Friday, September 30, 2011

Signs and Symptoms of Food Allergies

The most popular questions sent to Fun Without Food are in regards to food allergies, their signs, symptoms, how to seek medical help and advice, and how to make changes to the diet.  Consider this Part One:  Signs and Symptoms.

Signs of food allergies are not cut and dry.  There can be multiple symptoms.  Some children show all symptoms, others show only one or two.  In some cases, children may not show any visible symptoms.

There are many websites that explain what I am about to explain, click on this to see my favorite.  But, it's also nice to read it, written by someone who has experienced almost all of it and then some. Remember symptoms may take up to two hours to show themselves after contact or ingestion.  In rare cases symptoms may take more time to appear.

The most common food allergy symptoms include:

1. Tingling or itching in the mouth.

Make a note, that as a parent, we can not see this reaction in our children.  If they are infants and/or toddlers they will not be able to communicate this symptom.  Most often as a parent, you will notice extreme irritability and perhaps a refusal to eat.  If the child is older, they may try to itch their mouths or express that it hurts or feels funny.

2. Hives Itching or Eczema.

In my experience, eczema is one of the number one indicators that an infant has food allergies, especially if they are extremely irritable.  It may be hard to discover what food is causing the eczema, but once it's found, improvements in the skin are amazing.  Eczema can just be eczema too, and is not always an indicator, but I have only met one person who had eczema who hadn't been diagnosed with food allergies, especially in children.  Eczema can occur anywhere on the body.  My first child had eczema. At two he was diagnosed with allergies.

Hives is a very popular reaction in children.  Usually it is the first sign that is taken seriously by parents and caregivers.  Still at times it can be confused with other rashes on the skin.  Hives do not always occur where the food allergen makes contact with skin.

Itching can occur without hives.  The itchy spot can be anywhere on the body.  There are many other reasons a child may be itching, but once you have eliminated environmental and emotional factors, food allergies can be the reason.  Infants may not be able to itch, and may only show extreme irritability.

Though, not listed, I would like to add diaper rashes to this section.  Five out of six babies I have cared for have had food allergies.  The first symptom visible was a reoccurring diaper rash.  After switching diapers, trying all lotions and ointments, it was discovered that food was the cause.

3.  Swelling of lips, face, tongue, and throat, or other parts of the body.

Beware!  Swelling of the lips, face, throat, and especially the eyes can lead to an anaphylaxis reaction in a matter of seconds and should be taken very seriously.  Benadryl is usually the best way to stop the reaction from worsening.  Check with your doctor for dosage amounts.

Parents often don't catch the swelling of the tongue and throat, because they aren't visible.  If you child starts to speak differently or their voice changes in any way, these may be indicators of this type of reaction.  Often times a child will have difficulty swallowing and/or breathing.  At times their voice may become hoarse.

My second child has swelling of his internal digestive track every time he has an allergic reaction to a food. As an infant, when this would occur, he would arch back and become as stiff as a board.  Similar symptoms occur in reflux babies and children having seizures.  It was only after those were ruled out that his food allergies were discovered.  Swelling of the internal digestive track can and did lead to vomiting in my second child.

4.  Wheezing, nasal congestion, or trouble breathing.

These symptoms are most commonly associated with environmental allergies, but they can also be signs of food allergies.  My third child was constantly sick, with what appeared to be colds.  She did show other symptoms of food allergies.  We were surprised at how quickly her cold like symptoms disappeared when she was diagnosed, the food was removed from her diet, and she started using an inhaler twice a day.

5. Abdominal pain, diarrhea, nausea or vomiting.

This symptom is usually associated more with food intolerances, but should be taken more seriously in regards to food allergies.  In less than 24 hours after birth my second child was having massive diarrhea bowel movements every hour.  The smell was obnoxious.  He could not sleep because of his abdominal pain.  When he started solids he instantly began vomiting.  After two weeks of no sleep and a very irritable baby, we went to the doctor and had his stool tested.  This was our first indication of a milk protein allergy.

At six months, my third child was having six to ten bowel movements a day.  The smell was foul!  Her only other symptoms of food allergies were diaper rashes and nasal congestion.  She was referred to a gastroenterologist first.  They ran tests and had an upper GI scope done.  It was there they noticed eosinophils in her stomach.  Eosinophils are a sign of food allergies.  We were then referred to an allergist where they discovered multiple food allergies. Within a matter of days her bowel movements were reduced to one to two a day.

