Food Allergy Education and Management in Early Learning and Childcare Centres: A Scoping Review on Current Practices and Gaps.

Anaphylaxis has occurred in preschools/schools yet there are no consistent food allergy (FA) management practices in early learning and childcare centres (ELCC) across jurisdictions. Presently, there are no reviews that have synthesized FA-related knowledge and management practices within ELCC. We aimed to perform a scoping review of FA management in ELCC, and report on perceived gaps or barriers. A PRISMA-ScR-guided search was conducted for North American, European and Australian articles in English/French in the OVID-MedLine, Scopus, and PsycInfo databases. Two independent reviewers screened the titles/abstracts of 2010 articles and full-text screened 77 articles; 15 of which were specifically related to ELCC. If the two reviewers could not agree to the relevance of a given study, a third reviewer provided guidance. This third reviewer also screened French articles. Thematic and descriptive reports of the studies were presented. We reported solely on pre-Coronavirus Disease pandemic ELCC studies. We included ten articles in this review, which provide evidence that ELCC staff have variable baseline knowledge, comprehension, experience, and practices in place to manage FA. ELCC staff also have limited FA-related training and experience regarding administration of epinephrine auto-injectors (EAI). Emergency Anaphylaxis Plans (EAP) were described in four studies. One study reported the parental influence on the site's food purchasing and FA management. Three studies provided educational interventions, which demonstrated increased and sustained FA-related knowledge and confidence post-intervention. Participants deemed the training beneficial and desired annual training and more FA resources to be available. Across jurisdictions, ELCC staff have provided care and administered EAI in emergencies, but training remained variable. Communication and care planning amongst ELCC staff, and parents, is crucial. Annual education, available EAI and EAPs are tools necessary for effectively managing emergencies.

Winnipeg-based elementary school teachers' perspectives on food allergy management: a qualitative analysis.

BACKGROUND: Food allergy affects 7-8% of children worldwide. Teachers supervise children in school, where most children spend their day. Yet, teachers have variable food allergy-related knowledge. OBJECTIVE: We aimed to identify how Winnipeg-based elementary school teachers manage food allergy and prevent food-triggered allergic reactions in their classrooms and schools. METHODS: Kindergarten-Grade 6 public and private school teachers, from Winnipeg, Canada, were interviewed virtually upon providing written informed consent. Interviews were recorded and transcribed verbatim. The study followed a pragmatic framework. Data were analysed via thematic analysis by multiple researchers. RESULTS: We interviewed 16 teachers, who primarily identified as female (87.5%). Most teachers worked in public schools (87.5%) and, on average, had 5.8 years of teaching experience. We identified four themes within the data. Most teachers (68.9%) had direct or indirect experience with food allergy. Theme 1 described the minimal standardization and inconsistent enforcement of food allergy policies between and within schools. Teachers also had varied food allergy knowledge. Theme 2 reflected teachers' variable confidence/perceived knowledge towards food allergy management, including feeling of stress and anxiety. Theme 3 captured the lack of standardized food allergy education for teachers, and concerns about the adequacy of the current provincial program. Theme 4 described how teachers spoke of relying on other school staff, families and students to have effective communication. CONCLUSION: Teachers' food allergy management was informed by their knowledge and lived experience, guided by their school policies and individualized students' needs. Teachers identified gaps in knowledge and communication, and desired more training and resources.

Elementary School Teachers' Perceptions of COVID-19-Related Restrictions on Food Allergy Management.

(1) Background: Approximately 7% of Canadian children live with a food allergy (FA). Pre-COVID-19, ~20% of anaphylactic reactions occurred in schools. Yet, teachers reported poor FA-related knowledge, and experiences during the COVID-19 pandemic are not well-studied. Additionally, teachers' management approaches vary widely. We aimed to describe elementary school teachers' perceptions about FA management during the COVID-19 pandemic; (2) Methods: Using a semi-structured interview guide, English-speaking elementary school teachers in Winnipeg, Canada were interviewed virtually. Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically; (3) Results: Most teachers were female and taught in public schools. Two themes were identified. Theme 1, COVID-19 restrictions made mealtimes more manageable, capturing the positive impacts of pandemic restrictions such as seating arrangements and enhanced cleaning. Limited lunchtime supervision prompted some teachers to assume this role. Theme 2, Food allergy management was indirectly adapted to fit changing COVID-19 restrictions, describing how changing restrictions influenced FA-related practices. FA training was offered virtually with less nursing support. Class cohorts and remote learning decreased teachers' perceived risk and FA-related management responsibility; (4) Conclusions: COVID-19-related practices were perceived as positively influencing in-school FA management, although unintended consequences, such as increased supervisory roles for teachers and reduced nursing support, were described.

Food Allergy Education and Management in Schools: A Scoping Review on Current Practices and Gaps.

Currently, no synthesis of in-school policies, practices and teachers and school staff's food allergy-related knowledge exists. We aimed to conduct a scoping review on in-school food allergy management, and perceived gaps or barriers in these systems. We conducted a PRISMA-ScR-guided search for eligible English or French language articles from North America, Europe, or Australia published in OVID-MedLine, Scopus, and PsycINFO databases. Two reviewers screened 2010 articles' titles/abstracts, with 77 full-text screened. Reviewers differed by language. Results were reported descriptively and thematically. We included 12 studies. Among teachers and school staff, food allergy experiences, training, and knowledge varied widely. Food allergy experience was reported in 10/12 studies (83.4%); 20.0-88.0% had received previous training (4/10 studies; 40.0%) and 43.0-72.2% never had training (2/10 studies; 20.0%). In-school policies including epinephrine auto-injector (EAI) and emergency anaphylaxis plans (EAP) were described in 5/12 studies (41.7%). Educational interventions (8/12 studies; 66.7%) increased participants' knowledge, attitudes, beliefs, and confidence to manage food allergy and anaphylaxis vs. baseline. Teachers and school staff have more food allergy-related experiences than training and knowledge to manage emergencies. Mandatory, standardized training including EAI use and evaluation, and the provision of available EAI and EAPs may increase school staff emergency preparedness.