Published online September 5, 2006
PEDIATRICS Vol. 118 Supplement August 2006, pp. S19 (doi:10.1542/peds.2006-0900FF)
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Recognition, Evaluation, and Treatment of Anaphylaxis in the Child Care Setting

Helen Skolnick, MD

Princeton, NJ

ABSTRACT

PURPOSE OF THE STUDY.: Although many young children with a history of allergic reactions or anaphylaxis spend considerable time in child care centers, little is known about the centers’ knowledge of, experience with, and capacity to treat anaphylaxis. The purpose of this study was to evaluate the ability of child care centers to recognize, evaluate, and treat anaphylaxis episodes.

STUDY POPULATION.: Children aged 1 to 6 who attended child care center in the suburbs of Chicago, Illinois.

METHODS.: Eighty-five independent child care centers in suburbs of Chicago were selected randomly. They were contacted by telephone and asked to join the study by completing an initial questionnaire about allergic reactions and anaphylaxis. The center directors and teachers were then offered an allergy seminar on anaphylaxis avoidance, recognition, evaluation, and treatment. After the seminar, center directors were given a posttest that included some of the questions from the original questionnaire.

RESULTS.: Of the 85 centers, 44 agreed to participate. Forty-two centers completed the surveys before the seminar and 39 after the seminar. On average, each center had up to 7 children with an identifiable food allergy. The most commonly reported source of education concerning allergies was information provided by the parents. Before the seminar, 24% of child care centers would administer intramuscular epinephrine for a severe allergic reaction. After the seminar, 77% of centers stated they would administer intramuscular epinephrine (P < .001). In addition, center staff significantly improved their knowledge of symptoms of allergic reactions and the correct methods of intramuscular epinephrine administration.

CONCLUSIONS.: There is a knowledge deficit in anaphylaxis education at child care centers for children 1 to 6 years old. Intervention with individual education seminars can significantly increase the ability of child care center staff to recognize, evaluate, and treat anaphylaxis.

REVIEWER COMMENTS.: Although it is encouraging that the staffs at child care centers seem to be able to learn how to recognize and treat allergic reactions and anaphylaxis, it is at the same time discouraging that such a small percentage would have done so correctly before the seminar. Most child care centers receive their education from discussions with parents. However, studies have shown that only 50% of parents could identify all the critical steps for proper usage of epinephrine. Therefore, I agree with the authors that it is critical that health care professionals become more involved in the education of parents and the staffs of child care centers. In addition, detailed treatment plans should be written to help guide centers in the proper care of allergic reactions.

Bansal PJ, Marsh R, Patel B, Tobin MC. Ann Allergy Asthma Immunol. 2005;94:55–59[ISI][Medline]