In the summer of 2001, Congressional Camp found itself hip deep in allergies. Of the 490 campers on our campus, 222 had identified allergies. This fact left us limp and sweaty with concern ... and it wasn't because of the humid Virginia summers.
We knew that food allergies never take a break, never rest, never leave well enough alone, and never forgive a tiny transgression -- "just this one time." The worry about an exquisitely allergic child is continuous -- for the parents and for our director and staff.
A million questions swarmed like mosquitoes around our heads. How would we manage? Could we trust the counselors we hired to maintain the necessary precautions? How could we possibly avoid milk and peanut butter? After all, peanut butter crackers and ice cream are the staples of summer. Would allergic kids let us know if they felt bad or accidentally contacted something? Could we keep the medications organized and available, yet safe?
We realized that educating our staff was a big priority. The camp nurse was consulted and laid out some things for us to think about.
1. True allergies are not food whimsies of a child.
2. Food allergies are not necessarily based on religion nor self-imposed as voluntary food restriction.
3. Food allergies come in a variety of degrees of seriousness.
4. Food allergies can kill.
We consulted a leading authority in the field of food allergy, the Food Allergy & Anaphylaxis Network. Camp directors can find enthusiastic encouragement from the Food Allergy & Anaphylaxis Network. No one understands how important vigilant attention to detail is like this group -- an organization that knows of many children who have perished from accidental exposure to a common food.
The Network shared a story of a fourteen-year-old camper who went on an all-day canoe trip. When the group stopped for lunch, the counselors pulled out the previously set aside jelly sandwich for the food allergic canoeist. They then proceeded to make peanut butter sandwiches for the rest of the party. They realized that the girl's jelly sandwich was not cut, so they carefully wiped the knife and cut the sandwich. Everyone began to eat. In a very few minutes the counselors knew they were in serious trouble.
The trace amount of peanut butter on the knife was sufficient to precipitate an allergic response in the girl. The counselors realized too late that no one had thought ahead to bring the girl's emergency medication -- No one had thought to bring a cell phone to be able to call for help. No one could do anything to stop this young girl's body from collapse. Within minutes she was dead.
After reading some literature, viewing the nurse's videos, and talking over our mutual experiences, we felt it was best to start by talking with the parents and campers. Our camp director and nurse invited each parent to come for a visit and to give us the details of his or her child's allergies.
Learning from Parents and Campers
It is from the parent that a clearer picture of the extent of the allergic sensitivity can be determined. For instance, could a peanut allergic child be in the same room with others eating peanut butter or would the camper need to be isolated? The parent is the person best able to explain what has happened during previous contacts. Did the child have to go to the emergency room or was an oral antihistamine sufficient to stop the allergy in its tracks?
We created an Emergency Allergy Form so that the parent could formally authorize the camp officials and the nurse to give medications and proceed with emergency care in an orderly way. We use our own form, but an excellent form is available on the Food Allergy & Anaphylaxis Network Web site.
We were also able to talk with the camper and determine if the child had sufficient maturity to be able to cooperate. Could this child be trusted not to eat food offered from a best friend's lunch? If the child began to feel bad or realized that he/she accidentally ate something that was forbidden, would they feel it was important to report it to an adult? This is a fine-line judgment call, and we recognized that in every case nothing substitutes for proper supervision.
To increase and maintain an adequate level of staff awareness on the serious nature of severe food allergies, camp directors and camp nurses need to remind, reeducate, reinforce, and restructure, as necessary, the issues surrounding food preparation procedures, serving techniques, impromptu snacks, and "care" package inspection.
Our next step was to share as much about food allergies as we could with our staff. We had to teach them how to read a food label and to look for hidden ingredients lurking in unexpected places. For instance, who knew that hot dogs contain a binder made of milk? We learned that some Fig Newton cookies have ground peanuts inside. We taught everyone that they had to read every label every time. Recipes change and new warnings on labels are posted all the time.
The staff that we hired was indeed very conscientious, but in the heat of a late, lazy summer afternoon one of our campers asked, "Can I eat this?" Forgetting that those words are code for "I arm one of your super allergic kids," the counselor muttered, "Sure."
The label that was glanced over showed cholesterol, calories, fat, vitamins, but on the underneath side -- the ingredients held the real message -- "May Contain Peanut Particles." The counselor turned about in time and saw that the child was very pale, starting to cough, and was showing signs of distress. The nurse was notified, and our emergency planning went into full swing.
After a wild afternoon of medications and concerned parents flying through compacted traffic, we went home grateful that all was well.
Even though a child may not have had an allergic response in a long time, camp cannot function as an experimental venue "to see if he is still allergic." All experimentation of that kind must be done with a physician and parent in attendance in a hospital where extensive rescue equipment is available. We have irritated some parents when we wouldn't let their allergic child go on a field trip and "eat the foods the others are eating 'cause he wants to so bad.'" We can't accept that level of risk.
The child, teenager, or anyone with food allergy requires special planning, separate foods, emergency plans, AND huge doses of acceptance, inclusion, camaraderie, and fun that only the camp experience can bring.
RELATED ARTICLE: Managing Food Allergies at Camp
Food allergies can be life threatening. In any camp setting -- day camps, residential camps, and sports or travel camps -- the risk of accidental exposure for the very sensitive is present. Camp staff, physicians, parents, and campers themselves must work together to minimize the risk. There must also be medications and procedures in place to cover any occasion of accidental contact.
