Daughter at "Peanut Free" preschool

[PeterLB]

Hello, I am new to this forum, which I discovered today due to frustration.

My daughter is almost three years old and has a peanut allergy. On three occasions she has had a reaction. One resulted in ER care. Fortunately, she did not have breathing issues, nor did her epi pen have to be used. Nevertheless, it is a scary experience that has changed our lives. We now try our best to have a completely peanut free home.

She started school when she was two years old, and has really enjoyed her time there. When touring the place, we were told that "no" outside food was allowed and that they were peanut free. They use sunflower butter and do not make food that contains peanuts (however, they do use bread that was made in a facility, but my daughter has not had a reaction with such products).

Over the weekend, my daughter was exposed to peanuts in a dessert a family member (Arggggh!) gave her.  She experienced swelling and vomiting, but was okay after some Benadryl. I mentioned this to her new teacher just to be sure she was aware of everything and some of the possible symptoms, even though the school is peanut free, or so I thought. The owner was nearby and heard the conversation and mentioned that one of the the newer students is allowed to bring in his own lunch, which contains, you guessed it, peanut butter. This was puzzling because I was sure there was a no outside food policy. The owner assured me the student sits at an isolated high top table and they clean the area afterward.

Needless to say, I left feeling very questionable with this arrangement. I would like some advice from other parents. Do you think this is grounds to enroll in another school? Most likely I am going to approach the owner with my concerns before any decisions, but I feel very misled. 

[lakeswimr]

Hi Peter,

I want to first recommend you get a written food allergy action plan if you don't yet have one.  The reaction you had this past weekend would call for the epi pen on all emergency plans I have read.  If your plan doesn't call for the epi pen in that situation I recommend you get a 2nd opinion allergist.  Here is a sample food allergy action plan.

http://www.foodsafeschools.org/FSAG_CD/Resources/FAAN/Food_Allergy_Action_Plan_English.pdf

Most of us here have plans that would call for the epi pen in all the scenarios listed in this plan.

Any reaction that is systemic, meaning involving more than one part of the body and any reaction that involves any swelling of the face should get the epi per most all plans.  Benadryl and other antihistamines have no life saving capabilities and are for comfort only.  Please see also the new National Institute of Health's Guidelines for Managing Anaphylaxis which talk about this and that the epi pen or epinepherine is the only front line treatment for anaphylaxis.  Most anaphylaxis will self resolve without medication so the fact that your child was OK even though she didn't get the epi pen doesn't mean that she will be OK in the future without it.  The epi pen is very safe and untreated anaphylaxis can be deadly.

As for eating foods that have allergen warnings, I recommend you avoid those foods.  Cross contamination is not a constant so while one batch may be fine, the next may have a lot of the allergen in it.  One older study found 17% of foods with allergen warnings on them do contain enough allergen to cause a reaction.  More recent studies have shown the % is now lower for peanuts and tree nuts but still, if a food said, '1% chance this product contains poison' you would not give it to your child, I'm sure. 

If the school has good cleaning methods then another child eating peanut butter could be fine.  I would NOT let the school feed my child since it seems they use foods with allergen warnings on them.  Their policy is going to probably eventually cause a peanut allergic child to have a reaction and is not safe--no outside food and foods with allergen warnings--crazy policy IMO. 

It sounds like you can work with them.  You could also look elsewhere. I could not consider that school peanut free if they serve foods with warning labels and if they allow people to eat peanuts, though. But peanut-free is not necessarily as good as a school that really gets it and will do table cleaning, hand washing, etc.  It isn't the kid eating the peanut butter that worries me but the may contains and allergen warning products. 

[twinturbo]

I would echo previous poster's priority. Emergency Action Plan for you, share with school, make sure they have EpiPen Jr for her (preferably two from two different lot numbers) and are trained with both how to use it and when to use it. Anaphylaxis is two or more systems, and where a clear history of peanut induced anaphylaxis it's not uncommon for plans to call for epinephrine immediately upon a known ingestion.

I can't really advise on school until that's settled.

[CMdeux]

Hmm.

Well, "peanut-free" is a moving target, as you just discovered.

