On a flight earlier this week, I experienced a situation that once again compels me to turn to the FT "Travel With Children" forum for your feedback.

A 4-year old child who suffers from nut allergies was traveling with his mother. The allergy was NOT communicated to the airline at any time.

Following the meal service and approx. 2.5 hours into a 7 hour flight, one of the crew noticed the child beginning to show discomfort in his seat and developing swelling around the eyes. The mother was napping in the meanwhile next to him. The crewmember woke up the mother and asked about the child's health. At this point the aircraft was approximately 1.5 hours from the nearest diversion airport with adequate medical facilities.

The mother freaked out when she saw the child's condition and immediately started accusing the crew of endangering the child. When queried, she confirmed that the child had a nut allergy but "didn't think" that it was important for the crew to have been told in advance. The child had eaten the chicken option for the main meal, which came with cashew nuts sprinkled on top. Furthermore, the mother advised that the child's medication had been left in the checked baggage.

A PA announcement was made requesting medical professionals to identify themselves and a doctor responded together with 2 nurses. The doctor diagnosed Anaphylaxsis and prescribed the use of Epinephirine using the auto-injector "Epipen" contained in the aircraft's medical kit. The mother however refused to accept any treatment and instead preferred to simply wrap the child in blankets and attempt to sing lullabys to him. Throughout this time, the child continued to display significant discomfort, including weezing, shortness of breath and edema.

After discussion between the captain and the doctor, it was agreed that the actions of the mother were potentially life threatening to the child based upon the doctor's professional opinion, and accordingly the authority of the captain could be invoked to forcibly seperate the mother and the child if neccessary for the child's safety. This was conveyed discretely to the mother by one of the nurses, following which the mother consented to the treatment without having to resort to forcible seperation. The child was administered 10mg Epinephirine which stabilised the immediate condition.

Subsequently, approx. 60 minutes later, the child again complained of difficulties breathing and oxygen was administered from the onboard bottles. Although there was no deterioration in the child's vital signs, the child continued to cry and complain of significant discomfort. The mother demanded that the aircraft immediately land so that she could take out the child's medication from her checked luggage, but this was again rejected as a possible course of action due to the aircraft's position at the time. Accordingly, the doctor chose to administer 100mg Hydrocortisone via intramuscular injection, again under the "threat" of forcible seperation if the mother did not grant consent.

Following the administration of Hydrocortisone, the child's condition improved dramatically and he fell into a peaceful sleep. The aircraft subsequently landed safely at destination airport and the mother and child were removed to the nearest medical facility by airport paramedics.

I guess the questions here are what steps the airline and crew could have taken to better handle the situation, and what steps or policies might be implemented to prevent a similar situation from escalating in the future? While the airline will usually take reasonable precautions to accomodate allergy sufferers when notified, is it reasonable to expect these when the airline is not informed of the condition? Would the airline have been justified in forcibly seperating the mother from the child if the mother's conduct in denying medical treatment (presumably due to her own state of panic) was placing the child's life in jeopardy?

Thoughts and comments are appreciated.

 

What are your procedures for booking tickets for minors and children? Perhaps, during that process, you could insert screening questions, such as "Does this passenger have any allergies such as peanut, gluten, etc.) that we need to be aware of?" That would clue the customer that this is a concern that needs to be raised with the airline and also provide protection to the airline if the allergy is not disclosed.

This is from a purely customer service standpoint. I am sure your Legal Department can advise from that standpoint.

 

Based on what you have stated the airline/crew acted appropriately. As a mother myself I am unable to comprehend the mother's actions, but if as you say she was freaked out/in a bit of shock, in hindsight I should hope she is glad for the actions of the crew

 

The airline acted reasonably. Deciding against diversion was perfectly acceptable if the doctor agreed that it would not threaten the child's life. Forcibly separating the child from the parent to give the child necessary (i.e. life saving or close to it) treatment is justifiable.

Expecting an allergen-free environment without proper notice is unreasonable. OTOH, if I were running an airline, I would consider dropping items like nuts from the menu. It would depend on the frequency of incidents like this, the cost of diversions, how often we get notice of allergic passengers (therefore don't serve nuts on that flight), and how much my customers wanted nuts. This would be done primarily to save money.

FlyinHawaiian's idea of asking passengers about nut allergy's on booking is a good one, but I have the feeling that most self-reporters would not have actual nut allergies.

 

Beside also appaulding the actions of the captain/doctor; could easily see them figuring it would be so much easier accepting the mothers judgement.

You didn't say if the child was eating off the mothers tray, or had their own.
If the mother was asleep, the FA shouldn't let a child choose their own if a parent was present.
(And if it was the mothers, she shouldn't have chosen a meal like that).

Discontinuing a food only starts you down the road of how far to go.
Before you know it, they only offer drink service.

Can only think of the airline possibly offering a detailed menu, individually asking each person is way too burdensome.

