Monday, 17 March 2014

Allergies, Asthma and Health Care Plans, My Top Tips for Early Years Practitioners



The most basic guidance is to check your insurance if you are a privately run setting. Below are a few of my top tips to produce a working, individual health care plan.

1) Get a prescribing doctor or pediatrics allergy clinic to give you advice regarding emergency treatment plan and prescribed medication.  For some parents this is the GP, or a local consultant, but ideally this should come from the allergy clinic/ immunologist.  However most allergy clinics are run part time and Parents may be referred to different medical experts depending on the condition, for example many children with food allergies have asthma, and rely on their asthma doctor for food allergy advice. It is important to get a written emergency plan from the treating doctor to act as a starting point for the individual health care plan.

2) Get a holistic picture of the child's allergies, so that you can gain a clearer picture of their health needs. Children with food allergies often have other chronic conditions such as asthma, eczema, and environmental allergies. These conditions all play their role in allergic reactions, and have an impact on education and general health of child.  For instance eczema, asthma and rhinitis disturb sleep patterns, and can lead to poor concentration, infection and greater time off school with illness.  Environmental allergies may be more problematic at certain times of year allergies such as tree pollen hay fever or mold allergy and again the all year round allergies such as dust mite, and animal dander have an impact on this child's health and education. It may be worth questioning how you can make simple adaptions to the environment of setting to make this child more comfortable. 

3) Medication changes: During the hay fever/tree pollen season a child may be on greater levels of antihistamine, nasal sprays and eye drops, and medication again has an impact on concentration ability due to side effects, or the eye, nose, throat, skin and rise in asthma irritation during this time of year.

4) Buy a trainer auto injector for your setting. Practice using it every term as a refresher. Re-visit descriptions of an allergic reaction and if you have time, practice a scenario that may happen in your setting should an accidental ingestion (or new allergy) is discovered.

5) Parental duties: teaching child not to share food. To update on any new allergy or medical condition the child may have. To be open to communication from staff queries that you may have, and vice versa so that you are forming a working plan around the child.  If a child has a long list of food allergies parents tend to teach child to not accept food from adults other than them and ask if parents have read label to see if it’s safe. If that is the case, staff should ensure they do likewise and check with parents.

6) Be aware that parents may have seen their child have a very severe reaction to food and may have high levels of stress. They are forming an assessment on you as a teacher / EY practitioner, they want you to understand the serious of the condition, keep their child safe, provide an inclusive school experience, and be capable of reacting and using the agreed emergency plan.

7) Remember that the important social skills learnt in the early years, to make secure friendships, to be confidant and to trust others are highly important for these children. Those skills will ensure that they grow up to become confident people with regard to their allergies. We cannot assume that each child will outgrow their allergies, many become lifelong allergic people and they need to be taught the skills needed to keep themselves safe.

Wednesday, 7 December 2011

Our Early Allergy Story.

