The information and resources on this page will support your early years setting to develop best practice protocols to ensure young children with allergies are managed safely. This includes the importance of whole setting allergy awareness, information about our AllergyWise® for Early Years Settings online training course with additional benefits, best practice resources, such as an editable risk assessment, information about spare adrenaline auto-injectors, posters, responsibilities, plus more!

The importance of communication

It can be an anxious time for parents/carers when they first send their child with allergies to an early years setting. It may be the first time they are handing over the care of their child to someone outside the family.

Communication is essential. Parents/carers must be asked for information about their child’s allergies before the child starts. It’s important for key staff members to meet with them at the earliest opportunity, so that everyone is comfortable with the plans in place to help ensure the child is safe at the setting.

Allergy awareness

We encourage a whole setting allergy awareness approach and an awareness of all allergens, as this is the safest way to manage children with allergies.

The more staff who have an understanding of allergies, can recognise the signs of anaphylaxis and know what to do in an emergency, the safer all children with allergies in the setting will be.

AllergyWise for Early Years Settings online training

Our new AllergyWise® for Early Years Settings course is designed for all early years providers and includes resources for young children to encourage whole setting allergy awareness. 

The course will help you understand the common causes of allergic reactions, how to recognise and manage anaphylaxis, how to use adrenaline auto-injectors, and provides practical tips for safely managing young children with allergies.

The course takes ~1 hour and includes quizzes, practical scenario videos, optional narration, final assessment and downloadable digital certificate of completion. Additional benefits include our allergy awareness resources for young children and the opportunity to achieve our AllergyWise® Early Years Setting award!

AllergyWise® for Early Years Settings online training

Our allergy awareness resources for young children are included with our AllergyWise® for Early Years Settings online course!

 

Completing our course before delivering these activities will help staff to feel confident talking about allergies with young children.

All providers that complete our AllergyWise® for Early Years Settings online training course are eligible for our AllergyWise® Early Years Setting award!

 

Awarded settings receive a digital certificate and a digital logo to use on their website and letterheads.

Looking for information and online training for schools?

See our Safer Schools Programme

Anaphylaxis symptoms in babies and toddlers

Anaphylaxis (pronounced ana-fil-ax-is) is a serious, life-threatening allergic reaction. It can be challenging to recognise anaphylaxis in babies and toddlers as they may present with non-typical symptoms and are less able to express their feelings or give early warning of symptoms.

Recognising anaphylaxis in babies and toddlers can also be difficult as some symptoms also frequently occur in healthy infants and behavioural changes can be difficult to interpret.

It’s important staff are vigilant.

Anaphylaxis in babies and toddlers almost always involves skin reactions. Symptoms may include:
  • right_arrow_orange_icon a red raised rash (known as hives or urticaria) anywhere on the body
  • right_arrow_orange_icon swelling of the face, lips, tongue, eyes, hands or feet
  • right_arrow_orange_icon coughing, wheezing, difficulty breathing, hoarse voice, throat itching
  • right_arrow_orange_icon vomiting, diarrhoea and stomach pain
  • right_arrow_orange_icon dizziness, low blood pressure, fainting, skin mottling
  • right_arrow_orange_icon sudden behavioural changes (inconsolable crying, clingy, less active, lethargic, food refusal).

Treating anaphylaxis

The treatment for anaphylaxis is an injection of adrenaline into the upper, outer thigh. Adrenaline is available on prescription in single-use devices known as adrenaline auto-injectors or AAIs for short. There are three brands of adrenaline auto-injector available in the UK that a child at your setting may be prescribed – EpiPen, Jext and Emerade.

Anyone prescribed adrenaline should have access to two in-date adrenaline auto-injectors at all times. Two are needed in case one misfires, or a second dose is needed.

If adrenaline auto-injectors have been prescribed to a child at your setting, they must be available at all times, not locked away, and accessible to all staff.

Find out more about anaphylaxis symptoms and treatment

Learn more

Best Practice Resources

There are national minimum standards that early years providers must meet, such as the Early Years Foundation Stage statutory framework in England. See the Useful Links section at the end of this page for further information.

Early years settings are required to obtain information about children’s health and dietary requirements – including food allergies – before they attend, and record and act on the information provided.

The following best practice resources are designed to support educational settings to safely manage children with allergies.

