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With nut allergies increasing among children, early years practitioners need to take precautions. Suzannah Olivier offers advice in the latest of our series on special diets It is estimated that one in 100 children have nut allergies, which creates catering and logistical problems for all nurseries.

With nut allergies increasing among children, early years practitioners need to take precautions. Suzannah Olivier offers advice in the latest of our series on special diets

It is estimated that one in 100 children have nut allergies, which creates catering and logistical problems for all nurseries.

The most widespread nut allergy is to peanuts. The peanut is actually a member of the bean family - the way the peanuts line up in the pod gives the game away.

Tree nuts such as pecans, walnuts, hazelnuts and seeds, particularly sesame seeds, also cause reactions. Allergic reactions can happen after consuming many other foods, including milk, eggs, soya, fish and shellfish. Reactions can also be caused by bee or wasp stings, certain drugs such as penicillin and latex in rubber gloves.

Peanuts, nuts and seeds are actually excellent sources of nutrition for non-allergic children. They provide protein, essential fats, minerals and vitamins. But because peanut allergies are on the rise, the Department of Health advises that nuts should not be introduced into a child's diet until the age of three if they come from a family that suffers allergies such as asthma or eczema.

Symptoms

Serious symptoms of allergy include:

* Closing up of the throat

* Severe asthma

* Severe drop in blood pressure (weakness and floppiness) Mild to moderate symptoms include:

* Itching or swelling in the mouth

* Hives anywhere on the body

* Skin flushing

* Nausea or vomiting

Symptoms usually happen very quickly after ingestion, though they may be delayed by up to a few hours.

There is a greatly increased risk of anaphylaxis if the child is asthmatic, and parents should supply the nursery or carer with histamine and/or adrenalin injection medication.

If a reaction takes place, such as tingling in the mouth, childcarers should contact a doctor and the child's parents immediately. In the worst cases, closing up of the breathing tubes and anaphylactic shock can set in, leading to death.

Even if the reaction is mild initially, it is impossible to tell if it would be worse the next time or subsequent times, and a full-blown reaction could happen later.

Foods to watch

It is fairly easy to eliminate nuts and seeds from nursery menus. What is not so easy is identifying packaged foods which could be contaminated during production.

* Common foods that can include nuts or sesame seeds include: cakes, desserts, chocolates, sweets, fruit yoghurts, biscuits, salads, salad dressings, dips, curries, pre-made Asian sauces, chilli, stuffing and breakfast cereals.

* Other foods include pesto (pine nuts or walnuts), satay sauces (peanuts), marzipan (almonds), nougat (almonds), halva (sesame), hummus (sesame) and tahini (sesame).

* Peanuts and peanut oil (also called groundnut oil) find their way into many processed foods such as biscuits, cakes, breakfast cereals, savoury foods, Asian foods, breads and confectionery. A reaction to refined peanut oil (found mainly in processed foods) is unlikely, but unrefined peanut oil (mainly bottled oil and found in ethnic foods) carries a higher risk.

Small print

Always read food labels, and research problem foods in advance.

* Be aware that foods labelled as containing almonds, for example, may also contain peanuts which are not labelled.

* Pre-made composite dishes are often not fully labelled and fall within the 25 per cent rule - for example, pizza with salami on it does not have to declare what is in the salami if the salami makes up less than 25 per cent of the pizza. But the sausage meat could contain milk powder or ground nuts, which could be problematic.

* Many products are now labelled 'may contain nuts'. Manufacturers are also aware of the dangers of cross- contamination, and some are opening segregated production lines.

Safe environment

It is important to talk to parents about not bringing forbidden foods into the nursery. Managers should also make sure all staff are fully aware of suitable and unsuitable foods, food sharing issues and emergency procedures in the event of an allergic reaction.

Administering life-saving injections may alarm staff (although the pen-like kit is simple to use, and blanks can be used to practise on an orange). It is a good idea to contact a GP or health visitor who might know of examples of local nurseries or schools who can share their good practice. NW This article has been sponsored by the Organix Children's Food Advisory Service, where Suzannah Olivier is the consultant nutritionist.

Resources

* Anaphylaxis Campaign, tel: 01252 542 029, www.anaphylaxis.org.uk

* British Allergy Foundation, tel: 020 8303 8583, www.

allergyfoundation.com

* Department for Education guidelines for schools on nut allergies, www.dfes. gov.uk/schoollunches /annexa.htm

* Children's Food Advisory Service Pack for Nurseries, www.childrensfood.org and for advice on the quality of school catering and how to improve it, see www.foodforlifeuk.org

* Suzannah Olivier is the author of What Should I Feed My Baby? and Healthy Food for Happy Kids, (see www.HealthyFood4HappyKids)

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