Our Early Allergy story,

I have four children, who are now all in their teens, our third child, has multiple food and environmental allergies.
 He was born a respectable weight, and displayed the three main symptoms of food allergy before he was three months old. However, the medical profession’s understanding of allergy at the time of his birth 15years ago was patchy or totally unaware at best. That is still true for some today, depending on a GP’s and health visitors experience with patients with allergy.
The three main symptoms of an allergic infant, who is fully breastfed and under three months are, eczema, poor sleep pattern, and poor /slow weight gain.
 My son was fully breastfed, he had very dry skin ten days after birth, and by day fifteen we came home from boots the chemist with two carrier bags after being diagnosed with eczema.
 He was unable to sleep, and as my eldest child had colic I thought that he had it as well, showing all the signs of tummy ache that small babies often have.
 However, he was a tired baby, who scratched at his skin, and as the time went by, he slept for twenty minutes a day, and about two separate hours a night. He never slept for the four solid hours that most new born babies do. Of course sleep and weight gain in infants is linked, and although breastfeeding was going well, I was at a loss to understand his slow progress. At the time I had one son in afternoon nursery and a second son in morning pre-school. I was to put it mildly, rather tired!
Doctors and health visitors put everything down to the eczema and I concentrated on that, learning all I could about the routines, and how to apply the creams to stop the itch scratch cycle, and keep him cool and soothed. However, I think I knew something was wrong, the months passed, and the ‘colic’ didn’t disappear, still screaming at night and day by 5 months.
 By 7 months a health visitor and doctor asked me to keep a diary of the times he woke up during the night. By that stage if I got up past 8 times in one night I classed that as a bad night. They seemed shocked, and suggested I try a sleep clinic.
 I was on my knees with exhaustion and so we went. I was persuaded to try the controlled sleep method, something I had tried with my eldest and it did work very well for him. However, a child covered in eczema cries, gets hot, and starts itching, and the longer they cry the hotter they get and the more painful it is for them. I had to use cotton wool and warm water to remove his cot sheet from his bloodied face and neck. The resulting eczema flare up compounded my guilt. My eczema routine was all body moisturising about 5 times a day, with flare ups going up to 8 times or more.
 By 9 months we were referred for ‘wet wrapping’ by the GP, and suddenly he skin seemed a little better, (linked to time of year) and he slept for four hours for the first time.
 His sleeping pattern started to continue to match a new born, and he started to look better. Then by 12 months something happened to change all that, weaning was still a very slow affair, and started at 6 months. He still mainly preferred breast milk and only took small amounts of food, chewing well etc.
 I took older son to school one day and my hubby gave him toast with smooth peanut butter. I came back to a quiet baby, with glazed eyes, bright red skin, covered in white hard hives. His GP said it was a mild allergy as his throat was unaffected, of course this was totally wrong, but we were suddenly on a huge allergy learning curve.
 When he was 13 months, I tried giving him scrambled eggs, (still totally allergy unaware) in order to find something high fat to help him gain some weight. His symptoms were instant and horrific, violent vomiting and screaming and his bowels emptied with force (a serious sign btw) and were his vomit and poo touched huge hives erupted, and he went suddenly quiet. I gave him a huge dose of piriton, and washed him. Of course I should have called for help; I thought he was just exhausted after the vomiting. He recovered, and we were very, very lucky that day.
 My GP referred him to the local pead, who said his reactions were mild to moderate, and to just avoid all egg and peanut, and that he couldn’t have a epi pen because they were dangerous for infants under 25lbs (advice that was incorrect in so many areas…) but she did give me instructions on how to use a epi pen, which we would be able to have when he reached the magic 25lbs.
I went home and rang AllergyUK and spoke to a nurse, who sent me a letter, which explained that our son was at risk of anaphylaxis and did need an epi pen and referral to an immunologist. It took my GP two weeks to find one. We were sent a letter explaining that our first appointment date would be given between 8 months -18months.
These days London appointments only take 8-10 weeks which is a vast improvement. After his first appointment, we came home with a list of his allergies, peanuts, tree nuts, egg, dust mite, tree pollen, and hay fever. We were given a leaflet on dust mite allergies, with the doctor’s sage, if unhelpful advice to not vacuum if our son was in the house.
We came home and in the months that followed blew a pile of money on wooden flooring, chest freezer to freeze teddies overnight before washing, leather sofas, good quality allergy bedding, and to our joy, his skin improved and he slept and started to put on weight on a limited diet. One day a local nurse rang up about the wet wraps, but it was too little too late.
We found our own way to control his world as much as possible. The oncoming year brought new allergies that were discovered, so we were given epi pens by our gp and by the time we went back to London they were very surprised at the ever growing list of allergens and his symptoms, and were happy that he had epi pens. He didn’t reach the magic number 25lbs until he was nearly 3 yrs. old.
Our son followed the ‘allergic march’ growing slowly out of his eczema, and developing higher severity environmental allergies.
 As he had an ever longer list of allergies, and we were told that he might grow out of some, but not all , so we have brought him up to try and cope with his allergies. Teaching him in small steps to manage his own allergies, and this is still an on-going process.
 The impact on the family, and his life has been huge, every social occasion has food, and family trips to restaurants, days out and travelling have to be planned ahead to a vast degree. The emotional strain of being a young child and teen that has had many allergic reactions and has required his epi pen three times this year so far is huge.
 He is coping with a burden that an adult would find difficult.
By the time our son was two years old I was running a local allergy parent support group, was a member and volunteer for Allergyuk and the Anaphylaxis Campaign. My health visitors passed on my details to other parents struggling to cope with infants with eczema, and sleep problems and allergies. I spent time visiting these mothers, and passing on leaflets from the allergy charities. As time went by I had another baby and with all our boys at school, I organised open evenings with guest medical guest speakers, and raised money at carnivals. I worked part time with the campaign with teenagers, and started giving allergy management presentations to school staff, parents and school nurses and early year’s students at local colleges.
 This was a natural step for me, as my work background was in senior management roles in various child care establishments. I have given presentations on environmental allergies to members of the press; our family has appeared on documentaries, BBC breakfast news, sky news live, magazines and newspapers.
 I am currently a just starting my 2nd year of my early years degree, and work part time in a preschool, and still volunteer for the allergy charities, both local and national. I still support parents by e-mail or phone, as it’s important for parents of allergic children to be in contact with parents that few steps ahead of you, and support each other.

