Two years ago, I read an article about discrimination in daycare against children with allergies. I worried but I thought that by the time my little girl is two, things will have changed. Sadly, they haven't. Now that we are in the process of looking for daycares once again, we are bombarded with the same level of rejection. When the daycare staff discover that Maya has multiple food allergies which include milk, they tell me that they do not have the space. A few of them choose the more direct route and tell me that with Maya in their care the teachers would be too stressed to look after a child with severe allergies as well as other children. I can understand this type of rejection if I was asking those places to ban milk completely, but I am not. I am simply asking them to prevent cross contamination. Unfortunately, most daycares don't seem to understand what cross contamination is let alone how to prevent it.
In our last visit to the Allergy Clinic, the allergist suggested that a home-based (smaller) daycare is most likely a more suitable environment for Maya due to her multiple allergies. He seemed to think that in a smaller setting, cross contamination would be easier to prevent. I shared that opinion with him, until I visited a few of those home based daycares. Indeed they are smaller; small enough that all children sit at one or two tables and Maya would be seated next to someone consuming milk products, where spills would lead to cross contamination. Toys don't get cleaned that often either. We have gone down that road before with the previous daycare. Maya was seated at a separate table and still cross contamination was an issue.
I am constantly amazed by how the government boasts that our children are protected against discrimination and yet there is evidence to the contrary. It is true that daycares are breaking the law when they single out one child because of allergies and refuse to take her in. On the other hand, I think the severe lack of awareness out there is a primary cause of this discrimination. People who have a limited understanding of allergies often think in terms of black and white. In other words, they find it less stressful to ban the allergen rather than reduce cross contamination. Hence, the peanut free policies everywhere. I believe this is why banning ultimately fails. By banning the item, it becomes unnecessary to implement measures against cross contamination. However, this gives a false sense of security, because in reality, no one can ban an allergen consistently. There will always be the parent who forgot and put a peanut butter sandwich in their kid's lunchbox, or the one who sent their son to school with a granola bar that contained nuts. And even if the parents are conscientious, some kids will neglect to wash their hands and mouth after consuming peanut butter. Banning an allergen in a small setting may work temporarily, but in a larger setting, things are more complex and harder to control. You can control what 10 parents bring in to a home daycare, but you cannot control what 75 parents bring in to a big daycare centre. In our case, Maya is allergic to milk, eggs, and peanuts. As much as I would love the peace of mind that banning milk, eggs, and peanuts would give me, I would worry more about what would happen if someone accidentally brought it in while there are no measures to reduce cross contamination. So after much thought, I still believe that reducing exposure through prevention of cross contamination is the answer as opposed to banning.
Those who cannot ban the item prefer to ban the allergic child instead. Removing milk from daycare menus and school cafeterias is almost impossible. Some parents strongly believe that if their child does not consume milk they he or she will die of malnutrition. Regardless of the reasons, milk is a food item that is widely popular and so there is always a swift and extreme response when even a suggestion is made with regards to milk. The dilemma in daycares is twofold. On the one hand, parents of other children demand that their kids drink nothing but milk while in daycare, and in many cases that fuels the "us versus them" attitude which banning introduces. On the other hand, daycare staff finds it too much work to try and reduce cross contamination, and that is because there is no federal or even provincial mandate that urges them to do so. This is why I wholeheartedly believe and support Sabrina's Law. It dictates that every school have an anaphylaxis policy in place. In addition, one of the contents of the policy is that it include "Strategies that reduce the risk of exposure to anaphylactic causative agents in classrooms and common school areas". Once again, the law is not actually banning the allergen, but it sets the expectation that it is the responsibility of school staff to reduce cross contamination. When a request becomes a law, people tend to be more attentive to it.
Daycares seem to think that they have a choice when it comes to accepting a child with allergies. You don't often hear of a child being rejected from daycare because he's autistic, or has cerebral palsy. Those children are protected under the disabilities act, whereas children with allergies are not. Last month I put in some phone calls to several government departments inquiring about that very thing. The answers were vague and ambiguous. Other than Sabrina's Law, there is no definite law, that I know of, which protects children with allergies. In fact, the different departments I spoke to, were not even sure if children with allergies are protected under the umbrella of the disabilities act because allergies are not seen as a disability. Currently, daycares are more than willing to accommodate children with peanut allergies. Most daycares and schools are now practically peanut and nut free. Why is it easier to accept a child with a peanut allergy, yet reject one with a milk allergy? Perhaps because it's easier to ban than to work on reducing cross contamination. However, to me that implies that neither child's life is worthy of the effort, and that is simply unacceptable.
