Food Allergies and Childcare: In-Home
One of the hardest decisions when managing food allergies can be deciding on childcare. There's already enough stress and anxiety keeping your child safe at home, but childcare adds on a whole new level by putting your trust in others to keep your child(ren) safe.
We've experienced the gamut of childcare scenarios from in-home to nanny to center. So I thought it would be helpful to create this short blog series to share our experiences surrounding each one.
Before I continue I want to acknowledge that there is no right or wrong decision regarding childcare and food allergies. You need to make sure you choose what feels right and comfortable for you. These posts are only meant to share what we have personally experienced and what we've learned so far . . . along with some tips.
Our In-Home Childcare Experience
We began our childcare journey at a licensed in-home daycare through a friend's referral. I was able to stay home with baby Charlie until she was about six months old and then went back to work part-time.
At this point, we did not know of Charlie's food allergies. She had signs and symptoms (eczema, lots of spit up, etc.), but it was always diagnosed as something else - baby acne and reflux.
Charlie's first reaction actually happened at daycare. Not knowing of her allergies, I had also provided formula as a back-up if she ever ran out of breastmilk. One day the provider used the formula with her oatmeal instead of the breastmilk and that's when Charlie had her first reaction. This is actually the premise for much of my first book (understanding the early signs, what a reaction looks like, and what we did to confirm and support).
After this incident we had Charlie tested for food allergies and it came back that she was allergic to milk, egg, peanut, and tree nuts (except coconut).
When this came up, I had a discussion with the provider on her comfort level with having a child with food allergies and keeping her safe. This was all new to me and she stated it was fine, she was comfortable, and even said she was fine providing food for Charlie without those ingredients (apart from milk, which I continued to bring breastmilk and eliminated everything from my diet). I stated I was fine with also bringing her food and snacks. So we went from there and I trusted her to care for Charlie.
There's a lot more detail I could go into, but to keep this post relatively short let's fast forward. We ended up having multiple situations and more reactions between Charlie and her younger brother. We had him tested at 4 months because of the likelihood with a sibling and he had the same allergies although they did not tell me to eliminate as he seemed to tolerate a bit better than Charlie. We were assured again that the provider was comfortable with caring for them both.
The other incidents included:
An insect sting (assuming bee or wasp) on Charlie's face which resulted in an ER trip and epinephrine. No one saw it happen. Allergist said we couldn't test for it, so to avoid and keep an eye out. Not stressful at all!
The assumption that Charlie took a bite of another child's pizza at lunch. I state assumption because the provider did not see it happen, but said it looked like an extra bite was taken (?) and Charlie was having a reaction later on. She also waited to call us to tell us about it until after Charlie started having the delayed reaction. This incident ended with my husband arriving first to the house and giving her epinephrine and another ER trip.
The last incident happened when the provider's husband helped out and gave our son regular milk instead of my breastmilk. Thank goodness he did not react with a confirmed milk allergy (I think this was because our allergist said not to eliminate completely for him). This incident ended with me taking him to our pediatrician's office (which was very close by) and monitoring for a bit and they gave us the all clear.
The first reaction and insect sting were first-time incidents that could not have been avoided. No one knew she would react when there was no previous exposure or reactions. The other situations were more difficult because they could be stated as "accidents" and I know where all unintentional, they also could have been easily avoided and also life-threatening.
You may now be wondering, "why did you stay there after the second reaction?"
And you'd be correct. We knew it was time to make a change after that second pizza incident because we did not feel like we could trust the provider. We had just moved and we researched centers and found a wonderful one (where we are now), but there wasn't openings for almost a year! So we got on the list, but had to figure out what to do next.
We also believed there was so many important aspects for early childhood development and socialization having them around children their own ages. We decided it was important to pursue childcare, but realized we would have to put in lot more effort in educating and advocating for our children and their care. Eventually they would have to go to school, so we figured the earlier the better for them to learn to be around others with their food allergies. Again, everyone's comfort level is different, and that's OKAY!!
Figuring this out brought up a tricky situation for families with food allergies and one that I want to point out. There are many, many families who end up having a parent leave the workforce to care for their food allergic-child(ren) because of situations like these or not being able to find the right childcare fit. But the thing is, they shouldn't have to make that decision! What about single parents who need childcare?
Food allergy families shouldn't have to feel forced to stay home to keep their kids safe. I feel it's extremely necessary for all childcare facilitators, whether in-home, nanny, or center, to have food allergy training and be certified in identifying and responding to anaphylaxis. Did you know that food allergies affect up to 8% of infants and children? Children could (like Charlie) have their first exposure (and reaction) while at daycare or preschool. They also could have a known allergy and still have an accidental exposure. The most unfortunate example of this lack of training and the impact it can have is with the death of Elijah-Alavi, who was given a grilled cheese sandwich (with a known milk allergy) while at daycare and not informing his parents or calling 911. He died from anaphylaxis. This should NEVER have happened! If you are caring for children, you need to be competent in emergency situations. Yes, there are wonderful facilities that do a great job and have requirements, but there should be a standard across the board that covers it all, regardless of type of childcare. I am excited that the Elijah-Alavi Foundation and Belay have taken action to create a food allergy training, which you can check out here!
Okay, off the soapbox now.
So this brings us to our next post in this blog series - the nanny. We decided to pursue hiring a nanny so we could get our kids out of this dangerous in-home situation while we waited to get into the center. Make sure to watch for that post soon!
Overall, our experience with in-home was that it's a great option for those without food allergies, but isn't very conducive for those with food allergies. That's not to say all in-homes are the same. This was our experience and I also am taking into consideration that there were just too many situations that could occur with only one person monitoring everything for all the children. It's overwhelming for me to manage our three food allergy kiddos alone! I couldn't imagine managing them plus 10 other kids of different ages!
If you are considering an in-home daycare with food allergies, I urge you to check out the below tips from our learned lessons.
Tips & Questions for Attending In-Home Childcare with Food Allergies:
Are they familiar with food allergies and identifying symptoms of a reaction?
Are they comfortable administering epinephrine and do they know when to?
Do they allow or have pets in the home? This could flare allergies or asthma. Our in-home had a cat and got a dog right before we ended up leaving. Our kids do have mild allergies to dogs and a little more severe to cat (we found out later).
Are they licensed? Ours was. There are different levels of licensing and different requirements for each level, including the type of training. Ask if they've had food allergy or anaphylaxis training.
Are they capable of handling an emergency situation with multiple children by themselves? Do they have support if they need it that is reliable and trustworthy?
How do they feed the children? From seating arrangements for those with special needs to making the food.
Do they have a menu you can review? Let them know if you'd prefer to provide your own food and that they are only to feed your child that food.
Make sure they have a copy of your allergy action plan!
Have you had your food-allergic child(ren) attend an in-home daycare? Would you add anything to this list? Share in the comments!