The better question is why they didn't TELL you that this had changed.  If your child were severely contact-reactive (it sounds as though she isn't), then this would be a huge increase in risk.

Our own policy w/ daycare and preschool was that DD ate nothing that we didn't provide.  It was simple for her, and simple for them.  Just noting that.

We also avoid "may contain" items, as the amount of allergen in them can vary quite dramatically, unfortunately.  So what has been fine for months or even years can suddenly NOT be fine, just because a single bite happened to be highly contaminated.  I realize what a bummer that is when you've had a long history of using a particular product.  We went through that with any number of products that we'd historically used without problems... but I couldn't ignore what I knew was a game of Russian Roulette, effectively.

Yes, Epinephrine, and yes, learn (and discuss with allergist!!) when to USE it.

Have you seen our anaphylaxis grading chart here at our welcome page?  There are a pair of those charts toward the bottom of that page.

  If you've not seen that before, it's worth printing it out and using it as a common point of reference when discussing reaction history with your allergist as you formulate an emergency action plan.  Once you have anaphylaxis history, it's likely (unfortunately) that you're going to need that plan at some point.  (I'm just full of good news, huh?  Sorry.)

You never really know what the deal is with the other child and the outside food.  For all you know, there's a medical reason for it.   I'd ask why they didn't tell you that the definition of "peanut free" had changed, though-- that would be quite a serious breach of my trust in their communications with me.

[Macabre]

My son, now 15, was at a peanut free daycare/preschool. Well, they didn't allow peanuts, but they allowed a lot of TV, worksheets, and the daycare director's son was a year younger than my DS and walked around with Cheetos and Coke. 

Really.

His teacher's loved him, and it was peanut free.  That's all I can say about it.  It was also very close to our house.  But would I have moved him to a school with a lot of peanut butter?  No.  He'd had reactions a Mother's Day Out program when children near him ate peanut butter.  The staff was sure he did not come into contact with it.  They served him before they served the other kids. 

It's not easy, even these days, to find peanut free schools.  If you do some searching and find another, it wouldn't hurt to talk with them, but it sounds like this school initially had some good thigns in place.  Like the others said, talk with the director and find out why they didn't tell you.  This may make enough of an impression that they won't dream of doing it again.

If it is otherwise a good place for your child and you can establish good communications about this--and if you can be assured of their cleaning practices, it may be best to keep your child there.

I would be concerned a bit that they are isolating the peanut butter eating child.  It is safest for your child that they do, but how does it affect him?

[PeterLB]

First, thank you for the responses. There was a lot of information that will have me examining my processes for handling incidences.

I think my first realized mistake is that I do not have an allergist, nor do I have a specific plan of action. I am going to call tomorrow to make an appointment and get better informed. Here I will be able to talk about the issue of "May Contain". Typically, we do not allow this in our house, but have been okay with it at school because she has never had issues with it before. Obviously, reading these posts has changed that.

This last Saturday was the first time that two systems were involved: some swelling of the bottom lip, and some vomiting (not repetitive as mentioned on the grading scale provided by CMDeux). We gave Benadryl with the epi close at hand. We called our pediatrician, and when she started vomiting, were informed it was a sign her body was rejecting it and that we should watch her carefully for more signs. Shortly afterward the swell on her lip subsided. We didn't sleep that night. I am aware that each time can be additionally more severe, so the issue of knowing when to actually USE the epi pen needs to be more clear.

As for the school itself, CM is correct, I think my wife and I feel this lack of communication is one of the biggest concerns. We choose this school for our reassurances of being peanut free and not allowing outside food. It took me talking about our issues, and stating that "I know this school is peanut free, but..." for the owner to approach me and tell me about the other student. They are a good school, and I feel they will clean up after the student, but it really shatters the idea I had in my mind that she was relatively clear of peanuts while at school.

[twinturbo]

Can you call your daughter's primary care pediatrician tomorrow to get a prescription for an Epipen, Jr? Jr is probably the right strength for her current weight if she's under 50 lbs. I'd do that straight away because it sounds like you have no epinephrine anywhere. You're going to be careful, I know, but it really is something she needs you to have right away. There's no substitute for it, it can buy her time until EMS can arrive.