Remember, as a parent you can not see abdominal pain or nausea in infants and sometimes toddlers.  Instead you will mostly likely notice a hard stomach and/or extreme irritability.

6.  Dizziness, lightheadedness, or fainting
The only experience I have with this symptom is in regards to my second child.  When he has an allergic reaction he is the most clumsy kid I have ever seen. At times he appears to be staring into space.  Other times he can barely walk straight.

This symptom can lead to anaphylaxis in a matter of seconds so it is important to treat it immediately.

7. Anaphylaxis

In some people, a food allergy can trigger a severe allergic reaction called anaphylaxis.  Untreated anaphylaxis can cause comma or death.  The Mayo Clinic lists these life threatening symptoms:

A. Constriction and tightening of airways

B. A swollen throat or the sensation of a lump in your throat that makes it difficult to breathe.

C. Shock, with a severe drop in blood pressure.

D. Rapid pulse.

E.  Dizziness, lightheadedness, or loss of consciousness.

In children it may be very difficult to notice the onset of some of these symptoms.  Other times the child's face may swell extensively.  It is extremely important to carry a prescription Epi-pen at all times if there is possibility that a child may have a severe reaction.

Questions and Discussion:

1. How did you first discover that your child was having an allergic reaction to a food? Did someone else notice symptoms first? How long had the symptoms been occurring before you made the connection to food?

2. Has your child ever gone into an anaphylaxis reaction due to something he or she ate or inhaled? How quickly did the reaction come on and how long did it take to recover from it? Ever had to use your Epi-pen?

3. Are there any other symptoms that you saw in your child that alerted you to a possible food allergy, not listed above?

Wednesday, September 7, 2011

Back to School Safety

My second son starts preschool tomorrow.  Not too long ago, we didn't think it was possible for him to even attend school.  It was a very long road, filled with frustration and tears, but it paid off.  Along the way we learned MANY important lessons.  It's only seems fair to share our experience in hopes that it will benefit another parent and their child.  And since we're not as experienced as some, we hope for more ideas and added advice from other parents.

Our journey began with a simple conversation with our pediatrician, who just happened to be the medical director of the school we wanted our son to attend.  He then initiated a conversation with the education director of the school.  I was asked to bring in a list of my son's allergies.  A meeting was scheduled between the education director and the teaching faculty of the preschool.  My son's case was presented.  I was not permitted to be present.  There was much hesitancy, to the extent that a meeting was called between the education director and medical director.  The education director was very obvious in making sure I was not a part of this meeting.  Unfortunately her efforts failed.  The medical director, our pediatrician, made certain I was in attendance.

At first the answer was no.  It was too dangerous.  Preschools are allowed to deny enrollment.  Then our pediatrician stepped up to the plate and convinced the education director to allow Adam to attend school for one hour two times a week during the most regulated times of the day.  If he could remain safe during those times, his time at school would increase.

We were elated.  A few months later our pediatrician reported to us that another meeting was to be held.  He had not heard details but the ordeal was far from over.

Meanwhile, my second son was diagnosed with Autism.  He was transitioning from Early Intervention Services (EI) to services provided through the school district.  To date, the school district had not been involved in my son's case and enrollment into preschool.

After several evaluations and the new diagnosis, a CPSE meeting was to be held.  This meeting would determine the education my son would receive for the next year before entering PreK.  I spoke with the head of the CPSE board.  She was unaware of my son's allergies.  She requested that I bring a list of every allergy and it's reaction, along with medical proof of all allergies from a specialist, not our pediatrician.

Contention was building between staff members at the preschool we wanted our son to attend.  There was talk of not modifying the classroom to meet our son's allergy needs.  Allergies do not count as a disability and therefore a one-to-one aid cannot be provided, unless paid for by the parents.  If the classroom was not modified there would be no way to keep our son safe.  More importantly, if everyone wasn't on the same page... It was a very dangerous situation.

Our pediatrician, the medical director of the school, was once again summoned to attend the meeting, and asked to bring our's medical records.  My husband and I sat down with our Early Intervention team to review our son's case and suggested IEP goals written by our son's occupational therapist a few days before the big meeting.  We discussed EI's position and requests in regards to our son's transition and next year of school.  His test scores and diagnosis of Autism would suggest that our son be considered a special education student and attend preschool five days a week.  Yet with his allergies...  The meeting would be interesting.  We discussed best and worst case scenarios, and our rights as our son's parents and his right to a public education.  The EI team encouraged us to write down all our questions in advance and have them answered during the meeting.  Our son's IEP would be developed during this meeting and needed to include address all concerns in regards to our son.  That evening I did so, but then remembered I had read somewhere that children with food allergies should have a 504 Plan.  What was the difference? Did he need both plans?  What was a 504 Plan? What was an IEP exactly?  I found the perfect explanation HERE.  I've shared some of it below.