What do you think?
I've had several people inquire about my family's experience with daycare after hearing about the incident with Maya. In my emails I promised that I would publish a post about our experience. We are disappointed that it did not work out partly because that was the only daycare that agreed to accept Maya apart from one other that had no slots available. Most other daycare centres refused to take her in because of her multiple and severe allergies. She is anaphylactic to milk, eggs, and peanuts through ingestion and contact. The purpose of this article is meant to help prepare parents for the process of daycare in relation to severe allergies. It's not meant to be inflammatory or damaging to daycares in general nor to that particular daycare, rather a glimpse of what we, the parents of allergic children, are up against. This post is simply an account of the events that took place and why, in my opinion, things turned out the way they did. The following is a summary of the events that took place. For tips on how to ensure your child's safety in daycare please click here.
The incident that prompted us to pull Maya out of Wee Care Development Centre
On October 7, 2009 at 9:30 Maya went into anaphylactic shock at the daycare centre. Her teacher administered the EpiPen and called 911. By the time the paramedics arrived the symptoms had subsided and Maya was looking fine. They transported her to the IWK Emergency and we met them there. Maya's vitals were all checked and everything appeared normal, but the doctor decided to keep us there for observation. An hour later Maya's symptoms returned and within 15 minutes her body went into anaphylaxis again. She was given another dose of epinephrine and additional potent drugs to keep her system in check. For the next week, she was quite ill and symptoms of her allergy kept manifesting every day. The doctors had predicted that this may happen so we were instructed to continue giving her histamine blockers for several days. At this point, Maya is no longer exhibiting symptoms. I believe she has finally recovered. Her father and I are thankful.
Why it did not work for our family
Although we provided each staff member in the daycare with a package about allergies, I discovered very quickly that the majority of them just leafed through it and did not actually read it. Examples of that included, but were not limited to, storing Maya's soy milk in the fridge adjacent to the cow's milk cartons where there was milk residue even on the shelf. The teachers touched the contaminated soy container and gave it to Maya. They would then touch the food, so that Maya's hands and her food had traces of milk residue. She would have a reaction after incidents like those. That is the type of stuff I talked about in the session and I cited that example in fact, and also noted it in the documents. I explained to them how our fridge at home is segmented to keep Maya's food safe. Despite that, there was no care taken when placing her items in the fridge. I provided them with big plastic containers that contain Maya's safe food, and requested that all her food remain in those containers. Yet after the incident, I discovered that her food would come out of the box and would be put on the fridge shelves unsealed, where it could come in contact with other allergens.
Many of the teachers in the other classes did not put the effort to make sure Maya is safe. They did not wash the hands and faces of children after food, and on a number of times Maya would have an allergic reaction after one of the kids touched her hands or touched a toy she was playing with. Instead of ensuring that teachers follow the protocol to wash all hands and face, the staff decided it was easier to eliminate playtime with the other class altogether.
One thing that really bothered me was the clear delineation between job functions and the shirking of responsibility when it came to food. Maya's teachers were unwilling to read labels. They refused on the premise that it would consume too much of their time, thus leaving the entire responsibility on the shoulders of the cook who sometimes missed things because she is only in part time and cooks the meals for all the classes. On one of those days, Maya was fed chicken pot pie which contained Cream of Mushroom soup as one of the main ingredients. The label on the container clearly stated cream (contains milk protein). Maya had a reaction. Additionally, on that day the cook had neglected to mention that particular ingredient. We had an understanding that I would inspect all ingredients but on that day she decided to try something different. For the remainder of Maya's time in that daycare my husband and I came in early in the morning and each of us took turns inspecting the labels on all the food for that day.
In times when Maya had allergic reactions there was never an informed point of contact. I had to run around after the fact to get the details of what had actually happened. Several times, the teacher who was responsible for being the point of contact had finished her shift and went home without relaying the information to anyone else. I often found resistance the next morning when getting additional information as the teachers would be busy with the other kids. In the two times the paramedics were called, when I asked what happened, the teacher notifying me on the phone would state "I don't know". The person calling to tell me that 911 had been called was unable to tell me exactly what happened to my daughter, and that someone else had that information.
