ALLERGIES ANAPHYLAXIS

Instructions:

• This form is to be completed for any child with a known allergy.
• The child care program must work with the parent(s)/guardian(s) and the child’s health care provider to develop
  written instructions outlining what the child is allergic to and the prevention strategies and steps that must be taken if the child is exposed to a known allergen or is showing symptoms of exposure.
• This plan must be reviewed upon admission, annually thereafter, and anytime there are staff or volunteer changes, and/or anytime information regarding the child’s allergy or treatment changes. This document must be attached to the child’s Individual Health Care Plan.
• Add additional sheets if additional documentation or instruction is necessary.

THE FOLLOWING STEPS WILL BE TAKEN IF THE CHILD EXHIBITS SYMPTOMS including, but not limited to:

• Inject epinephrine immediately and note the time when the first dose is given.
• Call 911/local rescue squad (Advise 911 the child is in anaphylaxis and may need epinephrine when emergency
  responders arrive).
• Lay the person flat, raise legs, and keep warm. If breathing is difficult or the child is vomiting, allow them to sit up
  or lie on their side.
• If symptoms do not improve, or symptoms return, an additional dose of epinephrine can be given in consultation
  with 911/emergency medical technicians.
• Alert the child’s parents/guardians and emergency contacts.
• After the needs of the child and all others in care have been met, immediately notify the office.

MEDICATION/DOSES

When administering an epinephrine auto-injector follow these guidelines:

• Do not put your thumb, fingers or hand over the tip of the auto-injector or inject into any body part other than the mid-outer thigh. If a staff member is accidentally injected, they should seek medical attention at the nearest
  emergency room.
• If administering an auto-injector to a young child, hold their leg firmly in place before and during injection to
  prevent injuries.
• Epinephrine can be injected through clothing if needed.
• Call 911 immediately after injection.

STORAGE OF EPINEPHRINE AUTO-INJECTORS

• All medication will be kept in its original labeled container.
• Medication must be kept in a clean area that is inaccessible to children.
• All staff must have an awareness of where the child’s medication is stored.
• Note any medications, such as epinephrine auto-injectors, that may be stored in a different area.
• Explain here where medication will be stored:

MAT/EMAT CERTIFIED PROGRAMS ONLY

Only staff listed in the program’s Health Care Plan as medication administrant(s) can administer the following
medications. Staff must be at least 18 years old and have first aid and CPR certificates that cover all ages of children in care.

• Antihistamine brand or generic:
• Antihistamine dose:
• Other (e.g., inhaler-bronchodilator if wheezing):

*Note: Do not depend on antihistamines or inhalers (bronchodilators) to treat a severe reaction. USE EPINEPHRINE.

STORAGE OF INHALERS, ANTIHISTAMINES, BRONCHODILATOR

All medication will be kept in its original labeled container. Medication must be kept in a clean area that is inaccessible to children. All staff must have an awareness of where the child’s medication is stored. Explain where medication will be stored. Note any medications, such as asthma inhalers, that may be stored in a different area.

STRATEGIES TO REDUCE THE RISK OF EXPOSURE TO ALLERGIC TRIGGERS

The following strategies will be taken by the child care program to minimize the risk of exposure to any allergens while the above-named child is in care (add additional sheets if needed):