Sarah chapman.

Sunday, 1 November 2009

christmas is coming.

For us in the UK, the first warning of Christmas ,starts roughly at the end of August.
When the first catalogues   slip through the door.
I used to get such nice tempting ones years ago, featuring expensive high heeled shoes, wonderful underwear, expensive gold stuff, and i could leave the pages open to give a little Christmas hint....

but suddenly things have changed, and someone has taken note of my middle age, all i seem to get these days are tarten slippers with ring pull zips, man mad fabric trousers with elastic waistbands, ( which are becoming more temptingly comfy every year) and underwear that promises to scoop everything up, and pop it from were it came from.

my husband thought it was all very funny, until it became personal, when one arrived addressed personally to him, and was greeted with horror.
A smiling picture of a 70 year old man, on a motorized shopping scooter, and the caption,
' dear 'hubby', you too can enjoy shopping again with out all your normal aches , pains and discomfort'!!

oh, how I laughed...........until my 20% coupon for a box of tena lady came through the door.
I have seen the ads on telly, and I do not understand them, what is so funny about tena lady?,
why are they laughing so uncontrollably while pissing themselves?
does tenna lady have some happy drugs imprinted on to it?.............if it did I would take up the 20% coupon!

anyway , am drifting from subject, going back to Christmas, and the start of the never ending, and quite futile hunt for celebration food for the food allergic, something egg/nut/yeast/free, and not so bland and tasteless that the outer packaging can chewed with greater relish.

I look for a safe Christmas cake , Scottish shortbread tail biscuits with out traces of nuts on petticoat tails, Christmas tree chocolates without hazelnut puree.........

having got 4 kids, and a couple of part time jobs, finding the time to cook, shop/ shop/ shop/wrap/ look happy/requires a lot of time, and effort........

I  get Christmas eczema about this time, and take care not to waste the level of stress that causes such skin problems, and scatter dry flakes around mainly in the Christmas biscuit tin section of marks and spencer. Its my own from of decorative snow.

and so, I  promise myself  I will spend more time this year cooking, and try to avoid the temptation to search/e-mail/beg for nasty tasteless safe treats.

I can also add, that the underwear that scoops everything back to its original place, does work.
however, although reasonably  priced , it can cause some nasty expensive after effects. a distressing amount of pins and needles in lower limbs can result in accidents when standing after sitting , and wine spilled on a white shirt is not good news, esp when its not your own shirt,......
and later on in the (hellish) evening, you find that the small print requires a further purchase of machinery to get the stuff off your body.
hubby is far too busy with his own version of the one legged trouser dance at the end of the bed....

Monday, 21 September 2009

Saturday, 30 May 2009

sifting through accidents.

when you have children, accidents happen, sometimes the CHILDREN are THE accident, something i always refer to as a 'happy surprise'. Quite a lot of woman have those, or at least one in my case.

When you have four children, and one with a few allergies, a accident with one, means your eye is not always on the allergic child. That's when the risk of a allergic reaction rises.

one such accident happened a few years ago, when my children were young, cute , happy, and certainly more rewarding than my current now much older children.
Who are all now driven by hormones, hate , and the bitter gall of the mess the 'old people' ( yes, thats me) have made of the plant.
I dont get any brownie points for mentioning the use of terry cloth nappies for two of them, mainly because i still use them for mopping the kitchen floor. It didnt go down at all well when I waved one of them under his girlfriends nose, explaining that he loved wearing them.
I suppose it did spoil his current image of a more tidy guitar playing Russell Brand.

anyway, my 2 and bit daughter took a few lego bricks with her to the bathroom, and sat , face pink and chubby legs swinging, while playing with them.

I happend to walk past , to see her eyes widen, and wittness the large bulge in her throat as she swallowed.
Of course, being a calm mother i did the first thing that came to my head, ran down stairs ( like a headless chicken) and found the bucket of bricks and held up each one in front of her,( hands shaking) to find out which one she has now lodged in her tummy.
'is it this one darling'?

'no mummy.'

'this one'?


'no?, ermm this one'? ( am panicked, now getting bigger bricks out box)


'its diss one mummy, diss one, is 'ellow, like my t-shirt'.

you,ate. a .lego, because...'?