  • Risk Assessment

    We recommend a risk assessment is carried out with the child’s parents/carers for all new joining children with allergies, and any children newly diagnosed. Use the example, editable risk assessment below to support your setting to keep young children with allergies safe.

    Click here to download the Early Years Risk Assessment

  • Allergy Action Plans

    Every child known to be at risk of an allergic reaction (e.g. due to food allergies) should have an up-to-date and accurate Allergy Action Plan in place in their early years setting. We recommend settings use the British Society for Allergy and Clinical Immunology (BSACI) Allergy Action Plan to ensure continuity. This is a national plan that has been agreed by the BSACI, Anaphylaxis UK and Allergy UK. These plans have been designed to facilitate first aid treatment of anaphylaxis, to be delivered by people without any special medical training or equipment apart from access to an adrenaline auto-injector. Please note, the plans are medical documents and should be completed by a child’s health professional, in partnership with parents/carers.

    There are four plans available; a generic plan for individuals assessed as not needing an adrenaline auto-injector, and a personal plan for individuals prescribed EpiPen, Jext or Emerade.

    Click here to download the four different Allergy Action Plans here

  • Model Policy for Allergy Management at School

    Anaphylaxis UK and Allergy UK have worked with the British Society for Allergy and Clinical Immunology (BSACI) and the Medical Conditions in Schools Alliance, to develop a Model Policy for Allergy Management at School guide. It is designed to support schools to develop a ‘Gold Standard’ policy to manage children’s allergies safely, so that children and their parents feel reassured that a robust policy is in place.

    This guide will be useful for early years settings looking to produce an allergy policy and can be adapted for early years providers.

    Click here to view the model policy for allergy management at school guide

    Click here for an example, editable template model policy

  • Template allergy awareness letters

    Tracey Dunn, primary school headteacher and Education Ambassador for Anaphylaxis UK, has produced two template letters that schools and early years settings can adapt to their needs.

    Click here to download the Starting Reception Template Allergy Letter

    Click here to download the School Template Allergy Letter

Free poster for early years settings

Use our poster to help raise allergy awareness in your early years setting.

Spare adrenaline auto-injectors

Since 2017, schools and local authority maintained nurseries can buy spare adrenaline auto-injectors without a prescription, for emergency use in children who are at risk of anaphylaxis but their own devices are not available or not working (e.g. because they are out of date). These are a back up, and not to replace a child’s own prescribed adrenaline auto-injectors.

Schools and local authority maintained nurseries can buy spare adrenaline auto-injectors from any pharmacy. A letter on headed paper from the head teacher is needed. View a template letter.

The change in law only extends to schools and local authority maintained nurseries. Private nurseries, childminders, nannies, children’s organisations, clubs and groups outside of school can’t buy spare adrenaline auto-injectors.

Responsibilities

Early years settings should:

  • follow and implement statutory guidance, such as the Early Years Foundation Stage framework, which details the standards all early years providers in England must meet. Links to UK guidance can be found at the end of this page
  • work closely with parents/carers to support children with allergies
  • have a protocol in place which is accessible to all staff, to ensure everyone is aware of individual children’s allergies and symptoms

  • ensure that medications kept in the setting are appropriately stored, and easily accessible in a secure location (but not locked away)
  • arrange anaphylaxis training for all staff, including how to use an adrenaline auto-injector. Training should be provided on a yearly basis and on an ad-hoc basis for any new members of staff. All staff need to be aware of the symptoms of anaphylaxis and be vigilant at all times, as young children may not be able to give early warning of feeling unwell, or a clear description of how they are feeling.

All food businesses, including early years settings, are required by law to give details about the top 14 allergens in food they provide.

Early years settings should:

  • understand which allergens are present in every meal and snack they provide
  • always check the packaging for all ingredients when preparing food for a child with a food allergy. Top 14 food allergens will be emphasised on the ingredients label, or you can request information from suppliers. It’s important to remember that product recipes can change, that different brands may contain different allergens and that children can have allergies to foods not included in the top 14 list.
Find out more about understanding food labels

Early Years Settings FAQs

  • How many adrenaline auto-injectors should a child with allergies have at the setting?

    Anyone prescribed adrenaline must have immediate access to two of their own prescribed adrenaline auto-injectors.

  • Who is allowed to administer adrenaline in an emergency?