Although we provided the staff with the Allergic Reaction Review Form, it was seldom used. I had to have a meeting with the director to force the staff to fill out the forms, and after the fact I encountered some resentment. The teachers saw it as a demanding attitude and did not think it was necessary for them to fill it out. They preferred if I wait till the next day and gather the information myself.
Maya was constantly getting hives after playing with the toys. When I discussed it with her teachers I was told that they could not wash the toys everyday nor keep Maya away from them. They said that the best they could do was wipe her hands down after she played with them. This was an unacceptable solution for us. To me that indicated that they are still not aware of how allergic reactions work, that the reaction may not be as severe or mild as the one before even if exposed to the same allergen in the same amount. Another meeting with the director made sure that the teachers understood that toys had to be cleaned before Maya played with them.
Often when we spoke to one teacher about something, it never made its way to the other teachers. There was a visible communication breakdown even between the cook and the teachers. On more than one occasion Maya would end up missing her afternoon snack or given something insubstantial because the teachers were not sure if her food was safe. Since the cook was part time, she made sure to tell one of the teachers that Maya's food was safe, but because that teacher's shift ended at 2:00, she went home without telling anyone else about her communication with the cook. It made me wonder about the times when the food was unsafe but no one was told otherwise.
The staff demonstrated that they still did not understand the dangers of cross contamination when they used dates to make date squares. Maya reacted after eating a piece. Upon inspection I discovered that the date container came from Iran. It was produced, packaged, and inspected by a company in Iran. The container itself did not have a list of ingredients, and the writing on it was not in English or French, rather in Persian. Although I had explained to the staff in our first session that unlabeled food is unsafe for Maya, no one took the time to ensure that the ingredients were properly labelled.
The staff also did not understand that trace amounts of an allergen are just as dangerous as large amounts. On one occasion I was told that the kids would be having hummus (chickpea dip) that day. Upon inspecting the ingredients I discovered that the sesame seed paste (tahini) label clearly stated may contain traces of peanuts and nut ingredients. That is despite the fact that the daycare claims to be peanut free in their policy and guideline manual.
On more than one occasion a number of teachers commented on how grateful they were that her allergist and I decided to give Maya Reactine every time she came to daycare because then they didn't have to worry about her reactions. They thought that if Reactine was administered before an allergic reaction that it would prevent the reaction from progressing to anaphylaxis if she was exposed to milk.
I tried to have another session about allergies with the staff, just as a refresher course, but encountered resistance. I was told that they are all busy and that their schedules are hard to manage. The director could not get them to agree on any set time because they were not paid for being there for the session. The director would not pay them to stay for an extra hour, and the teachers were not interested in sticking around after their shifts.
Parents of other children were particularly difficult to convince about allergies. We attempted to get 25 parents to our allergy session. Only two signed up, one of them had a child with allergies. The rest were not even interested in talking to me. Some of the parents complained about our demands and declared that if it doesn't affect their child then they are not interested in learning about it. One parent in particular scolded the director and stated that he would not read or sign anything without his lawyer being present.
The responsibility of caring for an allergic child rattled some teachers. I remember one of the teachers responded to me with panic when I mentioned that Maya needs to take her puffer because she has a cold. She interrupted me midsentence and said that she cannot be with Maya on her own and is not responsible for giving her any medication and that I would have to find one of Maya's other teachers to take care of that. One other teacher in particular did everything she could to exclude Maya from all the celebrations. Some of her insensitive remarks included, but were not limited to, the claim that they had to change the date of the Thanksgiving party to a day when Maya is not there because they just can't take care of her. The same teacher approached me at another time about the Christmas party and demanded that Maya not be there on that day. She told my husband and I that if Maya really had to be there that they would rather she come for a brief visit to see Santa and then leave. I eventually approached the director about this because I had discussed it when we first enrolled Maya in daycare and she assured me that they would be working something out to keep Maya safe, and that such conversation between her and the teacher never took place. Either way, there was resentment and reluctance on the part of that teacher when it came to Maya.
In general, Maya was regarded as a monster that was going to explode at any moment. Her teachers were very worried around her all the time. They were all afraid of the responsibility, and it ceased to be about Maya very early on. Most of her teachers were thinking about what the legal implications were for them if she got sick during their care. When Maya had a reaction, often blame was assigned to the cook directly and indirectly. Teachers were more than willing to point the finger at the cook rather than look at what they were doing to prevent cross contamination. The general attitude was that if it involved food then it was the kitchen's domain, and because Maya's allergies were food related, they saw those allergies as an extension of the kitchen's responsibilities.
