Childs Individual Plan and Emergency Procedure

Anaphylactic Allergies

CHILD’S NAME:(Required)
DATE OF BIRTH(Required)
EPI-PEN EXPIRY DATE(Required)

**Epi-pen must be administered immediately upon contact with the allergen. The severity of symptoms can quickly change. All the symptoms can potentially progress to a life threatening situation.

Children can experience a variety of signs and symptoms of Anaphylaxis Reactions (please circle symptoms your child demonstrates):

MOUTH
THROAT
SKIN
GUT
LUNG
HEART
submit this training plan to the centre where my child is enrolled which is to be followed by all staff, students, volunteers and visitors. The action plan below for
is to be used by the child care staff in the event of an anaphylactic reaction.

Person # 1

  1. This pen must be marked clearly with child’s name
  2. Remove Epi-Pen from the container and verify child’s name and prescription #
  3. Remove the cap
  4. Place the tipped end of the Epi-Pen against outer thigh or arm (please circle which one applies) and press firmly for 10 seconds
  5. Inject
  6. place the child on side in case of vomiting 
  7. Return Epi-Pen to container and give to the ambulance attendant
  8. Accompany the child to hospital with individual plan and emergency procedure and file

Person # 2

1. Call an ambulance (911). Give the operator the address and telephone number of the centre: 3150 Middle Side Road, Amherstbug On, (519-736-0100)
2. Call Parents

Strategies to Avoid and Monitor Risks Ensure that:

  • proper hand washing procedures are being followed
  • a no-nut policy is in place at centre
  • all parents and visitors are aware that food containing nuts can not be brought in
  • non-latex gloves are used at centre
  • all policies related to food, stinging insects, and latex are being adhered to
  • clear directions regarding child’s needs are given to staff, volunteers, students and visitors
  • at least once a year the Supervisor reviews plans with parents to update child’s allergy condition

give permission to designated staff at Paula’s Playhouse Child Care Inc centre to administer the Epi-Pen in the event my child has an anaphylactic reaction. It is my responsibility to advise the centre of any changes to my child’s allergies, required medication or my child’s individual treatment plan which includes providing an updated Epi-Pen when my child’s medication expires. I also give permission to strategically post this information about my child within the centre
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