Au Pair Handbooks: Instructions about Child’s Allergies

by cv harquail on May 16, 2015

8753183037_79dba0f990_mAs part of a series of posts on very specific information to include in your AuPair Handbook…

One HostMom writes:

I need to update our handbook to for our incoming au pair with details on our child’s allergy.

I’m not sure what level of detail would be helpful, or how to make the issue serious (which it is) but not frightening (which it isn’t).

For example, does anyone go into detail about treating anaphylactic shock, such as using an Epi pen?

We’d love to see some examples as well as issues to consider, in the comments.


Image via Kristine and David Schmidt on Flickr


spanishaupair May 16, 2015 at 8:40 am

I think allergies are a very important problem on your kids safety and not all aupairs have dealt with allergies before, myself have never and i have been aupair four times and childminding for a while, so they might be clueless about what they might have to do in case of anafilatic shock.

My advice as aupair give as much info as possible in handbook and during matching, and of course during training.

UKAu Pair May 16, 2015 at 11:55 am

Put in as much as you think will be necessary for them to deal with it when you’re not around.

Anything the au pair needs to look out for (food allergy? Make sure she’s checking all the packets if she’s buying food. Is it so severe that the food can’t come inside the house at all?), anything she needs to do (DEFINITELY go through epipens, how to use them and where they’re kept) and any other important information.

In this case, more information is always better than less, particularly with very young children. I’d also expect an au pair with an allergy to make everything equally clear to her host family.

FirstTimeHM May 16, 2015 at 2:56 pm

We’ve got two kids with an allergy, so the au pair needs to know what she can give them and needs to be able to read the list of ingredients. The youngest one reacts with stomach aches, it’s bad enough for him but nothing near life threatening and sympathy and a hot water bottle go a long way to make him more comfortable. The third (we’ve got four kids) is more serious. Normally she will only get eczema but when she’s on the brink of developing an asthma attack, she will go to a full blown attack pretty much immediately and needs to be in a hospital within 30 minutes. The au pair needs to know this otherwise she’ll be completely stressed out (as we were the first time she had an attack and landed on the IC, DD was completely calm and said she only had a bit of trouble talking and breathing at the same time).
It’s always possible the au pair makes a mistake, it only becomes an issue when she doesn’t know what to do.

AuPair Paris May 16, 2015 at 3:22 pm

Allergies don’t need to be too terribly scary, but it’s best to have a worst case scenario planned. I have a serious allergy to shellfish, and after the first time, it’s never been an issue – it’s a fairly easy one to watch out for. If it’s something like nuts, it’s much harder.

If it were me (and I didn’t already know how to deal with allergies from my own), I’d find it useful to have the allergy stuff, not all grouped together, but put in appropriate sections in the handbook. So in a description of duties that includes maybe groceries or something, write there (bolded or large or underlined): “It is vitally important that you check packaging for whether products contain [item to which HK is allergic]”. In rules about playdates, something like “when dropping HK off, please remind playdate’s parent of HK’s severe allergy to x”. Later, if you put in a section on health/emergencies, have a section about how to use an epipen, directions to the hospital/a&e, emergency numbers (it’s not 911 everywhere in the world), etc etc. Maybe put it at the start, but nonetheless, group it with other emergency instructions – it’s less scary if it’s not separated out as like “DANGER! Very serious issue right here!”, I think. Also, it’s more realistic. Awareness of the allergy *isn’t* a one time, emergency procedure thing – you have to keep it in mind throughout daily life, so it should probably be kept in mind throughout the handbook. It could even be mentioned if you have a section describing each child. “HK A is sensitive but still sensible. He likes football, and playing board games. He also has a serious allergy to X. Necessary precautions are detailed throughout the handbook.

One note – often if my epipen is out of my bag, people of around my age will say things like “oooh, so that’ll stop your allergic reaction?” Very important, therefore, to be clear that the epipen is a lifesaver because it *buys time* and that, once used, rushing to hospital is still necessary.

The only downside to the tactic of spreading out allergy advice, is if the AP doesn’t read the whole handbook but skims through to find the headlines – but something like an allergy I guess you’d go through with her in person anyway – it’s vitally important after all. If kids are old enough, I’d also brief them, in case the AP is seriously lacking in sense, but I can’t imagine an 18 yr old or above who couldn’t handle this issue! After all, little kids do, all the time!

Query: I don’t drive – if the kids needed to be rushed to hospital, I’d ring an ambulance. For those with au pairs who drive, do you show your au pairs the route to the emergency department in their first week? I can imagine it’d be scary – but I think I’d be much *more* scared of having some kind of accident with one of the kids and rushing them to the car, only to have to find and programme the SatNav!
(My HKs have had emergency room worthy accidents three times throughout my year, and thank *goodness* it’s never been while I’m on duty. But it’s scary stuff, all the same!)