All in all, it was quickly apparent to us that the director and her assistant were absolutely on board when it came to Maya's safety. They did their best to make it work. The cook was also very accommodating. She changed whatever recipes she could to make them safe for Maya. Indeed, some things slipped through the cracks, but in all fairness, she always had the positive attitude and never made us feel like we were imposing. If I had to find fault somewhere, I would direct my attention to the teachers who did not appear to me as being a coordinated team willing to take ownership of Maya's safety while in their care. They had little confidence and refused to look beyond the scope of their classroom to create a safe environment for our daughter.
I hope that anyone who took the time to read this has gained some insight and wisdom from our experience. I did not write this with malicious intent, but only in the spirit of cooperation and support to other families living with allergies. Despite the fact that this was a traumatic experience for Maya and us, it did not deter us from searching for other daycares that might be suitable for Maya's situation. In fact, I will be meeting with potential daycares within the coming week. One of those daycares has already taken in 5 other children with severe allergies and so far has been successful in keeping them safe. It was our first choice last year but at the time they did not have a slot open for Maya. After the director heard of Maya's ordeal, she has generously invited me to meet with her to try and work something out for Maya in the near future. I will be posting about that experience as well. I look forward to it being a more positive one.Other issues worth notingEven though Wee Care Development Centre agreed to take in Maya, they clearly were unable to keep her safe. The other issues worth mentioning are strictly administrative and service oriented, but they do shed a light on the perceived accountability of the daycare staff.
- Despite their failure, the daycare director was not generous with the financials. For starters, they charged us for every single day whether Maya was present or absent. I understand that this is standard practice in the industry, but in our case there were mitigating circumstances that should have been taken into account. On some days she was only present in the daycare for the first hour because they were directly responsible for her allergic reaction that prompted calls to 911, whereby then she was transferred to the hospital.
- When we withdrew Maya from Wee Care, they initially said that they cannot refund the money because we were one week into the month and that they normally need a one month notice before any child withdrawal. After speaking to the director, she agreed to refund only two weeks of the one month payment. To me, this type of attitude suggests that the daycare staff did not feel they were responsible for causing Maya's allergic reaction.
- They suggested that I purchase one of their keycards to let myself in and out of daycare when dropping off and pick up Maya everyday. I agreed and the keycard was given to me on the same week we withdrew Maya. I had only used the keycard ONCE. Nonetheless, they refused to refund my money and gave back only a partial deposit. The whole thing was inexpensive so it's not about the money, but again, it suggests that they did not feel they did anything wrong.
UPDATE: Regal Confections produces Rockets but the candy is packaged in Canada in different facilities, some of which are not allergen free!! The candies themselves are safe, but the packaging is not. Therefore, you need to read the label very carefully to determine where it was packaged. The only safe Rockets that I know of are the ones sold by Walmart in the jumbo size packages during Halloween season. Those are manufactured and distributed by Regal Confections in Quebec and Ontario. I have contacted them to inquire about the difference. Rockets sold in grocery stores are distributed by the facility in Wolfville and are not safe for people with allergies! I put a phone call to verify, and was told that Rockets are produced in the USA and the candy is safe but that once it enters Canada, it is packaged and distributed by a facility that is not allergen free. This facility processes peanuts, tree nuts, dairy, and eggs, among other allergens. The person I spoke to in the Wolfville facility stated "Our workers may eat a peanut butter sandwich and then start packaging the candy so there may be traces of peanuts on the candy wrapper, and we also process peanuts and other allergens in our facilities in Canada." Additionally, the distributors do not have a may contain warning about this on their packaging. They said they would notify upper management. What prompted this was a grocery visit earlier today, and I noticed Sobey's has Rockets repackaged but they put a sticker on it with a warning that it contains traces peanuts, nuts, etc. So for all intensive purposes, the Rockets in grocery stores and the ones in department stores are two different products. Read labels carefully to ensure your child's safety. Have a safe Halloween!