Alot of companies take the easy road, saying it was made in an area producing items using x,y,z. So in that case the child would have had zip.
(but healthy)

 

Wow, they served meals Musta been international or up front? (oh no, not the "kids in first" thread again!).

As a parent who has travelled with (non-allergic) kids a lot, the carrier's response seems level headed and appropriate. It's a good thing there were medical professionals on board to advise the captain. Great that the kid was just fine in the end. Gotta wonder about that mom!

Certainly allergies could be queried on booking or put in one's profile. It must be the responsibility of the allergic person (or their parent or guardian), however, to query as to the ingredients in a prepared dish.

Today I noticed on a bag of peanut M&M's "ALLERGY INFORMATION: May contain almonds".

 

The mother had selected the child's meal but claimed she didn't think to enquire if it contained nuts. Although the foil lid had "BUTTER CHICKEN WITH RICE - MAY CONTAIN NUTS" printed on it, she claimed she did not read it before opening it.

Our airline has access to medical professionals via HF radio, although this is not always possible on that specific route being operated. In any case, the recognition and treatment of anaphylactic shock is something that the cabin crew are specifically trained for.

While anaphylactic shock is not uncommon on board aircraft (2-3 cases per year with our airline), most passengers who are at risk from this kind of allergy travel with their own medication and are able to administer it immediately upon the symptoms beginning to show.

The cost of diversions is not as much an issue as the inability to divert to a suitable location. Whereas you can put the aircraft down at a remote desert strip in Algeria or Mali, chances are that the medical kit on board the aircraft is superior to most facilities available at the en route alternates south of Algiers and north of Ouagadougou.

These particular passengers were in transit from Jamaica and the bookings were made by a travel agent there with an interline connection in London. Hence, any such procedures would not have helped in this case.

On a similar note, we actually have a crewmember who has a gluten allergy and it is very simple to provision GFML crew meals for him whenever rostered. He does however accept that when on reserve, we cannot guarantee that a GFML will be available in time on an occasion he is called out to operate a particular flight.

 

This mom's actions were incredible. Anyone with such a severe allergy should always have an Epipen readily available. And, of course, she should have notified the airline. It's almost as if she was in total denial of her child's problem.

What else could the crew have done? Notified Child Protective Services when they landed and reported mom for negligence and child endangerment.

 

Speaking as the parent of a child with life-threatening allergies:
The plane should have been met with an ambulance for the child and the local equivalent of Child Protective Services for the mother. If you have a child with a history of severe allergy, there is no excuse for putting the emergency response medication in the luggage, no excuse not to check the food before giving it to the child, and no excuse for refusing emergency treatment.

Yeah, I do know how hard those tasks can be to repeat every single meal of every day - I live that life. I have at least 2 kinds of emergency response medications (oral, inhaled or injectable) with me at all times for my son. My child never eats anything we haven't checked and double-checked the ingredients of.

Forced intervention to save the child's life was absolutely appropriate.

Most of my career was spent in pediatric health care, so I have certainly seen both panic and denial in parents of sick children. The mother's response sounds like a combination of mental denial of how severe the child's risk level is and guilt that she knew she'd been lazy and not checked the ingredients of the meal. Again, I think intervention from a CPS equivalent on arrival was warrented to educate her on her child's needs.

 

Maybe she was an evangelical with a strong belief in the power of prayer?

Excuse me for implying the mother was from the US.

 

The OP mentions Jamaica and lullabies, how do you make an American evangelical out of that? And for that matter, how do you determine that evangelicals willing to forego emergency medical treatment for their children are "Not uncommon in the US?"

 

I absolutly agree. The airline appears to have done all reasonably possible to manage the incident.

 

B747-437B - May I congratulate you on handling an extremely dangerous situation with professionalism and reason. You and the airline have gone the second mile. As you know, anaphylaxis can occur suddenly and quickly be fatal. I'm impressed with the airline's medical kit. There is no excuse for the mother's behaviour. She endangered her child's life IMHO, as well as almost causing an unnecessary diversion. Fortunately she did (finally) agree to treatment by the doctor. But suppose she had refused treatment. To treat a minor when a parent clearly refuses consent, would place the doctor and the airline in an uncomfortable position, particularly if treatment was unsuccessful.

 

It's mentioned that the mother did have medications for the child in the hold, so clearly she was not opposed to medical care in general. Given that, it does seem quite odd she tried to refuse the medical help.

Sounds like the crew did a great job. What would make this much stickier is if the mother opposed all medical intervention and depended exclusively on prayer.

 

^ for great service by the airline. I do not understand the mother at all. My daughter does have a life threatening allergy (though not to food) and we ALWAYS carry an epi pen as well as inhaled and liquid and chewable medicines (even though it would be highly unlikely we'd encounter it in the air). It's called common sense and good parenting as well as following drs. orders. I'm just shocked by the mother and as someone who has had anaphylaxis, it sickens me. Again, well done by the airline and crew.