How Child Care Centers Manage Allergies

Staff work hard to prevent reactions by keeping careful tabs on the lunch and snack table

Allergies seem to be on the rise. But for trained professionals, having to manage food allergies wisely — and on a daily basis — is a part of the job they’ve got well in hand.

A few years ago, a preschooler at the Explore and Discover Early Learning Center in New York City had a myriad of allergies. But the problem was, her parents didn’t know precisely what they were. At just two-and-a-half, the child was still going through a lengthy process at the allergist to sort it all out.

“She’d often come in after being at the allergist and they’d warn us what she had tried that morning,” recalls Andrea Merson, director of the center. As a result, staff was were often picking up the phone to report a rash or ask a question. The parents would come over to give the child an antihistamine when needed for allergic reactions. “We were constantly calling the parents, asking if she could have a cupcake.”

By about age three, the family had figured out a concrete list of food allergens, which got posted all over the child care facility — including the kitchen and all classrooms.

It was a process that caused a little bit more work and worry for the staff, but no one minded. “We operate with an over-awareness when it comes to allergies sometimes,” admits Merson. “We’d rather be safe than sorry.”

Indeed, child care facilities use a range of strategies to protect children with diagnosed or suspected allergies from food allergy triggers and severe allergic reactions. With the increase in severe food allergies today, most staff have years of experience with this — it’s just part of the job, and one they take seriously.


About eight per cent of people have a food allergy. The prevalence of food allergies in children is estimated to have risen by 50 per cent between 1997 and 2011.

That increase could be related to environmental or lifestyle factors. Or, it could simply be related to food allergy reaction awareness and more reporting.

kid and cupcake

Just over 30 percent of food allergic kids have multiple food allergies. And over 38 per cent of those children have had a severe allergic reaction.

When food triggers food allergy reactions — the most common allergens are nuts, milk, eggs, wheat, soy, shellfish and fish — a child may develop mild symptoms, such as a rash, or develop anaphylaxis. This can be life threatening.


Child care centers are very systematic when managing food allergies. They focus heavily on communication: lists of allergens (or suspected allergens) are posted all over the center. Staff who deal with food preparing and serving are very well informed about who in the center has allergic concerns. Even rooms where an allergic child does not spend their days gets a list.

If a child has medication, that’s always on hand. If the group goes for a walk, Merson says the antihistamines or EpiPen are always in the emergency bag. All staff have CPR training, and that covers off how to inject an EpiPen.

Meanwhile, Merson says many staff members also have medication administration training (MAT), which teaches them about giving medications and monitoring recipients afterwards.

kid and raspberry bowl

They closely watch all children in their care, as an undiagnosed allergy (or another medical issue) can pop up suddenly, and noticing symptoms early is key.

But staff also work hard to prevent reactions by keeping careful tabs on the lunch and snack table. At Explore and Discover, children bring in their own packed food. Teachers sit with the children at meals to keep tabs on food sharing — although centers teach kids not to share, little ones struggle to understand such rules, and don’t always obey them.

Staff also notes when someone brings in, say, an egg sandwich when there’s an egg allergy in the group. “We put them at two different tables,” says Merson, and keep a very close eye.

Indeed, that’s what child care staff to do best: they care for children. “They’re trained to know when something is off,” says Merson. Teachers spend entire days with their charges, so they know their personalities and notice when someone’s acting different or looking unwell.

Younger toddlers and babies in a child care setting, meanwhile, can have hidden allergies, and staff know this. They closely watch all children in their care, as an undiagnosed allergy (or another medical issue) can pop up suddenly, and noticing symptoms early is key.

Parents often want to share sweet treats for their child’s birthday party, but it can be very stressful on center management.

child reaches for cupcake


Preventing allergy-related issues involves not just child care staff and the family of the child, but all the parents in a center. Most parents are used to the message that their center is nut-free or nut-aware (it’s so difficult to prevent nuts or any nut residue from entering a facility that many are going with this more neutral term), but it’s more complex than that.

Some centers might ask parents to disclose when they’re bringing in shellfish or strawberries in a lunch, to mitigate the risk to another child. Meanwhile, the sharing of birthday treats is always an issue, so parents are often asked to itemize the ingredients, and warn the center in advance so the allergic child might get a separate treat from home.

Merson says asking all parents to help reduce the risk has always gone well, in her experience, and everyone is usually eager to help.

In her many years in the industry, Merson has never been around a truly serious allergic reaction in a child. That speaks to the prevention-based systems child care centers follow to keep everyone safe.

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