In my quest to find safe Halloween candy for Maya, I have stumbled across something interesting. Regal Confections actually makes candy specifically dedicated for children with allergies. Some of their candy includes the Rockets line (also known as Smarties in the USA, very different from the Nestle Smarties candy covered chocolates in Canada) which makes rockets, as well as those candy necklaces, and candy money. They have an allergy statement on Rocket's web site. It is really worth checking out. Rockets are dairy free, egg free, peanut & tree nut free, gluten free, sulphite free, and soy free, except for Bubble Gum Smarties which has traces of soy lecithin. But what attracted my attention was the fact that they have a web page dedicated to their allergy statement. Not too many manufacturers do that.
I just thought some parents may want to know that there is a safe candy out there for their little ones.
Have a safe and happy Halloween.
According to the Allergy/Asthma Information Association, Halloween rates as one of the most stressful holidays for parents of food allergic children. However, children with allergies should be able to safely enjoy trick or treating by planning ahead and taking some precautions.
Some of the key points to address include talking to your child about how to deal with all the treats collected while trick or treating. It's important for your child to understand that ALL treats are prohibited, until Mom and Dad have thoroughly checked them to determine which ones are safe. This means no sharing of treats between friends and holding back on snacking while trick or treating. It's a good idea to feed your child a good and healthy meal before going out that night. This will help ensure that they are satisfied and will reduce the chances of temptation to eat candy.
I have heard that some parents exchange all the treats at the end of the night with a gift or toy. Several parents mention that they've had some success using that particular method. Also, try to take the focus away from the candy. Some parents prepare for Halloween by decorating their house and yard with spooky items and enjoy looking at what others have done for decorations. This could be very fun for the kids. They can even partake in the decorations. Some of my neighbours asked me what would be appropriate treats for Maya because they were willing to provide them. So I told them the tiny Sunmaid Raisins boxes are great. I have heard that some parents offer safe treats to the neighbours beforehand so that on trick or treating night they can give them to the allergic child. That is a great idea too.
Remember to communicate with your child's school or day care ahead of time to make sure that their Halloween celebrations will be safe for your child. I am a big fan of celebrating parties with non-food items, such as little toys from the dollar store, or holiday themed stickers. Suggest a non-food party and see what the school/daycare thinks of the idea. If they still want to go with a food-based party, then make sure that the food being served is safe for your child. Alternatively, you may want to send a safe snack for your child and remind the teachers about the dangers of cross contamination.
For more information visit the AAIA's page on Halloween. In the mean time here is a useful checklist from The American Academy of Allergy Asthma and Immunology:
Halloween fun for children with food allergies
On Halloween, parents of food-allergic children must be extra vigilant to ensure their child is not at risk of a reaction. The AAAAI offers these tips for creating a safe Halloween for food-allergic children:- Accompany younger children as they trick-or-treat and send older children out with a group of friends. Don't allow your child to trick-or-treat alone.
- Verify that adults or friends with your child understand his food allergies and what to do in an emergency.
- Make sure your child carries emergency medication along on Halloween night.
- Before Halloween, distribute safe snacks to neighbors and request that they be handed out to your child.
- Eat dinner before trick-or-treating to reduce urges to sneak a treat.
- Remember that small candy bars passed out to trick-or-treaters may have different ingredients than their regular-size counterparts. Even if a certain candy is safe for your child, the 'fun size' version might not be.
- Carefully check all treats' ingredients on packages or company Web sites to ensure there is no risk for a reaction.
- If in doubt about ingredients, throw the candy away.
- Work with your child's teacher to plan a school party involving non-food treats, such as stickers or novelty erasers. Or, pack treats from home that other students can give to your child.
- Instead of trick-or-treating, host a party that focuses on costumes, pumpkin carving, games and other Halloween-themed fun.
- Create a "candy swap" with siblings or friends so that allergen-containing candies can be traded for other, safe, treats.
- Teach your child to politely refuse offers of home-baked goodies like cookies or cupcakes.
- Consider participating in a charity trick-or-treat event to raise money for a good cause, rather than collect candy. The Food Allergy and Anaphylaxis Network hosts an annual drive to raise money for food allergy education and research. Visit www.foodallergy.org for more information.
Additionally, allergyfreehalloween.org has a list of allergy safe candy that does not contain any nuts, milk, eggs, wheat, or soy. Check out their web site for more information. You can further show your support by putting up a free printable cat or jack-o'-lantern sign on your door to let allergic children and their families know that you are offering allergy friendly treats for Halloween this year.
Have a safe and happy Halloween.
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