I don't offer a nut free environment at this point, and will not accept a severe nut allergy.

My own son is severely dairy intolerant and we use almond milk as his milk alternative. I am very used to avoiding cross-contamination of foods, but I can't guarantee that between his milk and the fact that kids are not the neatest eaters that I can maintain a nut-free environement.

Ironically enough, after turning down a family for an interview based on peanut allergy, I now have to carry an epi-pen after a possible peanut reaction after years of eating them. Go figure! Even if care providers don't accept children with severe allergies, all care providers should be prepared to deal with a reaction, as they can happen at any time.

I think one of the best environments a family can find if they want home care and have a child with allergies / intolerances is to find a care provider with the same allergies in their home. The care provider will be knowledgeable about possible hidden allergy sources, not have to alter current menus, and be fully comfortable dealing with that particular allergy.