting or medication. Any anaphylactic reaction always requires an emergency response.

NATIONAL QUALITY STANDARD (NQS)

QUALITY AREA 2: Children's Health and Safety

2.1.1	Wellbeing and comfort	Each child’s wellbeing and comfort is provided for, including appropriate opportunities to meet each child’s needs for sleep, rest and relaxation.
2.1.2	Health practices and procedures	Effective illness and injury management and hygiene practices are promoted and implemented.
2.2	Safety	Each child is protected.
2.2.1	Supervision	At all times, reasonable precautions and adequate supervision ensure children are protected from harm and hazard.
2.2.2	Incident and emergency management	Plans to effectively manage incidents and emergencies are developed in consultation with relevant authorities, practiced and implemented.

We aim to minimise the risk of an anaphylactic reaction occurring at our School by following our Anaphylaxis Management Policy. We will implement risk minimisation strategies and ensure all staff members are adequately trained to respond appropriately and competently to an anaphylactic reaction by adhering to a child’s medical management plan and/or action plan. We also aim to ensure that the risk of children with known allergies coming into contact with allergens is eliminated or minimised.  


This policy applies to children, families, staff, management, and visitors of the School.


Our School has a legal responsibility to take reasonable steps to ensure the health needs of children enrolled in the school are met. This includes our responsibility to provide: 

• safe environment for children free of foreseeable harm and  
• dequate supervision of children at all times. 

Our focus is keeping children safe and promoting the health, safety and wellbeing of children attending our School. Staff members, including relief staff, need to be aware of children at the School who suffer from allergies that may cause an anaphylactic reaction. The Nominated Supervisor will ensure that all staff are aware of the location of children’s medical management plans, risk minimisation plan and required medication. 

BACKGROUND

Anaphylaxis is a severe, rapidly progressing allergic reaction that is potentially life threatening. The most common allergens in children are: 

• Peanuts 
• Eggs 
• Tree nuts (e.g., cashews) 
• Cow’s milk 
• Fish and shellfish 
• Wheat 
• Soy 
• Sesame  
• Certain insect stings (particularly bee stings)

Signs of anaphylaxis (severe allergic reaction) include any 1 of the following:

• difficult/noisy breathing 
• swelling of tongue 
• swelling/tightness in throat 
• difficulty talking/and or a hoarse voice 
• wheeze or persistent cough 
• persistent dizziness or collapse 
• pale and floppy (young children) 
• abdominal pain and/or vomiting (signs of a severe allergic reaction to insects)

The key to the prevention of anaphylaxis and response to anaphylaxis within the School is awareness and knowledge of those children who have been diagnosed as at risk, awareness of allergens that could cause a severe reaction, and the implementation of preventative measures to minimise the risk of exposure to those allergens. It is important to note however, that despite implementing these measures, the possibility of exposure cannot be completely eliminated. Communication between the School and families is vital in understanding the risks and helping children avoid exposure. 
 
Adrenaline given through an adrenaline autoinjector (such as an EpiPen® or Anapen®) into the muscle of the outer mid-thigh is the most effective first aid treatment for anaphylaxis.  

IMPLEMENTATION  

We will involve all educators, families and children in regular discussions about medical conditions and general health and wellbeing throughout our curriculum. The School will adhere to privacy and confidentiality procedures when dealing with individual health needs, including having families provide written permission to display the child’s medical management plan in prominent positions within the School. It is imperative that all educators and volunteers at the School follow a child’s medical management plan in the event of an incident related to a child’s specific health care need, allergy, or medical condition.  
 
Children diagnosed with anaphylaxis will not be enrolled into the School until the child’s medical management plan is completed and signed by their medical practitioner. A risk minimisation and communication plan must be developed with parents/guardians to ensure risks are minimised and strategies developed for minimising any risk to the child. 

