Playschools and Food allergy - can they cope?
Susan Lister runs
a playgroup in Cambridge where they have learned to deal with epileptic,
nut allergic, dairy intolerant and coeliac children.
It was 9am on a Monday morning and I was greeted by a very agitated parent. She had spent part of the weekend in A & E with Abigail, her 3 year old daughter who had had an anaphylactic reaction to something. They weren't sure what exactly, but the likely culprit was nuts. Would we be able to cope at playgroup, or would she have to leave?
My immediate and personal reaction was that of course we could cope, but to be fair to my staff I consulted them all. The collective reaction was the same, a deep breath and ‘yes, of course!’ After chatting to the parent we decided that we could cope, but in the interests of the child’s health we needed a little more time and more information to make sure that she would be safe with us. So Abigail stayed away for a week. This was enough time for the hospital to identify her precise allergens, and for us to think through our strategies. After a week we were all set.
We purchased a fluorescent-pink paint box that was highly visible in which to keep Abigail's emergency kit - the Epipen, contact phone numbers, GP details, medical conditions, hospital patient numbers (vital if she had to go to hospital) even some cash so that whoever accompanied her in the ambulance wouldn't be stranded. This was always kept on hand, even accompanying Abigail on school outings.
We developed all this through dialogue with her parents, her GP and our staff who were always consulted about what responsibilities they were prepared to undertake (administer the Epipen, accompany her to hospital etc). Abigail was with us for a total of five terms, and fortunately our precautions were adequate and she was well the whole time. This was six years ago.
Now add a coeliac
The most obvious area to look at is what she actually eats while at playgroup. Because Grace has only just been diagnosed the specialist wants her diet to be totally clean, with absolutely no possibility of cross contamination. Her mother is happy to supply gluten free bread and crackers, and her own margarine and marmite, so that it is all ‘'clean'.
But we have had to think about food preparation too. We now have a separate area of the kitchen in which to prepare Grace's food. A designated staff member cleans that area of the kitchen thoroughly, as we do not have sole use of the building so cannot be sure that the area has not been contaminated. We then place her food, a freshly washed knife, plate and cup (dried with a paper towel) on a cleaned area. We have a chopping board that is only used for her food and is not stored with the other kitchen equipment.
To produce 'clean' toast we use a toasting bag (www.toastabags.com) although we need to take care that the outside of the toasting bag does not come in to contact with her ‘clean' preparation area. The children are also offered fruit and vegetables, so some of it is washed and placed in Grace's area, and is prepared there, the surplus then being transferred to the other side of the kitchen after Grace's plate has been prepared
Having a special plate for children with special diets has never been a problem, and the matter is always discussed positively with the children, usually within likes and dislikes. They all know that Grace and Joe can not eat or drink some things that they can because it would make them ill. (Two children are about to have birthday parties, and have told their mothers that Grace will need to have special party food and that they will need to talk to Grace's mother about it.)
Both Grace and Joe are positive about their food intolerance and can confidently explain that they have special food so that they won't be ill. However, the dialogue with their parents is constant, and if one of them was at all unhappy about their special plate we have a contingency plan - each child would have their own plate (we don't at present because one of the important factors in our snack time is a concept of sharing our food).
However, there are other things to consider with a coeliac child. We thought very carefully about our activities and routine, and decided that we would need to examine any substance that we used with the children. We have discovered that glue is OK, but that paint might not be, as some paints contain gluten! We have discussed this with the specialist (via Mum) who says that it should be okay as long as the gluten is not ingested so an adult has to help Grace wash her hands after painting, to make sure that it is done thoroughly.
In cooking activities we use non-gluten flour (e.g.buckwheat) although we are still experimenting, as some recipes do not take kindly to change. Be wary though - lots of unexpected products do contain it. Some brands of icing sugar and cake decorations, for example. It is also in a lot of things that you wouldn’t expect - like ketchup and some stock cubes. We are also about to try using gram flour to make playdough. (An alternative gluten free playdough can be got from www.wholesomehouse.co.uk).
The vital thing throughout has been communication - with the parents, with medical personnel, between the staff, and with the rest of the children - so that everyone understands what is going on. The children in particular need to understand so that they don't offer their food to Grace. Adults also have to be very vigilant at times when we sit together and share food. We have another child who is gluten-intolerant due to start with us in September, and when his parents ask us if we can cope we know that - like Bob the Builder - we can confidently say 'Yes, we can!'
Recipe for a safe environment
First published in 2004