Mimi May 16, 2015 at 3:46 pm

We show the AP the local hospital because it’s near other places of interest, but we stress that in an emergency where someone needs urgent medical care, they should call an ambulance and then call me. Driving someone to the hospital in a stressful situation, especially when unfamiliar with the locale can be dangerous. Because I only work 5 miles from home, I usually come home and decide how to proceed when there’s a non-life threatening issue.

WarmStateMomma May 18, 2015 at 2:25 pm

Good question! If it’s immediately life-threatening, our AP is to call 911. The ambulance takes people to one of the crappy community hospitals but a world-class children’s hospital is only 30 minutes away. If it’s not life-threatening, she either drives the kids to the children’s hospital or calls us to do so. The hospital is programmed into the GPS.

AP#1 couldn’t drive but a neighbor took our baby (with the AP) to the children’s hospital and I met them all there. If the neighbor hadn’t been home, we would have had to rely on an ambulance and would not have been able to get her to the children’s hospital. We ask much harder questions about driving now….

AuPair Paris May 18, 2015 at 2:51 pm

I didn’t even think of car accidents because of stress. Probably because I don’t drive, and also because I grew up in a very rural area. To get an ambulance out would take forty minutes for them to get to my house, then forty more to the hospital – my parents would’ve always shoved us in the car and stepped on it, if it was life-threatening… Though it never happened. But an excellent point.

The other day, I picked my HK up from school with a gigantic bruise all over her head from where she’d fallen at recess. The school rang my host parents and then my HPs rang me to see if I thought it was serious enough that they should come home. I have first aid, and I said no, and it was fine… But even that amount of responsibility over the little one’s health was scary enough, so I can imagine that being the one person responsible for saving HK’s life by getting them to hospital in time would be terrifying.

Schmetterfink May 19, 2015 at 8:01 am

Not only because of stress but also because of focusing more on the child than the road. Plus, if an au pair cares for multiple children she wouldn’t only need to focus on the sick child but make sure the siblings were safe as well.

My order was to call host-dad (worked closer by). If host-dad can’t be reached call host mom. If neither can be reached, call next door neighbor (#3’s best friend’s mom) or send oldest next door to get next door neighbor.
If it was life-threatening, call 911. Then call host-dad
Simply because I took care of four and they’d rather I call an ambulance than try to get all four in a car and take them all to the hospital alone. HM said she didn’t think she could get them all to the hospital safely if she was home alone with all of them thus she didn’t expect it from their au pair either.

Thankfully, nothing major ever happened.

TexasHM May 16, 2015 at 5:07 pm

I would give the AP ALL the information and answer any questions you have and the way you make it less scary is by giving her a frame of reference. Ex. “HK1 is allergic to bee stings, XYZ happens when he is stung, this is what you would do (review all steps), but keep in mind he’s been stung once in 10 years and this is not a common occurance. We have never used the epipen and he knows to watch for bees so we just need you to be aware in case it happened to occur while you were on duty”.

Just like preparing them for a tornado drill :) or anything else make sure you temper it with actual odds of how likely it is and tell them what happens if they don’t know what to do. I point out to APs that even if we were hit by a tornado (highly unlikely), her odds of being unharmed are very high. People in Joplin survived an F5 in bathtubs, freezers and with little warning and that was as bad as it gets. Obviously this varies based on the severity of the allergy but just be honest and thorough and you’ll be fine.

Au Pair in France May 17, 2015 at 2:30 am

I would make it clear what the allergy was and explain how to use an epi pen if necessary. It was casually mentioned to me a few months after arriving that one HK is allergic to bee stings and this was where the epi pen was. I feel like that’s probably something that I should have been told soon after arriving (they don’t have a handbook) and while I was taught several times at school and at scouts how to use an epi pen, I’m sure many au pairs don’t know, and I’d feel more comfortable being prepared, than knowing I’d be clueless. Just make it clear how unlikely it is that they will ever have an allergic reaction (e.g she’s only x no. of times had an allergic reaction), to avoid it sounding like something to be frightened of.

SEvans May 17, 2015 at 11:32 am

I have a child anaphylactic to peanuts. We have a big section in our handbook around how to deal with a peanut exposure, and instruction cards everywhere we keep an epi-pen. Below is what I put in my handbook:

In case of peanut exposure

Two scenarios:
IF: ***child*** has been exposed to peanuts and has either:
? Swelling of the lips, tongue or face OR
? Repeated vomiting OR
? Difficulty breathing OR
? Lethargic or unresponsive behavior
THEN: Administer Epipen. Call 9-1-1 immediately.
(911 must always be called when an epipen is used. The effects of an epipen will last only about 5-10 minutes)
Only after calling 9-1-1 should you call the parents.

IF: ***child*** has been exposed to peanuts, and does not have any of the symptoms above
THEN: Administer childrens benedryl (dosage on the box), predinisone and Xyrtec (all in her epi-purse). Call parents. Put her in the shower if possible. Watch closely for further symptom development. If she shows symptoms of scenario 1, then use Epi-pen immediately and follow steps in scenario 1.