'is like my t-shirt mummy'

'well,.... of course you did, i totally understand,......

sweetheart dont you think this co-ordination thing is going a step to far'?,

Of course next step was to take my panic to someone else to deal with, someone with a nice crisp clean white coat, and badge, with 'doctor' on.

theres a always slight panic about taking all four kids in a hospital waiting room, and you run through a list of someone you could dump them onto.

But there isnt going to be a long list when you have a child with food alleriges.
Anyone who looks after them needs pre-training beforehand.
you have no idea how long you are going to be, and allergic child will need feeding, and thats difficult, if not impossible, if you are not in our allergy world.

So you drag them into the car, go back inside for allergic sons forgotten meds, while daughter crys for her lego, and the others try and make a dash for freedom as the hosptial emergency room has been visited far too frequently lately.

The hospital car park is another stress point, a space hard to find near the hospital, and you have to pay for the privilage of using it. A brief fumble under the seats and the bottom of your hand bag and you find enough coins to stay for a short while.

of course its raining, and you dont have any coats for the kids, but you get in to the heaving accident and emergency room, dripping wet, and look around at the selection of the great damp , steaming, unwashed, the bleeding and half dead, or half drunk, and its going to be a long wait.

A few hours and you give up all pretence of being a caring devoted mother, having spent have the previous night up with two kids, one had a nightmare , and one who doesnt seem to enjoy sleep. So i am crumpled, worn out in the corner, with the bags under my eyes like two used tea bags.

The older boys are trying to distroy the coffee machine, and I would get up and stop them, but I spent half an hour trying to get any kind of fluid out of it, and then another half hour trying to get my money back. So it deserved some sort of kicking.

we are huddled away from the vending machine filled with rather nasty snacks , and of course that machine is working very well. everyone is eating nut filled chocolates, and other high salt snacks.
Other son has found a hole in the seat of his chair and is pulling out the foam, and the youngest is following another little girl around the room with a dislocated shoulder.
Time passes, am promised that doctor will look at my baby soon.
While we wait , the little girl with the shoulder/arm problem, leans heavily on a chair, there is a loud click, and weary parents scoop her up and go home.

finally the doc arrives, worn out , and grey with tiredness, and is of course, impossibly young , and he has dribbled his last meal down his grey dirty coat.

I try to listen to what the doctor is saying and keep one eye on the four kids running around the bed, and in and out of the garish clown curtains.
which are there I presume, to make the doctors appear more friendly, as the clowns are of the steven king varity, and promise to fill any adult slumber with horror,let alone a small child.

The doctor calmly instructs me one what I should do, which is something I really dont want to hear.
now if i had more energy, i would of told this doctor the real truth, that he could shove his helpful advice were the sun doesnt shine, and ask him what mother of four has the time and energy to sift through her daughters bowel movements for two weeks? what about when she goes twice a day? or if I feed her sweetcorn?
what kind of advice is that?

but the kids are hungry , bored and need a good wash,(hospitals are germy)and i need coffee and chocolate if i am to keep going, so we leave, drive home, and carry on.

Wednesday, 13 May 2009

food shopping with allergies , and four children.

During the summer hols, I  often ended up dragging all four kids with me to do the food shop.
It required vast amounts of what I was short of, mainly patience, money, and energy.

A major part of allergy management is reading, and understanding food labels. All information in very tiny print, sometimes ( in the case of toiletries,) in Latin.

we had learned quite early on, what the mysterious label 'may contain' really meant, the hard way.
Mainly due to the projectile 40 min vomiting, which was repeated the next day instantly after trying another plain biscuit, from the same pack.
We tip -toed over the clean patches on our carpets, and cleared the house of all foods with may contain labels.

Here is a typical trip to a large supermarket.

I start with a brief wash, and pat dry of both damp ends of baby, find clean t-shirts for the boys, and sponge the stains of my top, and try to get out of my pjamma bottoms and shabby but comfy flip flops.

While I dabbed the marks ( most forms of bodily fluid) off my shoulders, I would ask the boys go to the bathroom, or go on the potty.
of course this leads to lot of fun for boys, and a shout of 'lets play star wars'! is a terrible sign, which often led me giving up on the t-shirt sponging thing, go and rush upstairs while begging them to 'not cross the streams'!!!

