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Toddler?s near death highlights education need

Allergy New Zealand

An Auckland toddler with a dairy allergy almost died from an anaphylactic reaction at his childcare centre after a teacher gave him a pikelet containing milk last month.

Ambulance staff gave fifteen-month-old Jesse Tu’inukuafe three shots of adrenaline before he was stabilised and raced to hospital.

"The childcare centre was fully aware of his allergy," says Jesse’s mother, Tulaki. The centre had been given an allergy action plan, which detailed Jesse’s allergies to dairy, peanut and egg, and had been told not to feed him foods containing even traces of these allergens.

Allergy New Zealand has expressed grave concerns, as this was a case where the centre’s teachers had been fully informed of Jesse’s allergies, yet still gave him "unsafe" food.

"Preschool-age children are less likely than school-aged children to be able to speak for themselves and, as in the case of Jesse, unable to communicate at all," says Allergy New Zealand’s president, Natalie Lloyd. "Parents and staff need to work together to ensure all staff at a childcare centre fully understand the implications of a child’s severe food allergy. Staff need to know how to avoid exposure to the food, and how to recognise and treat a reaction."

According to Tulaki, a new cook at the centre was making pikelets for morning tea and had asked a teacher whether Jesse could eat these because she saw his allergy action plan and was unsure.

"The teacher said yes, it wouldn’t harm him because there was only a little bit of milk, and the other kids with milk allergies could have them," Tulaki recalls. "That teacher was ignorant because Jesse had had three mild reactions in the one month he’d been there."

Within one hour of eating the pikelet, Jesse had turned blue and the centre called the ambulance, and then Tulaki.

"When I got there, they had given him a shot of adrenaline, but it had no effect and he needed three shots all up. They tried to get an IV into his arm, but they couldn’t because he was so puffed up. They did it at the hospital."

Tulaki says the doctors were "awesome" and within two hours of being in hospital, his puffiness had gone down and he had returned to a normal colour.

The Tu’inukuafes have since removed Jesse from the childcare centre, although Tulaki is not bitter towards them.

"They have been hit hard. They had never seen a reaction like this before and they were really shocked and upset. It was just a lack of education and not knowing that even just traces of an allergen can be life threatening."

The childcare centre has since put strict procedures in place to ensure no other child has a near death experience.

Unfortunately, this childcare centre is not alone when it comes to a lack of education regarding allergies and although some centres are well organised and informed, it highlights the huge need for education about allergies at every level, says Lloyd.

"It is essential that preschools and schools accepting children with severe allergies realise that each child’s needs is completely different and that you can’t assume that instructions for one child is appropriate for another."

Another worry is that some children have not had an adequate diagnosis or allergy management plan developed with their doctor or specialist.

"We know of instances where parents have instructed a centre that ‘a little bit won’t hurt’. Teachers with little knowledge of allergies could interpret this as applying to all children with food allergies. This is completely incorrect and, in fact, for some children is a death sentence."


How a child may describe a reaction

Children have unique ways of describing their experiences and perceptions, including allergic reactions. Precious time is lost when adults do not immediately recognise that a reaction is occurring or don’t understand what the children might be telling them.

The following text contains examples of the words a child might use to describe a reaction.

In addition, know that sometimes children, especially very young ones, will put their hands in their mouths, or pull or scratch at their tongues, in response to a reaction. Also, children’s voices may change (i.e., become hoarse or squeaky), and they may slur their words.

If you suspect your child is having an allergic reaction, follow your doctor’s instructions.

• This food’s too spicy.

• My tongue is hot (or burning).

• It feels like something’s poking my tongue.

• My tongue (or mouth) is tingling (or burning).

• My tongue (or mouth) itches.

• It (my tongue) feels like there is hair on it.

• My mouth feels funny.

• There’s a frog in my throat.

• There’s something stuck in my throat.

• My tongue feels full (or heavy).

• My lips feel tight.

• It feels like there are bugs in there (to describe itchy ears).

• It [my throat] feels thick.

• It feels like a bump is on the back of my tongue [throat].

Reprinted with permission from the Food and Anaphylaxis Network for more information visit the Allergy New Zealand website www.allergy.org.nz