For pediatric feeding therapists, whether working in the home, school/community or hospital/clinic setting, understanding safety precautions for kids with food allergies is essential. Here are five things every SLP should know when treating a child with food allergies:
- Know the symptoms of the reaction. They often occur suddenly, but a slight delay after exposure is also possible. They might vary from client to client, so ask parents to describe their child’s unique symptoms. According to physician Kirstin Carel of Children’s Hospital Colorado, symptoms may include:
- Respiratory: wheezing, coughing, shortness of breath, hoarseness, throat swelling.
- Skin: hives, redness, itching, swelling, eczema.
- Gastrointestinal: mouth or throat itching, lip or tongue swelling, vomiting, diarrhea, cramping.
- Cardiovascular: low blood pressure, abnormal heart rhythm, pale or blue skin, fainting.
- Neurological: fainting.
- Behavioral: sudden irritability (in combination with other symptoms).
- Know how your client communicates his or her symptoms. A child might perceive bodily changes before any of the signs noted above become apparent to you. According to Food Allergy Research & Education (FARE), children can communicate their symptoms by saying:
- “This food is 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].”
Ask parents if their children describe their feelings or symptoms with specific language or how they respond to the body changes after being exposed to the allergen. Learn more about various symptoms here.
- The epinephrine auto-injector stays with the child. Severe allergic reactions can happen suddenly. A caregiver sitting in a waiting room or away from the treatment setting might run out of time to locate this life-saving device. Know your agency’s policies on using an auto-injector when the parent is not nearby. Ask the parent to walk you through the steps on how to use it, should it be needed.
- Avoid cross-contact. Whether treating a child individually or in a group setting, everyone in the room should wash hands thoroughly with soap and water before beginning the session and dry with their own paper towel. Hand sanitizers are not adequate for getting rid of food proteins. Equipment used in food preparation is another factor, including knives, cutting boards, blenders and more. One common mistake is using a community toaster when toasting gluten-free bread for a child with celiac disease. Crumbs in the toaster contaminate the gluten-free food. Likewise, scrub tables, countertops or other surfaces where another child many have played with or eaten the allergen. Toys or equipment that you take from home to home, or even your clothes, may spread an allergen. Being cautious about cross-contact is essential, especially in the realm of feeding treatments where each client is exploring new foods throughout your work day.
- Know how to read a label. According to FARE’s website, food manufacturers must note major allergens in ingredients on conventional foods, dietary supplements, infant formula and medical foods containing milk, eggs, fish, crustacean shellfish, peanuts, tree nuts, wheat and soy. Manufacturers might add the phrase “contains _____” or list it in parenthesis. For example: “albumin (egg).” Read the label every time before serving the food. Ingredients and manufacturing processes can change without warning. Advisory labeling such as “Processed in a facility that also processes ____” and “Processed on equipment shared with ___” is voluntary on the part of the product’s manufacturer. Be cautious after reading both statements, especially the second, because the risk of exposure is much greater for products processed on shared equipment,.
What strategies do you use to keep your clients safe when they have food allergies? Or do you have allergies yourself that require special precautions? Share your ideas in the comments below.
Melanie Potock, MA, CCC-SLP, treats children, birth to teens, who have difficulty eating. She is the co-author of “Raising a Healthy, Happy Eater: A Parent’s Handbook—A Stage by Stage Guide to Setting Your Child on the Path to Adventurous Eating” (Oct. 2015), the author of “Happy Mealtimes with Happy Kids,” and the producer of the award-winning kids’ CD “Dancing in the Kitchen: Songs That Celebrate the Joy of Food!“