I'm a little more open towards the school simply not knowing how dangerous it was to your daughter because they did not have the information you now have about epinephrine and anaphylaxis. I think you have a solid plan.

1. Allergist and Epipen (or other autoinjector such as Auvi-Q)
2. Get emergency action plan from allergist
3. Share with school to update them, get them prepared

I think then you can revisit with them on what the rules will be because they've definitely changed for one of their students. On the allergist I highly recommend going to AAAAI.org to find one in your area that is a board certified pediatric allergist/immunologist who has an established specialty in food anaphylaxis. There are some out there who are better at environmental allergies, and some who aren't even allergists who claim to be allergists but have no allergy background. Caveat emptor.

[Macabre]

It looks like y'all were posting at the same time probably, as the OP does have an epipen. 

Sometimes throwing up puts the kabosh on a reaction. That happened to my son after eating chips fried in the supposedly safe peanut oil.  He grew very lethargic and once he threw up felt better.  Of course, it can go the other way, as well--with tragic results. 

So think:  2 body systems or throat/airway swelling=Epi.

Once my son had anaphylaxis to his allergy shot after the 20 minute mark we stayed at the office through.  His symptoms permitted after dance class.  Then it was just like completing a mathematical formula.  He had X, Y and Z symptoms, so we Epid.  I had that grading chart running through my head, and I've got to say, it was all very straightforward once I told myself that we need to follow our plan.  It took the guesswork out of it.

I will say--there is guesswork and uncertainty involved in all reactions, and we've epid  . . . hmmmm . . . more times than I care to count this late at night.  I have FAs, too, and I ate sesame by accident in December and epid. That was the second time for me.  It's very difficult not to have doubt.  Having a plan at least helps with that.


Whatever happened, just move forward. 

And welcome!

[PeterLB]

Twin,

I actually do have an Epi-Jr on hand always and was ready to use it on Saturday. The issue is knowing when to use it, which is why I agree 100% on getting an allergist and action plan.

The school, however, was well aware of the ER visit, as it was our main concern in scouting the location. They have one of our Epi pens and approval from our pediatrician to use it on my daughter if necessary.

I feel the introduction of the physical peanut butter on campus has me the most concerned. Reading these responses make me realize there are equal parts prevention and preparation, which is where I am lacking.

Once again, I need to communicate the action plan once I get that in place, as well as get more epi pens (different lots numbers as someone mentioned) so each location has two on hand. In the meantime, I will find out what has changed with the no outside food policy and why I was not informed in a timely manner.

[twinturbo]

Oh, oops. I was talking and posting at the same time. Sorry 'bout that! 

[lakeswimr]

You are right to be concerned because you need the school to protect your child and you need to trust them and they broke your trust.  But I think as far as actual danger the may contains foods and other allergen warnings is a far bigger risk than the child eating pb there.  The school ALREADY isn't peanut free even if that child weren't there because they are using foods with allergen warnings on them.  My son was OK for several years with a particular food that didn't labhel for sesame.  One day he had one drop of this food, literally, and it had sesame cross contamination and he had lip swelling, etc.  Turns out they make the product on the same equipment with sesame and don't clean for sesame.  I must have gotten a batch made right after a sesame containing product was made.  So, for two years we had simply been LUCKY.  Having eaten a food successfully in the past doesn't mean a person is less sensitive to cross contamination.  it means they have been lucky.  Cross contamination varies greatly, even in a single product like ONE cookie, you could bite into one side and be fine and bit into the other side and get a whole peanut.  It is best to avoid foods with any allergen warning unless you call the company and get more info.  Sometimes the warnings are CYA. Sometimes the warning is there but the company will tell you they take extensive precautions but also give a warning so people can decide.  If the precautions are very good the product might be OK for your child.  But sometimes a warning truly is a real warning.  Better to avoid unless you know for sure.

You are doing all the right things.  Many of us have been right where you are and you are asking good questions, being proactive.  Good work!

[yelloww]

Sounds like you have some good advice here! Welcome!!!