Nominated Supervisors/ Responsible Person will ensure: 

• that as part of the enrolment process, all parents/guardians are asked whether their child has been diagnosed as being at risk of anaphylaxis or has severe allergies and clearly document this information on the child’s enrolment record 
• if the answer is yes, the parents/guardians are required to provide a medical management plan and ASCIA Action Plan signed by a registered medical practitioner prior to their child’s commencement at the School 
• all staff members have completed ACECQA approved first aid training at least every 3 years and this is recorded with each staff member’s certificate held on the School’s premises
• at least one educator or Nominated Supervisor with a current accredited first aid certificate, emergency asthma management and emergency anaphylaxis management certificate (as approved by ACECQA) is in attendance at all times education and care is provided by the School 
• that staff are provided with ASCIA anaphylaxis e-training (every two years) to provide consistent and evidence-based approaches to prevention, recognition and emergency treatment of anaphylaxis including training in the administration of the adrenaline auto-injection device (not mandated, but recommended as best practice) 
• all staff have undertaken training in administration of the adrenaline auto injection device and cardiopulmonary resuscitation (CPR) at least every 12 months 
• staff responsible for preparing, serving and supervising food for children with food allergies should undertake the National Allergy Strategy All about Allergens for CEC online food allergen management training/ or similar 
• that all staff members are aware of  
  • any child at risk of anaphylaxis enrolled in the School 
  • the child’s individual medical management plan/action plan 
  • symptoms and recommended action for allergy and anaphylaxis and  
  • the location of their EpiPen® / Anapen ® device  
• that a copy of this policy is provided and reviewed during each new staff member’s induction process 
• that updated information, resources, and support for managing allergies and anaphylaxis are regularly provided for families 
• anaphylaxis risk management plans are developed prior to any excursion or incursion consistent with Regulation 101 
• ensure that at least one general use adrenaline injector is available at the School in case of an emergency- Regulation 89. First Aid Kits.

In Schools where a child diagnosed at risk of anaphylaxis is enrolled, the Nominated Supervisor/Responsible Person will: 

• meet with the parents/guardians to begin the communication process for managing the child’s medical condition 
• not permit the child to begin education and care until a medical management plan developed in collaboration with the family and a medical practitioner is provided  
• develop and document a risk minimisation plan in collaboration with parents/guardian, by assessing the potential for accidental exposure to allergens while the child at risk of anaphylaxis is in the care of the School  
• ensure the medical management plan includes: 
  • specific details of the child’s diagnosed medical condition 
  • supporting documentation (if required) 
  • a recent photo of the child 
  • triggers for the allergy/anaphylaxis (signs and symptoms) 
  • first aid/emergency action that will be required 
  • administration of adrenaline autoinjectors 
  • ASCIA Action Plan 
  • contact details and signature of the registered medical practitioner 
  • date the plan should be reviewed  
• ensure that a child who has been prescribed an adrenaline auto-injection device is not permitted to attend the School without a complete auto-injection device kit (which must contain a copy the child’s anaphylaxis medical management plan) 
• ensure that all staff in the School know the location of the auto-injection device kit 
• collaborate with parents/guardians to develop and implement a communication plan and encourage ongoing communication regarding the status of the child’s allergies, this policy, and its implementation 
• display a medical management plan or (ASCIA) Action Plan for Anaphylaxis 2021 (RED) for each child with a diagnosed risk of anaphylaxis in key locations at the School, for example, in the child’s room, the staff room, kitchen, and / or near the medication cabinet 
• display ASCIA First Aid Plan for Anaphylaxis (ORANGE) in key locations in the School 
• ensure that all staff responsible for the preparation of food are trained in managing the provision of meals for a child with allergies, including high levels of care in preventing cross contamination during storage, handling, preparation, and serving of food. Training will also be given in planning appropriate menus including identifying written and hidden sources of food allergens on food labels 
• ensure that a notice is displayed prominently in the main entrance of the School stating that a child diagnosed at risk of anaphylaxis is being cared for or educated at the School, and providing details of the allergen/s (regulation 173) 
• ensure that all relief staff members in the School have completed training in anaphylaxis management including the administration of an adrenaline auto-injection device, awareness of the symptoms of an anaphylactic reaction and awareness of any child at risk of anaphylaxis, the child’s allergies, the individual anaphylaxis medical management plan and the location of the auto-injection device kit 
• display an emergency contact card by the telephone 
• ensure risk assessments for excursions consider the risk of anaphylaxis  
• ensure that a staff member accompanying children outside the School carries a copy of the anaphylaxis medical management action plan with the auto-injection device kit 
• ensure an up-to-date copy of the medical management plan and/or ASCIA action plan is provided every 12 to 18 months or whenever any changes have occurred to the child’s diagnosis or treatment 
• provide information to the School community about resources and support for managing allergies and anaphylaxis.

