Open Discussion Forum

  • 1.  FPIES Advice

    Posted 07-17-2018 06:36 AM

    Hello All,
    I'm Lizzie and I teach infants and toddlers and I practice 3 year looping at a Reggio inspired school. I have been a looping infant-toddler teacher for 13 years and I have worked at my center for a total of 17 years.

    My current class is at the end the infant year of our 3-year loop, but in August the class will transition with me to a young toddler classroom. We engage in family-style meals at our center around home-like tables (not kidney shaped ones). 

    Currently I have a child in my classroom with FPIES, a rare and serious allergy condition. Here is a link if you would like to know more about the condition: http://fpiesfoundation.org/about-fpies-3/. Essentially, we need to keep the child away from any of the six trigger foods that we know the child is allergic to AND ALSO any other food that the child has not yet tried. If the child consumes one of the trigger foods, we then must go to the emergency room. We have been developing our own safety protocols since the child was diagnosed, however, I am curious what other practitioners are doing in the field. So, I was wondering if anyone out there has practical advice for me about keeping a child with FPIES safe during meal times and clean up after meal times in a toddler classroom. 
    At this time I am thinking about:

    • What is the safest seating option for this child? 
      • We currently have her in a high chair while the other children eat at the table (we still do have a couple of the smaller children in the class who also use high chairs)
      • However, in August when we transition to the young toddler room we usually have all the children sit at the table. However, I tend to feel safest with this child remaining in a high chair to keep her safe, but since our center (and I) highly value family style eating I am concerned about her beginning to feel alienated over time eating in a high chair when everyone else eats at a table.
        • I am grappling with my values about family style eating and her safety and I would appreciate hearing different perspectives on this…However, in my internal struggle safety is really foremost in my mind.
    • For other toddler teachers who have navigated concerns with this diagnosis, what strategies do you use for post-meal clean up and maintaining the child's safety from accidental exposures to food?
      • Do send the child to a structured activity/experience/or specific area?
      • Do you send the child out of the room completely?
      • Bank on the child being engaged in learning areas in the room?
      • Other strategies
    • Do you have other table safety strategies you might share?
    • Are there other concerns, important lessons, or sage advice that you would like to share with me?

    I appreciate you taking the time to read this post and comment! Many thanks!

    Lizzie Kelly



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    Elizabeth Kelly
    Demonstration Teacher
    University of Tennessee Early Learning Center for Research and Practice
    Knoxville TN
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  • 2.  RE: FPIES Advice

    Posted 07-18-2018 07:03 AM
    That is a daunting challenge. Have you considered one of those traveling booster seats? They fit on a standard chair and offer a high-chair style tray or the ability to pull the child right up to the table. By using the tray, you can control the space in which the child has access to food items while allowing the child to still take part in family-style dining. 
    In terms of cleanup and protocols, perhaps the child's family can provide the necessary information needed via their treating physician?

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    Tara Guido
    Kindergarten Teacher
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  • 3.  RE: FPIES Advice

    Posted 07-18-2018 11:31 AM
    Hi Lizzy,

    We also have a toddler in our program that has FPIES. It sounds like you are handling her care similarly to the way we have been doing. Our infant toddler classrooms (more similar to an open landscape apartment) have children from 2 months up to 3 years old together. We have tables and high chairs in the kitchen space, so we have been able to keep her in the highchair along with some other children around her age. We can then transition her to a separate play area with a teacher and group of children after the meal.

    We will be experiencing the scenario that you have mentioned when she ages up to our Preschool program. I'm curious to hear how you proceed, and how it goes. I also look forward to hearing about any other programs that may be familiar with FPIES.

    Mary

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    Mary Cain
    Executive Director
    Stony Brook Child Care Services
    Stony Brook NY
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  • 4.  RE: FPIES Advice

    Posted 07-18-2018 01:24 PM
    Thank you both for your replies! I have asked the parents for a little more information from their medical team about more practical advice (other than the emergency care plan) and how child care providers can provide the ultimate in safe care for the child with FPIES and still care for the group. We have an activity studio space next door to our classroom that also offers some "break away" space that we might utilize as well. 
    One of my goals is to assess her receptive language and give her more challenges where that is concerned because I think her ability to follow one-step and two-step directions over the next year will be important...Knowing that she can listen to a teacher prompt regarding moving away from the meal area or an undesired food item will be important.

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    Elizabeth Kelly
    Demonstration Teacher
    University of Tennessee Early Learning Center for Research and Practice
    Knoxville TN
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  • 5.  RE: FPIES Advice

    Posted 07-18-2018 04:17 PM
    I appreciate how thoughtful you and others are about this difficult situation.  The only similar situation I had as a teacher was with severe food allergies.  I had a child in my classroom with a severe allergy to dairy, including a contact allergy.  Since many of the other children brought yogurt for lunch and yogurt tends to get on everything, the parents agreed to not send yogurt in their child's lunches.  If someone forgot we made sure to sit the child with he allergy at a different table.  Though the child in your class may not react to skin contact with a known trigger, since he's so young if it got on his skin he's be likely to lick it off.  I wonder if you could consider a request that parents not send certain foods, similar to the no yogurt rule that we had.  Once parents realized that the allergy was serious, even life threatening; they were all on board.

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    Aren Stone
    Child Development Specialist
    The Early Years Project
    Cambridge, MA
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  • 6.  RE: FPIES Advice

    Posted 07-19-2018 07:09 PM
    I have had a young child with severe allergies to eggs, nuts, peanuts and dairy as well as a few other minor allergies.  All of his triggers caused severe anaphylactic reaction.  He began with my program at about 2.5.  With parent approval, we had a constant conversation about keeping our food "Braiden-safe."  I usually sat him between two of the most "responsible" children at the end of the table.  I felt it important that he learn to live with his allergies, eat and socialize with the other children.  All of my children have their own place settings, and we color coordinate all -- Some duplication occurs but I was sure to have his color NOT be duplicated and drummed into my own routine that if I see orange, I must stop and think.  Additionally, I worked with Braiden that EVERY time I or anyone served him any food he was to ask "Is this Braiden safe?" before his even tasted it.   If the other children didn't hear it, they were to ask.  He's been away for the summer, and the other children are still asking me if its Braiden-safe.  It worked.  Braiden is off to kindergarten this year, and Mom and I are reasonably comfortable that he is prepared to keep himself safe.

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    Sheryl Eichenlaub
    Bethel Park PA
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  • 7.  RE: FPIES Advice

    Posted 07-19-2018 07:37 PM
    Oh, and for clean up time..... I made an effort to serve only Braiden safe foods.  However, when we did have food that might trigger an allergic reaction for Braiden just with contact and was messy (i.e. yogurt), Braiden was to clean his area first, be first in the bathroom to wash up after the meal, and proceed to the next activity. Fortunately, he was usually done first anyway.  As he approached five, we even had real peanut butter quite often and were quite successful in teaching not only Braiden to be safe but also the other children to be aware of their responsibility to their friend.

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    Sheryl Eichenlaub
    Bethel Park PA
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