Infants and toddlers with severe food allergies are particularly vulnerable. Babies who can't yet speak depend entirely on the adults around them. Toddlers may be getting a grasp on what their food allergies are. Yet, being able to explain their allergies to adults lies off in the future.
Given this vulnerability, childcare centers and their workers take on a critically important task when they care for young kids with food allergies. They simply must be prepared for anaphylaxis. However, there remain big gaps in childcare centers' knowledge of managing severe food allergies.
The good news is – childcare workers in a growing number of U.S. states are finally getting the anaphylaxis training they need and deserve. This involves a concerted advocacy effort and is a work in progress.
Thomas Silvera's name is synonymous with this massive effort. “At the heart of this is one simple belief: Change is possible,” says the executive director of the Elijah-Alavi Foundation (EAF). “We have seen it happen," Silvera says with no small measure of hope. "Laws get passed, childcare centers trained, staff gain confidence, and communities become safer.”
The mission of Silvera’s foundation aligns closely with the goals of the Early Childhood Anaphylaxis Collaborative (ECAC or the Collaborative), of which he is a founding partner. The Collaborative is on a mission to boost knowledge and provide tools for those caring for young children with food allergies. (It welcomes advocates to join the cause here.)
Silvera has seen firsthand the difference anaphylaxis training makes to individual childcare workers in a center. He speaks of staff who feel trepidation about making a mistake under pressure. With training, they change from fearful to ready to act.
“One of the most powerful things we witness is the transformation in a staff member,” Silvera says.
Crucial to Know: Allergies Will Emerge
Children aged 0 to 4 are the group with the highest rate of food allergy, notes Jenna Riemenschneider, the Asthma and Allergy Foundation of America's vice president of policy and advocacy. (AAFA is another of the ECAC's founding partners.)
In fact, about 75 percent of early childcare professionals reported working directly with food-allergic children, according to a data analysis cited by the Collaborative. Additionally, 1 in 4 childcare staff reported witnessing a child’s allergic reaction to food while on the job.
To add to this context, about 60 percent of all American children under the age of 5 are in childcare. Riemenschneider calls early childhood settings – from preschools to daycare – "a crucial place for emergency preparedness.”
Early childcare expert Lori Buxton raises another food allergy concern. The executive director of the Association for Early Learning Leaders (AELL) reminds that infants and toddlers keep adding new foods to their diets. And that is when allergies can reveal themselves.
“As new things are introduced, there is the risk that something is going to go sideways,” Buxton says.
Yet, policies for allergic emergencies in the early childhood learning environments have traditionally been more reactionary, she says. “We didn’t have the resources, the training or the collaboration,” says the head of AELL, another ECAC partner.
She's witnessing improvement, as childcare policies evolve, laws pass, and as Collaborative representatives meet with hundreds of early learning leaders. However, with almost 100,000 childcare centers in the U.S., the task is immense. This is why the Collaborative is urging those interested in this awareness mission to get involved.
"Real change happens when ordinary people decide that a child's safety is worth speaking up for," Silvera says. "Every major advancement in food allergy policy began with a parent, caregiver, educator, healthcare professional, or advocate who chose to get involved."
Food Allergy: Training is Everything
It is incumbent upon childcare centers to create strategies to prevent and respond to allergic reactions, Buxton says. However, she has seen many childcare center owners worry about the threat of lawsuits, especially related to the need to administer epinephrine in anaphylaxis.
Her view is that proper information may ease legal concerns while training makes the protocols succeed. “Knowledge brings confidence, and confidence brings best practices,” she says.
Silvera agrees and stresses that training gives staff members a plan to manage an anaphylaxis emergency, so there's no delay. “If you train, it stays in the brain,” he says.
Staff know what symptoms to look for, the steps to take, when to administer epinephrine and to call 911. These are key aspects of Elijah's Laws, which have been passed in several states in honor of Silvera's late son. “In an emergency situation, hesitation can cost precious time, it can cost a life,” he says.
Silvera notes that leaving a child with allergies or asthma in someone else’s care "can be emotionally heavy.” But staff anaphylaxis training both creates a safer environment for children and provides peace of mind to parents.
When childcare workers understand the food allergy policy and practices, "they'll have the tools readily available and respond when seconds matter," he says.
The Collaborative notes that preparedness boils down to some key steps. It starts with an Anaphylaxis Response Plan that includes:
- Measures to prevent allergen exposures.