Educators will: 

• ensure that a complete auto-injection device kit (which must contain a copy the child’s anaphylaxis medical management action plan signed by the child’s registered medical practitioner) is provided by the parent/guardian for the child while at the School 
• ensure a copy of the child’s anaphylaxis medical management plan is visible and known to staff, visitors, and students in the School 
• follow the child’s anaphylaxis medical management plan in the event of an allergic reaction, which may progress to anaphylaxis 
• practice the administration procedures of the adrenaline auto-injection device using an auto-injection device trainer and ‘anaphylaxis scenarios’ on a regular basis, preferably quarterly 
• ensure the child at risk of anaphylaxis only eats food that has been prepared according to the parents’ or guardians’ instructions 
• ensure tables and bench tops are washed down effectively before and after eating 
• ensure all children wash their hands upon arrival at the School and before and after eating 
• increase supervision of a child at risk of anaphylaxis on special occasions such as excursions, incursions, parties, and family days 
• ensure that the auto-injection device kit is: 
  • stored in a location that is known to all staff, including relief staff 
  • NOT locked in a cupboard 
  • easily accessible to adults but inaccessible to children 
  • stored in a cool dark place at room temperature  
  • NOT refrigerated 
  • contains a copy of the child’s medical management plan 
• ensure that the auto-injection device kit containing a copy of the anaphylaxis medical management action plan for each child at risk of anaphylaxis is carried by a staff member accompanying the child when the child is removed from the School e.g., on excursions that this child attends or during an emergency evacuation  
• regularly check and record the adrenaline auto-injection device expiry date. (The manufacturer will only guarantee the effectiveness of the adrenaline auto-injection device to the end of the nominated expiry month).

Families will:  

• inform management and staff at the child’s school, either on enrolment or on diagnosis, of their child’s allergies and/or risk of anaphylaxis 
• provide staff with an anaphylaxis medical management plan giving written consent to use the auto-injection device in line with this action plan and signed by a registered medical practitioner  
• develop a risk minimisation plan in collaboration with the Nominated Supervisor/Responsible Person and other school staff 
• develop a communication plan in collaboration with the Nominated Supervisor/Responsible Person and lead educators 
• provide staff with a complete auto-injection device kit each day their child attends the School  
• maintain a record of the adrenaline auto-injection device expiry date to ensure it is replaced prior to expiry 
• assist staff by offering information and answering any questions regarding their child’s allergies 
• communicate all relevant information and concerns to staff, for example, any matter relating to the health of the child 
• notify the School if their child has had a severe allergic reaction while not at the school- either at home or at another location 
• comply with the School’s policy that a child who has been prescribed an adrenaline auto-injection device is not permitted to attend the School or its programs without that device 
• read and be familiar with this policy 
• notify staff of any changes to their child’s allergy status and provide a new anaphylaxis medical management plan in accordance with these changes 
• provide an updated plan every 12-18 months or if changes have been made to the child’s diagnosis.

ANAPHYLACTIC REACTION THE SCHOOL 

If a child suffers from an anaphylactic reaction the School and staff will: 

• Follow the child’s medical management plan/ASICA action plan- administer an adrenaline injector  
• Call an ambulance immediately by dialling 000 
• Commence first aid measures-  
• Record the time of administration of adrenaline autoinjector 
• If after 5 minutes there is no response, a second adrenaline autoinjector should be administered to the child if available 
• Ensure the child experiencing anaphylaxis is lying down or sitting with legs out flat and is not upright 
• Do not allow the child to stand or walk (even if they appear well) 
• Contact the parent/guardian when practicable 
• Contact the emergency contact if the parents or guardian cannot be contacted when practicable
• Notify the regulatory authority within 24 hours  

In the event where a child who has not been diagnosed as at risk of anaphylaxis, but who appears to be having an anaphylactic reaction:

• Call an ambulance immediately by dialling 000 
• Commence first aid measures 
• Administer an adrenaline autoinjector  
• Contact the parent/guardian when practicable 
• Contact the emergency contact if the parents or guardian cannot be contacted when practicable 
• Notify the regulatory authority within 24 hours. 

REPORTING PROCEDURES

Any anaphylactic incident is considered a serious incident (Regulation 12):

• staff members involved in the incident are to complete an Incident, Injury, Trauma and Illness Record which will be countersigned by the Nominated Supervisor of the School at the time of the incident  
• ensure the parent or guardian signs the Incident, Injury, Trauma and Illness Record  
• place a copy of the record in the child’s file 
• the Nominated Supervisor will inform the School management about the incident 
• the Nominated Supervisor or the Approved Provider will inform Regulatory Authority of the incident within 24 hours through the NQA IT System (as per regulations) 
• staff will be debriefed after each anaphylaxis incident and the child’s individual anaphylaxis medical management plan/action plan and risk minimisation plan evaluated, including a discussion of the effectiveness of the procedure used  
• staff will discuss the exposure to the allergen and the strategies that need to be implemented and maintained to prevent further exposure.

