Food Service Issues Relating to Food Allergies in Residential Nurseries and Children\u27s Care Homes : A Study Based on the Comments of Dieticians and Registered Dieticians with Regard to Their Use of Food Allergy Guidelines

Abstract

乳児院・児童養護施設を対象におこなった食物アレルギーの給食対応に関する調査の自由記述欄の内容を分析し、食物アレルギーの給食対応に関して両施設にみられる課題およびガイドラインの有無別にみられる特徴を検討することを目的とした。自記式質問紙調査の自由記述欄に記入があり、ガイドラインによる取り組みに回答のあった施設のうち栄養士・管理栄養士が回答した乳児院30施設と児童養護施設71施設を分析対象とした。社会的養護に特徴的な課題として《施設体制》の【入所時のアレルギー情報把握】の欠如による〈緊急入所・情報不足による食事提供への不安〉、【小規模化における課題】が示された。ガイドラインの有無別にみると、乳児院での〈初発のリスクへの不安〉、児童養護施設での〈事故対応に対する不安〉〈重症児対応に対する不安〉といった不安感はガイドラインがない施設に見出された。ガイドラインがある乳児院の栄養士は《給食業務》の〈献立例〉の心配は少なく、《施設内連携》の〈情報共有・共通理解の重要性〉や〈職員間の認識差〉を課題ととらえていた。また、ガイドラインがある児童養護施設の栄養士は《食事場面》での【食事指導】や【児童の心理面への配慮】などの課題は少なく、施設外の情報交換を求めていた。以上のことから、ガイドラインがない施設の栄養士は、献立や食事指導の仕方などの児童に対しての直接的な支援が課題であると認識していたが、ガイドラインがある場合は、施設内連携・施設外連携などの児童を取り巻く職員間・部署間の情報共有や、他施設との関係を課題ととらえていることが推察された。The aim of this study was to analyze comments provided in our survey on the provision of allergy-appropriate food services in residential nurseries and children\u27s care homes, to examine the issues identified, and to compare facilities that used food allergy guidelines with those that did not. The facilities analyzed were 30 residential nurseries and 71 children\u27s care homes where dietitians responded through comments in self-administered questionnaires. Characteristic concerns with children\u27s social care related to problems with food services during an emergency admission due to lack of allergy information at the time of admission. Among dietitians that did not use food allergy guidelines, concerns such as anxiety around the risk of allergy onset were found at residential nurseries, and concerns about appropriate responses to accidents and to children with severe conditions were found among dietitians at children\u27s care homes. Dietitians that did use food allergy guidelines had little concern about using specific menus, but raised the importance of information sharing, having a common understanding, and recognizing differences in food allergy awareness among staff. Dietitians at children\u27s care homes that used food allergy guidelines had few issues with dietary guidance and less need for consideration of children\u27s psychological state, but sought additional information outside of the facilities. As indicated above, comments made by dietitians working at facilities without any food allergy guidelines acknowledged problems in providing adequate menus and dietary guidance. Where guidelines were used, challenges such as information sharing between staff and departments surrounding the children (including cooperation within and outside of facilities), and maintaining relationships with other facilities, were expressed.本研究はJSPS 科学研究費（課題番号16K12745）の助成を受けたものです