Ensuring the physical and psychological safety of children with food allergy at schools: some considerations

An estimated 2-8% of children have either probable or confirmed food allergy; this corresponds to an average of 1-2 children in a classroom. Food-allergy training for teachers ranges from national-level guidance to variable levels of training, or even none. An estimated 8% to 18% of all food-induced anaphylaxis occurs in school settings. Adrenalin or epinephrine, the first-line medication for the treatment of anaphylaxis, is much more commonly used when reactions occur at school (including childcare centres), but compared to the use when reactions occur elsewhere adrenalin is underused. Individual health plans should be available in schools to help prevent allergic reactions and to serve as support for the use of adrenalin if a reaction does occur. To promote the psychological safety of children with food allergy at schools, a shared decision-making model may be appropriate. The family (and child, when appropriate) and teachers are encouraged to have timely discussions about food-allergy management. But at no time should children be systematically excluded because of their food allergy and zero-tolerance policies about bullying, including food-allergy bullying, are strongly encouraged. This article offers some guidance about managing food allergy in schools, which is intended to promote the physical and psychological safety of children with a food allergy.