Also… I found a great reminder magnet on the FAIR website that I’m ordering (plus posters for her classroom/ school). It lists the signs of severe reaction and instructions of what to do. Link here:

CAtoTXMom May 17, 2015 at 4:57 pm

We have a child with a peanut and tree nut allergy and are now on our third Au pair. We discuss this issue during our interviews as well as when she comes during the first week. We don’t outline all the steps of what to do in the handbook because it seems to be a waste of time. They read it once and don’t really view it again (except for when we needed to highlight our rules during a rematch with our second Au pair). Our handbook says that our daughter is allergic to nuts. That means that the Au pair is not allowed to bring in any outside food into the kitchen that contains nuts. I do not buy food with nuts so everything our Au pair gives to her at home is safe. I don’t have the Au pair take her to birthday parties and if they have a play date our Au pair brings snacks for our daughter. I train them how to use an Epipen and signs to look for. The Allergy Action plan is in the same bag as the Epi Pens and Benedryl. This bag is always in the backpack where ever they go and a matching one is the kitchen. We go over where the hospital is too for emergencies but if our au pairs know that they must call 911 if the epipen is ever used. We have never had a problem except for our second Au pair who broke many rules including bringing in food that contained nuts (one of the many reasons we went into rematch with her).

Susannah May 17, 2015 at 9:24 pm

I think empowerment is going to be the best solution. Give information that will allow your AP to feel in control of the situation, even though she may not be in control of a reaction is happening, or if something out of any of your control happens. I’ve looked after a series of kids with alleriges in different environments, and when I felt the most secure was when I was informed about how to prevent a reaction and trained in how to stop one if it happened. Granted, I have a fair bit of medical/first aid experience so my comfort with stuff like that is higher than average i think, but yeah, empower her to do the things you would do would be my suggestions.

Eliana (ex au pair) May 18, 2015 at 12:28 pm

I was an infant specialized au pair with APC and during our 5 days of training they covered issues such as allergies and the treatments, and we all used an Epi-pen on a doll to see how we should do it.
We were also trained in CPR and primary care. Luckily during my year as an Au Pair I never had to use any of that but I did feel that I was ready if I had to.

Taking a Computer Lunch May 18, 2015 at 9:14 pm

As the parent of a medically fragile child, who, thankfully does not have any known allergies, but does have medical protocols for medical events, my advice is to be up front. Tell candidates whom you are interviewing everything – because the last thing you want is an AP who has had a bad experience in the past to arrive in your home, panic, and go into rematch even if your child has never had to use an epi pen/rescue inhaler/medicine administered by g-tube or syringe.

While you may not consider a child with a life-threatening peanut allergy, “special needs” it’s very important to be up front with candidates in your initial contact with them – especially if you’re asking her to give up all peanut products during her year – including a handful of peanut m&ms in a candy dish at a party. If failure to abide by the protocol that will keep your child alive will result in immediate rematch, then state that fact up front, and invite the candidate to ask questions.

Don’t worry about having difficulties in matching. You want to match with an AP who will take your child’s needs seriously. I speak from experience on this – you want an AP willing to rise to the challenge of successfully caring for your child without the constant worry that her or his behavior will lead to an ER run.

While my experience leans toward a child I know is heading south (medical fragility can be very different from an allergic reaction, although it is not always), I will say that having the added benefit of warning, verbal repetition, and asking the AP to convey her understanding of the instructions – we still have had moments when it was absolutely clear that the AP had absolutely no understanding of what had been conveyed. At that moment, we surrender, stay home, and oversee her care of the Camel, so that the next time (or the next day) she is capable of doing it properly.

I’m talking from the standpoint of a parent who had barely changed a diaper, when not only did I have a newborn, but she was in a NICU isolette with tubes and wires running out of her that made diapering a challenging experience. I strongly believe that everything can be learned, but know from practical experience that many APs cannot take what they have read or heard and translate it into action – sometimes the best way to learn is by doing (which is exactly NOT a skill on which you want to rely if you have a child who might go into anaphylaxic shock as the result of exposure to an allergen).

Schmetterfink May 19, 2015 at 8:28 am

Even a moderate allergic reaction will be frightening for an au pair that has not been instructed how to handle the situation. Medicall issues can and will be frightening if you don’t know how to deal with them. Make it sound as frighting as necessary – you want your au pair to know what she is getting into to live up to your standards and be a great au pair.

I asked my second (non-US) host family about allergies, medical conditions during matching (while I disclosed a chronic medical condition)… the answer was no, everybody was healthy. After arrival I learned a) oldest had Ehlers-Danlos which led to frequent joint dislocations and b) middle child was allergic to bees. Neither was a real problem for me but it made me question what else they might not have disclosed in matching. Also, a child with a dislocated kneecap IS frightening if you are not aware the child is prone to it due to an underlying medical condition. If you know that this can happen easily and what to do, the whole situation is much less stressfull for everybody involved (especially if the child is old enough to tell you – 13 – but your grasp of the child’s native language is not very strong when it comes to medical lingo).

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