Then of course ,you clear up the pee, find clean ( but crumpled ) t-shirts for the boys to wear.
however, you are now getting a little , ..erm...frazzled, so plop shirts over the nearest heads , and drag them to the front door.
one son now flashes his belly button when he breathes in, and the other has a shirt flapping around his knees. But you have no time to stop and sort all that out, because soon the baby will need feeding again.

You wriggle in to jeans, grab your money and car keys , and put the children that have a tendency to escape in the car FIRST.

once you count the heads of the kids, have made sure that you checked that the front door is shut ( you only do this three times, any more than you have to go to the doc and get drugs for your after pregnancy OCD hormones. They are the same ones that make you want to clean the oven before you give birth.) then you start the car and go!

During the journey you lecture the children on holding in bad gas, and stop 2yr old from trying to throw shoes out of the car window.
By the time you get to the car park, your head is sticking out the window as your eyes are burning and strips of skin are peeling from the back of your throat.

Farting is a constant source of entertainment for any male, of any age. It gets worse as they grow up.

The baby and parent parking space is taken up with sports cars, and slim looking woman without children ( who cant possibly have stretch marks, but you our  not bitter, NOT AT ALL! ) and you find a space.
Not near any other cars , because of the damage your older boys do with the car door slamming.

A reasonably clean double shopping trolley is found, a blanket for baby to feel comfy, and 2 year old sits with his comfort blanket ( lankey), and thumb in his mouth.

Once in the shop, you avert gaze from high heeled shoes, because mummy's do not get to wear them very often, and the pretty bras, because new mums still need to wear grey pregnancy bras, or stern feeding no nonsense bras.
Which have all the sexual allure of a dead fish. In fact the bras are a pretty good contraceptive in the early months.....

Everything has to speed up because you have two hands to push trolley, heavy with two children, and two mobile children that like to run away.

You try and ignore the fact that your 6 yr old has brought his 'sooty' puppet with him, and is skipping ahead, and pausing to 'listen' to what sooty is saying to him, then laughing out loud.
I'ts really best not to dwell on the fact that for the past 6 months your child has been talking almost non stop to his own hand.............

The four year old loves the big supermarket shop, once he met a shop worker , flipping the hidden control programs open under the big freezers.
He tried to climb in a freezer once, I had to shake his trousers and socks free of peas when i got him home.
Buttons , switches, that could be pressed, must be pressed. They call him and beg for a pudgy finger to set them off. In fact the in store phones have been used as well. Often to call 'fireman Sam' a favourite BBC cartoon character.

I whizz through the aisles, allergy problems mean that some sections of the supermarket are not going to be visited , ever, the on store bakery section, the deli section, and the pizza , curry , roasted chicken section.

some sections require a pause for thought, working out what ' nut free , but nuts on site' really means in relation to one small jam tart, when you realise that its all gone far too quiet.
2yr old is calmly chewing through a toothpaste tube packet, and trying to kick me while he sits in the trolley.

Around the corner of an aisle, you see a flash of the boys, and take a chance to ponder over a packet of toilet roll tissue.
hmmmmmmmmm? Aloe vera? has that ever touched allergic son's skin before?
The anti bac spray on the toilet seat last week has still left its mark, and not just on HIS bottom. Bearing in mind that tender area, is aloe vera a allergen for some?

A couple of old grannies walk by complaining loudly , you catch a drift of the comments, 'broken bread sticks' 'abandoned children' 'sword fights' seem to hit a memory, so all shopping is halted, and race to bread section.

once boys retrieved, and bread kicked under the shelf, you drag them off quickly. Hissing madly in anger.............bribery is your only option now.

Somehow you get all shopping paid for, ( all fruit bruised and ruined ,but you are running out of time, baby is crying) get the mobile boys back in car.
Strapped up , and shut up with a chocolate bar,
and allergic son with something safe to chew on.

pause to
scrape the toothpaste off the babies legs, arms, and clothes, and sit in car to feed her.
Then drive home. and shopping does get into kitchen, but by now you need to cook a meal, do some washing, and sink in to the evening routine.

by 11 pm , all tins are put in to the cupboards, but there is a small pile of food that you cant use. hidden small print missed, and now declared  unsafe................and that happens all the time, every flipping week.

Now, these days, all children are at school, and my only problem is reading the labels. my eyes seem to be giving out on me.
But my real theory is that my arms are just getting shorter, that's why the shape of the top of your arms changes so much!

bones shrink and your arms resemble the glorious shape and texture of a raw pork sausage.
our only choice is to buy expensive glasses to distract the attention from our arms.

well, that's what I do.