EDUCATING CHILDREN ABOUT ALLERGIES AND ANAPHYLAXIS

Allergy awareness is regarded as an essential part of managing allergies in early childcare services. Our School will:

• talk to children about foods that are safe and unsafe for the anaphylactic child. They will use terms such as ‘this food will make ______ sick’, ‘this food is not good for _____’, and ‘ _____ is allergic to that food’. 
• help children understand the seriousness of allergies and the importance of knowing the signs and symptoms of allergic reactions (e.g., itchy, furry, or scratchy throat, itchy or puffy skin, hot, feeling funny) 
• encourage empathy, acceptance and inclusion of the allergic child 
• Plan to implement Food Allergy Smart Education Program (added to QIP 6/10/23) to be introduced from 2024 cohort of  children- My Food Allergy Friends

Allergy Aware- A hub for allergy awareness resources A project developing national Best Practice Guidelines and supporting resources for the prevention and management of anaphylaxis in schools and children’s education and care services (October 2021)

Australasian Society of Clinical Immunology and Allergy (ASCIA) provide information on allergies. The ASCIA Action Plans for Anaphylaxis are device-specific and must be completed by a medical practitioner.
allergy.org.au/health-professionals/anaphyla... 

Current ASCIA Action Plans are the 2021 versions, however previous versions (2020 and 2018) are still valid for use throughout 2021. There are two types of ASCIA Action Plans for Anaphylaxis:

• ASCIA Action Plan 2021 (RED) are for adults or children with medically confirmed allergies, who have been prescribed adrenaline autoinjectors (Plans are available for EpiPen® or Anapen®)   
• ASCIA Action Plan for Allergic Reactions (GREEN) is for adults or children with drug (medication) allergies who have not been prescribed adrenaline autoinjectors.

ASCIA First Aid Plan for Anaphylaxis (ORANGE) 2021 EpiPen have replaced the general versions of ASCIA Action Plans for Anaphylaxis (Orange).    
Allergy & Anaphylaxis Australia is a non-profit support organisation for families with food anaphylactic children.  Items such as storybooks, tapes, auto-injection device trainers and other resources are available for sale from the Product Catalogue on this site.   
Allergy & Anaphylaxis Australia also provides a telephone support line for information and support to help manage anaphylaxis:  Telephone 1300 728 000.

Royal Children’s Hospital Anaphylaxis Advisory Support Line provides information and support about anaphylaxis to school and licensed children’s services staff and parents. Telephone 1300 725 911 or Email: anaphylaxisadviceline@rch.org.au

NSW Department of Education provides information related to anaphylaxis, including frequently asked questions related to anaphylaxis training. 

ADDITIONAL INFORMATION

WESTERN AUSTRALIA (WA)

ww2.health.wa.gov.au/Articles/A_E/Anaphylaxis-info...  det.wa.edu.au/policies/detcms/policy-planni...

Australian Children’s Education & Care Quality Authority. (2014).  
ACECQA. (2021). Policy and procedure guidelines- Dealing with Medical Conditions  
ASCIA Action Plans, Treatment Plans, & Checklists for Anaphylaxis and Allergic Reactions: allergy.org.au/hp/ascia-plans-action-and-tre... 
Early Childhood Australia Code of Ethics. (2016). 
Education and Care Services National Law Act 2010. (Amended 2018). 
Education and Care Services National Regulations. (2011).      
Guide to the Education and Care Services National Law and the Education and Care Services National Regulations. (2020).  
Guide to the National Quality Standard. (2017). 
National Allergy Strategy. (2021). Best practice guidelines for anaphylaxis prevention and management in schools 
and children’s education and care (CEC) services (Guidelines). 
National Health and Medical Research Council. (2013). Staying Healthy: Preventing infectious diseases in early 
childhood education and care services (5th Ed.). Australia: Commonwealth of Australia. NSW Government. (n.d.).  
New South Wales Department of Education and Communities. (2014). Anaphylaxis Guidelines for Early Childhood Education and Care Services. 
Revised National Quality Standard. (2018).