- An action plan to help recognize severe allergy symptoms in all children, including babies and toddlers.
- Training on allergic reactions and when and how to use an epinephrine device.
- And preferably, having stock epinephrine on hand for first-time reactions.
Childcare: Elijah’s Law Momentum
An important aspect of childcare staff education is that an allergic reaction can look different in infants and toddlers, Riemenschneider says. Common symptoms for young children include skin reactions, swelling, vomiting, and diarrhea, but also behavioral changes (fussy or withdrawn).
Training is clearly vital, yet state support for it is anything but consistent. State-level policies protecting children with food allergies in childcare programs vary widely, according to a report published by AAFA and EAF.
“Many states do not require basic safeguards families would expect,” Riemenschneider says. Those include food allergy care plans, staff allergy training, clear emergency communication plans, and food-service policies that address allergies.
Silvera and EAF co-founder Dina Hawthorne have been instrumental in advocating for legislation that ensures childcare centers are better equipped for food allergy emergencies. The work they do through their foundation is in memory of their 3-year-old, Elijah-Alavi, who died of anaphylaxis in 2017. Elijah was at his New York City preschool when he was served a grilled cheese sandwich, despite his known dairy allergy. The preschool then failed to call 911.
The young boy’s legacy is Elijah’s Law, legislation requiring anaphylaxis protocols in childcare centers. Since Elijah’s Law first passed in New York state in 2019, the foundation’s work has grown into a national movement that continues to gain momentum.
Most recently, in July 2026, Elijah’s Law (part of House Bill 2372) became law in Missouri. Versions of Elijah’s Law have also passed in California, Illinois, Maryland, New York, Arkansas, and Virginia. Kansas City also passed an Elijah's Law at the city level.
Childcare Still Lacks Stock Epinephrine
A key tool in emergency preparedness is stock epinephrine. A doctor prescribes it to an "entity" rather than an individual for use in an allergic emergency. Up to one-third of all food-allergic reactions in childcare centers or schools occur in children with undiagnosed food allergies, or the allergy is unknown to staff.
While almost all states have laws allowing stock epinephrine for K-12 schools, that's not the case with preschool. Riemenschneider says access to epinephrine is one of the big gaps in protecting children who experience anaphylaxis at childcare centers.
In New York, Silvera lobbied for stock epinephrine bills on the state level that would strengthen New York’s existing Elijah’s Law. The amendments (Senate Bill S8587A and Assembly Bill A9245A) mandate stock epinephrine for childcare centers. The revised law, passed on June 3, 2026, also requires that staff trained to use stock devices and recognize anaphylaxis are always on-site.
The push for stock epinephrine on the state level, followed success in New York City. Silvera helped develop a new city ordinance requiring that city childcare centers and schools have stock epinephrine.
About 33 states "allow" childcare centers to keep stock epinephrine. But Silvera notes that a much smaller number "require programs to have stock epinephrine on-site, ensure staff are trained, and establish emergency response procedures." The distinction is important to child safety.
Until stock epinephrine availability becomes more widely required, Buxton says that providing staff members with emergency allergy plans and training at the very least needs to be undertaken.
The Collaborative: Voices Raised
Advocates interested in helping improve childcare readiness are invited to join the Collaborative. Then to help get a bill like Elijah’s Law started in your own state, Collaborative partner AAFA offers advocacy guidance. Simply reach out to aafa.org/advocacyteam. The Elijah’s Law Report and Toolkit also has valuable resources.
Silvera says that change doesn’t always begin with state legislation or a city ordinance. Sometimes a childcare center willing to train their staff, or one family telling their story is the impetus for action.
“When I share Elijah’s story, it opens hearts. But strong policy language creates change,” Silvera says. “You need both."
Silvera and Hawthorne need the food allergy community's help. By joining the collaborative, individuals can "help shape policies and create safer environments for children in childcare centers nationwide," he says. "One voice may tell a story, but many voices working together can change systems and save lives.”
Joining the Collaborative here gives you access to essential childcare and anaphylaxis resources. ECAC founding members include Kaléo, early learning organizations, food allergy nonprofits and researchers, as well as Allergic Living.
“At the heart of everything, we all want to do the very best for these children," says educator Buxton. "We want to be prepared to do the right thing.”
This article was supported by Kaléo, Inc.
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