patient care perspectives
Pediatric Food Allergy–Associated Anxiety Among Parents and Children
Anxiety related to food allergy is very common. It typically emerges in parents first, at the time of the child’s first reaction, and then later in food-allergic children. Strategies to mitigate anxiety include discussions about the practical aspects of living with a food allergy, and, in some cases, connecting families with behavioral health specialists.
Robert A. Wood, MD
Julie and Neil Reinhard Professor of Pediatric Allergy and Immunology
“Examples of day-to-day anxiety related to food allergy include difficulty sleeping at night; refusing to leave the house, touch a doorknob, or hold hands with another child; and not wanting to touch a piece of playground equipment, such as a swing set.”
Anxiety associated with food allergy occurs with a wide range of severity, and it can be extremely debilitating for both the parent and the child in the extreme situations. At first, the anxiety usually falls to the parent and begins the day of their child’s first reaction, which typically occurs in the child’s first year of life. However, even early on, children can recognize and respond to their parents’ fears.
There are specific stages of an allergic child’s life that tend to be particularly worrisome. For example, the preschool years are often anxiety provoking because children are not yet able to look after themselves and the parent may feel the weight of responsibility, fearing accidental exposure at school. Entering grade school is another such stage. While many families are comfortable by the time the child is in the early school years, some are not, and, in some cases, a child’s activities may be limited (eg, going to a friend’s home). Parents’ fears never truly resolve; in fact, some parents may become even more fearful when their child becomes a teenager.
An allergic child’s anxiety typically emerges in the late school years, around ages 9 to 12 years. Approximately 10% to 15% of our patients in this age group see a psychologist to help them deal with the degree of anxiety that they are experiencing (ie, the anxiety is impacting them daily). If your patient is experiencing significant anxiety related to their allergy, connecting them with behavioral health specialists may be helpful. Examples of day-to-day anxiety related to food allergy include difficulty sleeping at night; refusing to leave the house, touch a doorknob, or hold hands with another child; and not wanting to touch a piece of playground equipment, such as a swing set. Many of these families keep peanut-free houses. We find that children raised around the foods to which they are allergic tend to be much less anxious about events related to their allergy, such as sitting next to someone who is opening a candy bar that contains peanuts.
Anxiety is just one part of the burden. Many studies on food allergy have shown a substantial impact on quality of life, in both the parent and the child. At every visit with a food-allergic child, the clinician should discuss the practical aspects of living with a food allergy, such as navigating the cafeteria at school and figuring out where the child should sit. We should ask them whether they sit at a special table and whether they have noticed any bullying or teasing related to their allergy.
Allergists should also impart realistic expectations about the tools for managing a food allergy. Although carrying an epinephrine autoinjector can empower children to bring their allergies out into the world and can reduce anxiety in children and parents, some families still have an irrational fear about epinephrine. Further, the internet can provide both good information and the worst information. A parent may feel comfortable with simply checking food labels before offering the food to their child until they see a post on social media saying something like, “No, you cannot just read labels. You need to call the company before eating every food.” So, this person who previously thought that they had things worked out is now staying up at night, worrying that they have been deficient in protecting their child.
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