    Regulation 238 of the Human Medicines Regulations 2012 allows for adrenaline to be administered by anyone for the purpose of saving a life in an emergency.

  • Can milk allergy be serious?

    Milk allergy can cause serious allergic reactions (anaphylaxis). Special care and vigilance are needed. Even a splash of milk or yogurt may cause a skin reaction in a child with milk allergy. Spillages need to be wiped thoroughly and hands washed. If a child with a milk allergy has a milk substitute (such as a soya drink) there needs to be a robust system for ensuring that the child is not given the wrong drink by mistake. For further information about cow’s milk allergy, read our factsheet.

  • Who are spare adrenaline auto-injectors for?

    From 2017, all schools and local authority maintained nurseries in the UK can purchase spare adrenaline auto-injectors for emergency use. Spare adrenaline auto-injectors are primarily for pupils known to be at risk of anaphylaxis and for who both medical authorisation and written parental consent for use of the spare auto-injector has been provided. The school’s spare auto-injector can be administered to a pupil whose own prescribed device cannot be administered correctly without delay.

    A schools’ spare adrenaline auto-injector can also be used for any pupils or other person not known by the school to be at risk of anaphylaxis in an emergency. Written permission is not required in these exceptional circumstances where the reaction could not have been foreseen.

    Further information on the use of spare adrenaline auto-injectors can be found in this Clarification of adrenaline autoinjector guidance for schools

  • Is playdough safe for children with allergies?

    Commercially produced playdough can contain allergens, such as wheat. Find out the ingredients from the manufacturer. You can make your own play dough using cornflour, baking soda, water, bottled vegetable oil and food colouring. Make sure you don’t have a child who reacts to any of these ingredients.

  • Is there a risk for children with allergies from cosmetics, such as nappy creams and sun cream?

    Some cosmetics contain food ingredients, for example, some creams contain nut oils. It’s difficult to determine the level of risk posed by cosmetic products containing food ingredients, however, unless the allergic child accidentally ingests the cream it’s likely to be very low. Anaphylaxis from skin contact with the product alone is extremely unlikely, however, contact reactions such as a skin rash/hives could occur. Nut oils are made from the fats of the nut, so likely have very little amounts of nut protein in, reducing the risks further as the proteins cause allergic reactions.

    Further information about food ingredients in cosmetics can be found in our factsheet.

  • Could children kissing each other be a risk?

    Kissing can be risky if someone eats a food that the other person is allergic to. Allergens can remain in saliva for several hours – anywhere between 2 and 24 hours, and even brushing teeth may not get rid of them effectively. If, for example, a child eats something then kisses a child allergic to that food on the cheek, this is unlikely to cause anaphylaxis, but a contact reaction such as a skin rash/hives could occur.

  • Is it safe to hatch chicks in the classroom around children with egg allergy?

    Generally speaking, watching chicks hatch in an incubator poses no risk to children with egg allergy, but all children should be encouraged to wash their hands after touching the incubation box in case there is any residual egg content on it. There is a little more risk when it comes to children handling the chicks. Speak with the parent/carer about the activity – they may want to ask their child’s allergy specialist, who is best placed to answer a question about an individual child and their sensitivity.

Tips to keep children with allergies safe

  • Tables should be cleaned thoroughly with hot, soapy water before and after meal and snack times.
  • Everyone wash their hands before and after meal and snack times.
  • Wash all utensils, straws, cutlery, plates and cups in hot, soapy water.
  • Use different coloured plates/drinking cups for children with allergies.
  • Have a “no sharing” rule for food and drinks.
  • Staff watch over children while they eat, wash and clean up.
  • Any toys that are likely to be in infants’ mouths should be washed on a daily basis.
  • All activities should be risk assessed. Staff need to check that any materials used are suitable for children with allergies.

Interested in fundraising for us?

Contact our fundraising team

UK Guidance & Useful Links

English guidance

Early years foundation stage (EYFS) statutory framework

English guidance

Example menus for early years settings in England

Welsh guidance

Food and nutrition guidance for childcare providers

Welsh guidance

National Minimum Standards for Regulated Childcare

Scottish guidance

The Early Years Framework

Scottish guidance

Food Standards Scotland - Childminders

Northern Ireland guidance

Early years education and learning

Northern Ireland guidance

Guidance for pre-school education providers