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The emotional toll of food allergies

"Food is life," or so the saying goes. We need it to survive. But what if the food you eat, even accidentally, could kill you--or worse, your child?

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Peanut butter and jelly sandwich
By
UNC Health Talk
Editor's note: This article originally appeared on the UNC Health Talk blog.

“Food is life,” or so the saying goes. We need it to survive. But what if the food you eat, even accidentally, could kill you—or worse, your child?

For parents who have children with a severe food allergy, the fear that one wrong bite could result in a life-threatening allergic reaction is a universal worry. Every time your child is around food, it can become a source of anxiety and stress for you—and your child.

The Food Allergy-Anxiety Connection

Throughout different developmental phases, it’s normal for children with food allergies to experience fear and anxiety, especially as they begin school. And research shows that children with food allergies are more likely to suffer from anxiety than children without them.
“Children feed off their parents. They see our behaviors and reactions and they model their behavior after us,” says Edwin Kim, MD, director of the UNC Food Allergy Initiative and parent of two children with food allergies. “So, parents set the stage for how a child with food allergies navigates their life with that allergy. Every single situation around food is a learning opportunity for our kids.”

For parents of children with food allergies, Dr. Kim says it is important to teach them what they are allergic to and begin to model the strategies that will help them best manage the allergies as they grow older. Early on, it might be politely asking a waiter if the food contains the allergen, for example. As they learn to read and have opportunities to select their own food, you can show them how to read food labels. Most important across all ages is to remind them to be vigilant about what goes in their mouth, which often means not sharing food.

Throughout these conversations, Dr. Kim cautions parents to be mindful of their tone, body language and word choice when talking to their child about his or her food allergy.

“Try to imagine how a 5-year-old is going to interpret what you tell him about his allergy. If you put the fear of God into him that he will die if he is around that food, he may have a more exaggerated separation anxiety,” Dr. Kim says.

In extreme cases, children may be too scared to eat at school or anywhere away from home.

“Unfortunately, we do see cases of food aversion where they will go eight hours or more (without eating) because they are petrified that something might happen at school,” he says.

If your child experiences anxiety related to eating, Nadia E. Charguia, MD, a child and adolescent psychiatrist with the UNC School of Medicine, suggests teaching your child coping strategies, such as “belly breathing,” to help calm themselves down.

“Have them place their hands on their belly and imagine that they’re sucking in air from a balloon, and then blowing the balloon back up,” Dr. Charguia says. “Teach them to watch how their hands rise and fall. Building those tactile sensations can help them really focus on the physical experience to draw them out of the emotional reaction.”

Another option: Find a distraction, such as coloring, holding a stuffed animal or pillow, or petting an animal. The idea here is to give them “something that they can go to that helps draw their thoughts away from what is triggering that anxiety,” Dr. Charguia says.

Once your child is calm, then try encouraging him or her to eat. Dr. Charguia says the more children are exposed to whatever is causing the anxiety when they are calm, the easier it will be for them to cope with the anxiety and eat outside the home.

If these tactics do not work, Dr. Charguia suggests working with a child therapist or pediatric feeding specialist.

Also, watch for signs of bullying. Children with food allergies can feel singled out by their teachers and peers.

“You start to see some of the early signs of those kids being treated differently. And while it may not be malicious, other kids start to see that as well and that potentially affects how classmates treat these kids,” Dr. Kim says. “That can lead to some types of bullying as these (food-allergic) kids get older.”

What Parents Can Do

So, what can parents do to help minimize their child’s anxiety around a food allergy?

The hardest but most important step for this is for parents to accept and then to control their own anxiety. Being able to stay calm during a food allergic reaction can send a powerful message that reactions are serious, but can be managed. Avoid negative words such as “shot” or “stab” in reference to epinephrine, medication used during severe allergic episodes, to help make reactions less scary.

“We can try to teach our kids the importance of the diagnosis, the importance of the avoidance and the potential severity of reactions, but at the same time try to normalize that,” Dr. Kim says. “Because at the end of the day, all kids, including food-allergic kids, just want to be like everybody else. The food allergy makes them different but not that different.”

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