Early Childhood Facility Staff Knowledge and Confidence with Food Allergy Management: A Preliminary Study
Mullan, Judy, Rich, Warren, Kreis, Irene, Fleming, Catharine, Australasian Journal of Early Childhood
The aim of this study was to conduct a preliminary investigation into the level of staff knowledge and confidence in managing food allergies among children attending early childhood facilities (ECFs) in regional Australia.
Food allergy produces an undesirable physical reaction resulting from the ingestion or inhalation of a specific food antigen and is referred to as either a non-severe food allergy or a severe food allergy resulting in anaphylaxis (Burks, 2002). Non-severe food allergies are an abnormal physiological response to an ingested food and are in most cases not life-threatening but may cause physical complications for the child (Burks, 2002). Severe food allergy, of which anaphylaxis is a subset, is defined by Kumar and Clark (2009, p. 73) as 'a serious allergic reaction that is rapid in onset and may cause death'. Clinically, it can manifest itself as bronchospasm, facial and laryngeal oedema, hypotension, nausea, vomiting and diarrhoea (Kumar & Clark, 2009). Food allergies are most commonly caused by nine food items: cow's milk, fish, shellfish and seafood, egg, peanut, soy, tree nuts (brazil nut, hazel nut, walnut and cashew nut), sesame seeds and cereals (wheat, barley, rye) (Anaphylaxis Australia, 2011a).
In Australia, it is estimated that at least 3-5 per cent of children aged 0-5 years suffer from severe food allergies which can result in anaphylaxis (Anaphylaxis Australia, 2006). However, historic trends may indicate that this group is increasing. Mullins (2007), in an analysis of clinical records of patients referred to a community-based specialist allergy practice in the Australian Capital Territory (ACT), found that the percentage of children diagnosed with anaphylaxis increased from 9 per cent to 15.4 per cent. He also found similar trends in national hospital admission rates for anaphylaxis in children aged 0-4 years. While this study was confined to one practice in the ACT, the confirming trend in national hospital admissions may indicate transferability of the ACT findings to the similar-aged general population. Coupling this with Australian Bureau of Statistics (ABS, 2011) data indicating a trend towards greater use of ECFs (17% of children aged 0-5 years in formal child care in 1999 rising to 22% in 2008) provides grounds for concern that a similar group (3-5%) of children attending an ECF may be at risk because of the lack of both preventative and proactive knowledge by facility staff on how to respond effectively to an anaphylactic episode (Boros, Kay & Gold, 2000; Sinacore, Kim, Murthy & Pongracic, 2007).
Until recently, apart from Victoria, Australian ECFs had no compulsory legislation regulating food allergy management for children in their care. Rather, only voluntary state and relevant association guidelines were available to guide practice. This had the potential to place children at risk of a life-threatening food allergy reaction while attending ECFs. This absence of national, compulsory legislation changed from January, 2012, when the National Quality Framework (Education and Care Services National Regulations, 2011), became national legislation. This legislation requires ECFs to become fully accredited, which among other things mandates staff to become competent in the management of food allergies of children in their care.
Following human ethics approval, the research was conducted between June and September, 2007. A mixed-methods research design (Hardy, 1999) using both quantitative data (i.e. a two-part survey and a knowledge quiz), as well as qualitative data (semi-structured one-on-one interviews and small-group interviews) was used to determine staff confidence and perceptions about their management of food allergy among children attending their ECFs. This research design was deemed appropriate for the study because it validates collecting, analysing and mixing both quantitative and qualitative data in a single study (Creswell & Piano Clark, 2007). …