The sharing of information implies a willingness on the part of parents and campers to suspend some guarded privacy. Allergy information must be shared but dealt with in a reasonable and supportive way. Camps do not need to post allergic campers or staff in the manner of "advertising," but put information in a discrete but accessible, useful place
* Notify the camp of the camper's allergies or suspected allergies.
* Use the camp application to fully describe the allergy.
* If necessary, attach a detailed explanation of the nature of the sensitivity.
* It is important to let the camp director know about the allergy early in the process so that appropriate personnel can be hired.
* Make personal contact with the director, counselor, or the division supervisor before the camper's arrival at the facility. Make certain that the camp director notifies all affected personnel of the allergy.
-- pool lifeguards,
-- transportation drivers,
-- dining hall/cafeteria workers,
-- camp nurse, counselors,
-- specialty area workers, and
-- anyone else who may offer food, and/or plan parties or events.
* Provide the camp with a recent photo of your child, attached to written instructions, medical documentation, and medications as prescribed by the physician for handling accidental contact.
-- Do not simply transfer school documentation.
-- The specific camp personnel need to be authorized and instructed on how to proceed.
-- The camp may have an Allergy Action Plan, OR use the Food Allergy Action Plan from the Food Allergy & Anaphylaxis Network.
* Check the expiration date of all medications. Be prepared to replace any expired or unsealed, previously used medication. Review with the camp director and nurse the location and storage of medications.
* Educate and review often with the camper the self-management of their food allergy. The family should teach the child his or her personal reactions and needs.
* The camper should know:
-- safe and unsafe foods,
-- strategies for avoiding exposure to unsafe foods,
-- symptoms of allergic reactions,
-- how and when to tell an adult about a possible allergic response, and
-- how to read a food label, if age appropriate.
Although there are expectations for the child camper, camp directors and experienced counselors understand that the camp setting blurs the edges of judgment. Nothing takes the place of constant supervision to prevent mistakes that could be fatal.
* Camper must NEVER trade food with others.
* Camper must not eat anything with unknown ingredients.
* Camper should read every label and check with counselor, if age appropriate.
* Camper must be proactive in the management of discreet reactions and understand his or her own body's cues that something is wrong.
* Camper should tell an adult if a reaction seems to be starting, even if there are no visible signs of allergic response.
* Camper must never go off alone if symptoms are beginning.
* Be informed of the availability of emergency care and know:
-- how to contact EMT/ambulance,
-- how much time is needed for an emergency crew to arrive, and
-- how far it is to the nearest hospital, and if the hospital has a medical doctor present at all times.
* Camps located in nonurban settings must understand that rural ambulance and emergency crews may be volunteers. Therefore, additional plans and additional medications will be required.
* Someone needs to carry a cell phone on any trips away from camp site.
* Review the health records submitted by parents and physicians.
* Establish the prevention protocols for your camp.
-- Make plans so that the food allergic camper may be safely included in all activities.
-- Be certain that all food service or kitchen personnel are aware of the allergic child.
-- Post a photo of the child in the serving area.
-- Discuss meal plans and alternative plans with the parents and the camper.
-- Plan how camper will participate in meals. For instance, the food allergic camper should go first in a buffet line to avoid the chance of accidental cross contamination or he/she may need a place to sit apart in a special nut free space.
* Assure that all who will be in contact with camper know of the allergy and can recognize the symptoms of allergic response.
* Maintain an appropriate sense of confidentiality and respect for individual privacy. Even though privacy concerns must be modified in service of the health and safety of the individual, respect can always be displayed across all ages and gender.
* Identify your Camp Core Emergency Response Team. The team should include, but is not limited to the camp nurse, camp director, and counselor.
-- Arrange to have this team meet with the parents and camper prior to the opening activity, on or before the first day of camper's participation.
-- Assure that the nurse has the required authorizations and appropriate medications to manage in the event of accidental contact.
-- Assure that appropriate personnel are familiar with Epipen usage. Be sure that travel personnel understand that Epipens must be stored in a correct temperature range. The medication is rendered ineffective if left in the sunshine or inside a closed vehicle.
* If there are planned field trips or out-of-camp activities:
-- Be certain any emergency medications and authorizations accompany the camper and the counselor.
-- Be certain there is a way to contact emergency assistance.
-- Enforce a "no eating" policy in the vehicle.
Congressional Schools and Camp is an ACA-accredited program located in Falls Church, Virginia, a wooded suburban area outside of Washington, D.C., which serves a wide ethnically and culturally diverse community of children in several camp sessions.
Contact the Food Allergy & Anaphylaxis Network for further insights and excellent publications at www.foodallergy.org or 800-929-4040.
Cassandra Piper has been the director of Early Childhood/Great Adventures Programs at Congressional Schools and Camp for five years. She has a B.A. in psychology and an M.A. in child development. She has accumulated sixteen years of experience teaching and administering programs serving young children.
Helen Rebull, B.S.N., R.N., and N.C.S.N. has been the camp nurse at Congressional Schools and Camp for two years. She is a member of the Association of Camp Nurses. Rebull has ten years of experience as a school nurse and thirty years experience managing allergies in children as a parent.
Greg Cronin, Congressional's camp director, served as consultant on this project.
Photos: Page 20, Tarheel Triad Girl Scout Council, Sophia, North Carolina/G. Taylor; page 21, YMCA Benjamin Harrison Day Camp, Indianapolis, Indiana/P. Hammond; page 24, Camp Young Judaea, Amherst, New Hampshire/M. Zidel.
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|Date:||Jul 1, 2002|
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