Talking Allergies

What are the issues about dropping your child off and handing a stranger an epipen ? My wife works for a company than runs children's gym classes. A mother has handed her an epipen and said "use it on my child if he needs it" !!!

Do you need training ? Should you require a doctors prescription ? Can you do any harm if you use it inappropriately ? Do you need a legal form to "consent to administer medicine". If another kid from the class gets the epipen, can he harm himself or others ? Are there legal/liability concerns ?

We are very uncomfortable with the situation and the company is not really providing any answers or support.

Help !!!

Training would be a good idea. I remember when I was prescribed an epi-pen by the allergist, and at my next appointment with my regular doctor, he brought out his dummy pen and asked me to show him how to do it. I didn't do it right. And this, from someone with an allergy! The most common mistake is not holding it around the tube part. If you hold it near the front, you could set off the needles and give it to yourself by accident.

My understanding re doing harm was that you do need medical attention after getting dosed with one, because it does an immediate physiological effect on the body regardless of whether the dose was needed or not. But the effect wears off. You can do a lot more harm by NOT giving it, and I was always told to err on the side of caution and when in doubt, give them the dose.

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Asthma and eczema
Drug allergy (succinylcholine)
Food (corn, raw apples, green beans, tree nuts, flax)
Misc (pollen, grass, mold, dogs, cats)

I always carry a trainer. Someone once explained that rather than say "Let me show you how..." you can say, "Do you know how? If they say yes, pull it out and matter of factly say, "Please show me." If people think they know how, they won't really listen to you. This gives you an opportunity to see whatthey know and to correct them if necessary.

I try to be very approachable and most people who know me, know that they can ask me any question and I will gladly tell them or find the answer if I don't know.

Before I go somewhere that I think I might drop my daughter off at, I try to call ahead so that there aren't any surprises. At birthday parties, I usually start the conversation with, "D--- is really excited about so and so's birthday party. Where you aware that she has food allergies?... Yes, they are really serious , Epi-Pen and the whole nine yards.... Yes, we've been to the hospital 2x so far but don't worry, each time she was fed at home. She's really good at functions and won't eat anything that we haven't sent.....Before I tell you if she can come may I ask you a few questions?...Will you be feeding the children anything other than the cake? I'll make a cupcake for D---. Do you plan on playing games before or after the cake?

At this point I ask if I can stay for the party because myh daughter is very timid and wants me there. If I thought there'd be a problem I wouldn't ask and plan to sit in the car outside the party. I don't offer to teach the parent because I don't think they would retain the information just prior to a party.

I usually make myself very useful. I take pictures with my digital camera and give the mother a disk with a slideshow afterwards.

No one has ever told me not to stay-usually they ask me to!

I haven't left our daughter too many places. (I'm a control freak)

I have left her with my girlfriend and her husband, IKEA ballroom, my mom and with her Sparks leader.
1. Girlfriend has an Epi-Pen herself.
2. Girlfriends husband - knew about the allergies in advance-brought all food which she would be eating, vetoed the Cheesies and gave him a quick lesson on the use of Epi-Pen and asthma medication, reviewed allergy/asthma plan, made sure he had my cellphone #, showed him where all of her contact info was.
3. IKEA ballroom inquired about their first aid training, reviewed Epi-Pen procedures -I was in the building.
4. Mom, reviewed Epi-Pen and allergy/asthma action plan.
5. Sparks leader is a nurse - asked her to show me how she would use the Epi-Pen. reviewed the allergy/asthma plan ensured she has our cellphone #.

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Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb

That isn't a good situation! Parents should *not* be simply dropping their children off with an epi. How are people supposed to know when it should be used! There is a chance, though, that the parents themselves might not have all the necessary info. to look after their child's safety.

In my opinion, any company which deals with children ought to have a plan in place for dealing with potential emergencies . . . including allergic reactions.
If the company just isn't providing any support (!), perhaps you could ask the parent for a signed doctor's note . . . and maybe you could have the parent sign a consent form.

Here are some good resources (provided by Canadian allergists):
http://www.allergysafecommunities.ca/pages/default.asp

I'd speak with the parent about the issue and I'd ask him or her to demonstrate how to use the epi. Who knows--the parent might be a bit fuzzy on how to operate the epi him or herself. (Doctors often prescribe epis and don't demonstrate how to use them!)

The other thing I'd ask the parents for is for an "action plan" from the allergist/family doctor detailing exactly under what conditions the epipen should be administered. (Very important!)

Another option might be to speak with a pharmacist . . pharmacists at Shoppers Drug Mart provide training on how to use the epipen. (They *might* help someone out who isn't prescribed one.) Good luck with this!

How old is this child? Is the child old enough to recognize their own symptoms and are they able to communicate that they are having a problem? Personally, I would not feel comfortable having a child at risk for anaphylaxis in my care if I did not know the signs and symptoms and how to administer the Epipen if the need arose. Does your wife even know what the child is allergic to? It's important to know that reactions not only happen during or immediately after a meal with allergen exposure, there can be a delay in the onset of symptoms. Also, trace amounts can be transferred through hand holding and then into mouths, and spark a reaction too. I'd have your wife explain the reasons why she didn't feel comfortable with how she was left last time (I would think that a parent would be more concerned that your wife knew these things prior to leaving their child in your wife's care). If this parent will not provide your wife with any info or training, I would insist that she stay during the gym class. See if your wife can get support from her employer to take this stance. Her employer should really be giving her more support around this issue. It's just an unsafe situation all around.

That's really unfair of the mother to just drop this on your wife.