There are two types of written plans, which must be developed and implemented by public schools regarding students with disabilities.  First, students with disabilities requiring only reasonable accommodation must have a written plan under Section 504; this is commonly referred to as a 504 plan.   Each public school should have a person (usually an assistant principal or a guidance counselor, but not a special educator) who serves as the school's "504 coordinator."  This person should coordinate the development, maintenance, and implementation of 504 plans.

504 plans should be developed by a committee, consisting of the student with a disability (if appropriate), the student's parent(s)/guardian(s), the student's teacher(s), the student's counselor, and the 504 coordinator.
Additionally, special educators often serve as advisors to 504 committees.  The student's disability and corresponding need for reasonable accommodation are identified and documented in the plan.  Likewise, the plan delineates the specific accommodations, which will be implemented by the school.  All school staff involved in the provision of accommodations should be contacted by the 504 coordinator and made aware of their duties and responsibilities.  The plan itself should be updated at least annually.

For students with disabilities who require specialized instruction, the IDEA controls the procedural requirements.  The IDEA process is more involved than that required under Section 504.  Instruction and accommodation under the IDEA are provided in accord with a plan called an Individualized Education Program, known as an IEP.  A student's IEP is a legal document which, in part, sets forth the duties and responsibilities of the school district and staff regarding that student.  It is the responsibility of special educators, regular education teachers, administrators, counselors, and other professional educators to be thoroughly familiar with the provisions of the IEP for EACH of their students with disabilities.

Our son did not need a 504 Plan because he has an IEP.

The meeting went very well.  Our pediatrician, later speaking of the event said, "If you get enough people in one room, things happen!"  Our son was granted a five day a week special education program in a classroom modified to fit his allergy needs.  He was also purposely enrolled in the smallest class (made of seven students) with five adults present at all times to help keep him safe.  All of our questions were answered and documented in the notes of the meeting.

Below is a list of questions to help you assess the situation at your school and examine school's policies.  It is taken from THIS article.

  • Where medications are stored
  • Where each student's emergency healthcare form is filed
  • Who is trained to deal with emergency reactions and how they will be trained
  • How substitute teachers will be trained to identify and treat reactions
  • Where students eat lunch and snacks
  • Who provides snacks
  • Whether the classroom can be made allergen free
  • Cafeteria procedures, including food preparation and the cleaning of tables
  • Hand-washing policies for students
  • Food policy on buses (can students eat on buses)
  • Field trip planning, including who is in charge of the medications
  • After school activities—how are teachers and coaches trained to deal with food allergies and how they gain access to medications when necessary
Also taken from the same article are questions that will help you and your school write your Emergency Action Plan.

  • What are the potential symptoms of a reaction?
  • Where should the student go for help?
  • Which medications should be administered and in what dosage?
  • Who should accompany the child?
  • Who is to stay with the other students?
  • What should be done if the student is in the lunch room, classroom, or gym?
  • Who's responsible for calling the nurse?
  • If the nurse is not present, who's next in line for action?
  • When should the person in charge call 911?

Besides addressing all concerns and questions, the school requested that we, as our son's parents, write a letter to the parents of the children in our son's class, explaining our son's allergies and requesting their help to keep him safe.  It will be distributed the first day of classes.  The school is not permitted to share information about our son with other parents.  Therefore the letter was crucial for creating awareness and safety in the classroom.

We hope for a great year!

1. What has been your experience working with school official and teachers with regards to special dietary needs or allergy issues? Have you met much resistance or have others been cooperative? Any issues related to classmates or (more likely) parents of classmates?

2. What does your child's school do to accommodate students with special dietary needs? A lot of these guidelines come from the state or federal level, but have there been any unique initiatives in your community that have contributed to improved understanding, acceptance, and overall safety in your schools? What would you like your school district to do that isn't being done currently?

3. The federal and state guidelines for education, especially for special education, can be quite murky and incomprehensible to most parents. That, combined with feeling intimidated or alienated by school personnel can be hard to navigate. Have you found any resources or information that has helped you to understand your child's educational rights? Any good war stories out there of parent-teacher meetings or IEP meetings? Does it help to know that you are not alone in feeling overwhelmed or frustrated by this process? 

We can't wait to hear your comments!