In a decisive bipartisan effort, Missouri has enacted sweeping new healthcare legislation to significantly strengthen medical safety nets for vulnerable residents. Among the most anticipated provisions is a new mandate to protect children with severe food allergies by expanding access to epinephrine and establishing stricter emergency protocols in licensed childcare facilities.
The far-reaching legislation, sponsored by State Representative Tara Peters and State Senator Mike Bernskoetter, updates decades-old medical definitions to reflect modern healthcare advances. By changing the legal terminology from “epinephrine auto-injector” to “epinephrine delivery device,” the law paves the way for daycares and schools to stock new needle-free technologies, such as newly approved epinephrine nasal sprays. Prior state laws had explicitly restricted emergency stock to syringe-style auto-injectors.
Under the newly signed law, all licensed childcare providers in Missouri are required to implement structured allergy prevention and response policies. This includes keeping life-saving epinephrine devices readily accessible on-site to combat anaphylaxis—a rapid, potentially life-threatening allergic reaction. Governor Mike Kehoe praised the legislative package, stating that the new measures would “protect our most vulnerable, hold insurance companies accountable and change the landscape of healthcare access and outcomes in communities across the state.”
The aggressive push for childcare allergy reform in Missouri is part of a growing national campaign known as “Elijah’s Law.” This legislative movement honors the memory of Elijah Silvera, a three-year-old boy who tragically died on November 3, 2017, after experiencing a severe allergic reaction at his New York City preschool. Despite the facility having full documentation of Elijah’s severe dairy allergy, staff fed him a grilled cheese sandwich.
Following the exposure, the childcare facility failed to follow proper emergency protocols, failing to call 911 or accurately notify his family. Elijah’s mother was forced to carry her failing toddler ten blocks through the city streets to South Harlem Hospital, where he ultimately passed away from complications of anaphylaxis. Determined to transform their profound grief into a protective shield for other children, Elijah’s parents, Thomas Silvera and Dina Hawthorne, co-founded the Elijah-Alavi Foundation to fight for standardized allergy safety mandates across the United States.
“Every day we’re fighting, not fighting to be angry, but fighting to bring change, that’s our mission for my son and everyone else who suffers with severe food allergies,” Thomas Silvera stated as the family began their nationwide advocacy work. Realizing that lack of staff training and missing on-site medication were systemic issues in early education, the family successfully lobbied New York to become the first state to sign Elijah’s Law in September 2019. Comforted by the progress but remaining relentless, Silvera previously emphasized: “With every tragedy there has to be change. My son didn’t die in vain.”
Missouri’s implementation of these allergy protocols represents a major milestone for the advocacy movement, bridging the gap between local municipal rules and statewide mandates. Previously, Kansas City, Missouri made history in 2023 by becoming the first US city to pass Elijah’s Law as a local ordinance. The newly enacted statewide legislation ensures that children in all corners of Missouri—from urban centers to rural communities—receive identical, life-saving protections.
As the legislative momentum continues to build, state houses across the country are increasingly recognizing that swift preparedness in early childhood settings means the difference between life and loss. To date, several states have successfully passed standalone versions of Elijah’s Law or embedded its core safety pillars—mandated staff training, prominent allergy tracking, and stocked emergency epinephrine—directly into their state licensing regulations.
States That Have Enacted Elijah’s Law
The following states have officially signed Elijah’s Law into effect to protect infants, toddlers, and preschool-aged children in childcare environments:
- New York (2019): The pioneer of the legislation, establishing the nation’s baseline for comprehensive childcare food allergy safety frameworks.
- Illinois (2021): Enacted as the Childhood Anaphylactic Policy Act (HB0102), expanding standardized emergency protocols across both daycare and school settings.
- Virginia (2022): Formally mandated strict anaphylaxis training and designated epinephrine access within early childhood programs.
- Maryland (2024): Enacted House Bill 1195, instantly securing allergy safety parameters across the state’s 5,000 licensed childcare centers.
- California (2024): Successfully signed into law to mandate uniform allergen management, training, and response policies for early educators.
- Arkansas (2025): Governor Sarah Huckabee Sanders signed the bill into law, establishing critical safeguards for children inside early childhood education facilities.
- Missouri (2026): Enacted via a sweeping healthcare package expanding emergency stock parameters to modern epinephrine delivery devices across all licensed daycares.