That said, I agree with Helen, there needs to be training and the mother should provide an anaphylaxis action plan (can find on the allergysafecommunities site that Helen has provided).

Now re the Epi Jr. itself:

First, it's a drug that is considered safe for most children - even if used in a reaction where it wasn't really anaphylaxis. Best to know the signs, symptoms, and reaction prevention strategies - again, the best site is the one Helen pointed out.

2nd. It's really very easy to use, don't be afraid of the training. To get an Epi trainer kit, and if your wife just wants to ask some questions, I'd recommend calling Catherine McGill at EpiPen. She's at 1-877-374-7361. Or you can order a kit from their site - you can click through on the banner ad at the top of this page. In fact, on the site they have a video showing how the pen works.

3. Liability - the Good Samaritans' Act protects people from liabilty in the case that - say, you used the EpiPen and then the mother complained that it was used. If the person perceiving it as an emergency acted in good faith, the law is on your side. All teachers in Ontario, for instance, are now told it is their responsibility to administer should a child be having a reaction.

4. Other children - EpiPens aren't toys. It should either be strapped on a holster or pouch on the child. Or if the child is too young, your wife should have it in a place such as a drawer that's easily accessible to her, but not to the kids. One caution, I've not heard of instances of other kids playing with Epis, but there certainly have been instances at schools of keeping EpiPens locked in the principal's office - and then principal goes to lunch. Tell your wife to make sure she knows where it is and other staff do too - and that it's not locked away.

But above all, tell her this should not have been thrust upon her in such a scary fashion. Blindsiding someone is a terrible way to introduce a highly manageable condition.

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Allergic to soy, peanut, shellfish, penicillin

I agree with what everyone else said.

I also think somekind of consent form/emergency plan should be filled out by the parent when they leave an allergic kid with your wife. Being prepared in case of emergency is very important in cases of allergy. Also, even with the good samaritan act, it's preferable to have authorization to use medicine on a child... At daycare, they won't even use moisturizer without a prescription!

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Me - Kim - No allergies
DH Ben - 31 - Allergic to nuts and peanuts, lots of environmental allergies.
DD Anne - 4 - Asthma. Allergic to dairy, eggs, mustard, kiwi, peanuts, wheat and barley... for now...
DS Francois - 1 - No allergies so far...

Thank you for all the responses.

I forgot to mention that the gym class is for 3, 4 and 5 year olds. The small training that my wife did receive involved talking to the adult who was having the reaction - and veryifying with them that they were having a reaction that required the epiPen.

This does not seem to apply to these very young kids - who, in general, could be incapable of describing their condition and needs in the moment...

At that age I agree, the child may not be able to describe what they are feeling. And the child may have no memory of any past reactions.

However, they can have a carrier that is safe. My son has been wearing his own belt since he was in jk. He can wear it during gym class as well -- although some teachers insist it be removed when they use climbers.

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I do know of one instance when a child got hold of someone else's epi-pen at school. The child then injected himself in the hand -- which from what I understand is one of the dangerous places to use it. He was taken to hospital by ambulance, but he was fine -- just a little more hyper then usual.

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Will your wife's employer pay for CPR/First Aid training? Usually epi-pens are now part of the training -- she can specifically request it when she books it. If the employer will not pay for it, it is tax deductable in Canada (expense for employment) if the cost is over $100 -- which it usually is. I'm surprised the employer doesn't have some kind of medical forms to be filled out considering such young children are being left without parents there.

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self: allergy to sesame seeds and peanuts
3 sons each with at least one of the following allergies: peniciilin, sulfa-based antibiotic, latex, insect bites/stings

Maybe it should be on the registration form. Youknow something like, "Does the individual have any health conditions that the staff need to be made aware of?".

This would allow the instructors to identify issues before they arise. Drop off for the first class can be caos. Not the time that I want to review polcies and training.

Perhaps she can discuss this with her employer.

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Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb

Personally, my kids attend gymnastics, dance and skating and I NEVER drop them off. I always stay. If the parents want to drop them off...then it has to be up to the activity teachers to decide IF they are comfortable with the parents leaving. If they are not comfortable being put in charge of an "at risk" child...then ask the parents to stay.

I also wanted to add that while my kids NEVER drink from the public fountain at their gym class...I know other allergic kids do and it freaks me out! It is very risky.

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DD age 9 1/2 -peanuts, nuts,
DD age 7 1/2 - milk, eggs, chicken, peanuts, treenuts, cats, dogs,
DS age 2 1/2
Husband- asthma, eggs, treenuts, fish, shellfish environmental
Self - penicillan, eurithromiacin, mild laytex allergy.

I'm with you - I would never leave a 3-5 year old whether they have allergies or not. I have a 9 year old boy who takes martial arts. In this case, I know the staff is trained and I would leave him quite comfortably. I was very upset once where my friends took him and their son to class (his epipen was in his bag) and left without informing the staff. I still don't leave him as the class is only 45 min and its not really worth my while or worrying about it. If I did, the procedure is to inform the staff and give them the epipen.

As for my non-allergic 4 year old - I never leave her in classes (dancing, gymnastics) , just because I think she might need my assistance for going to the bathroom, etc. and frankly I think its a bit young.

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Jacqueline Labossière-Jager
Stittsville, ON

son - born 1998, allergy to peanut, nuts, sesame, shellfish and kiwi; a bunch of allergies to plants, animals, etc. and asthma
daughter - born 2003, no known allergies

I worked in a nonprofit for youth and the guideline was we would assist a child to dose if needed. So essentially adult would prepare the pen and holding the childs hand on the container dose the child. I'm sure there is some legal on why it was done this way. Maybe someone else would know the exact rational.