Advice from leading experts on how to speak to food allergic children about the risks and precautions – without instilling fear. See also our full article on “Your Child and Food Allergy Fears“.
Toddlers and Preschoolers
Start the awareness – You’ll need to inform a young child that an allergen can make him or her sick. Show what that food looks like, perhaps using a photo, and stress that it must be avoided. Begin to introduce the allergy rules (e.g. no sharing, hand washing, and never eating a food unless your parents approve it.)
“As with any difficult topic, keep it simple,” says Lynn Miller, an assistant professor of psychology at the University of British Columbia, who researches prevention of anxiety disorders in children. “You can have the child restate what they think they have understood.”
Above all, talk in positive terms.“You can tell your child they are raised with something special, and that everybody has to learn to manage something in their lives.” If you are going to be present at birthday party, she suggests saying you’re coming as a “special helper” – then you’re not the food vigilante.
Don’t say “you could die” – allergist Dr. Zave Chad suggests instead: “It’s serious, you could get hurt,” while other experts opt for “you could get really sick.” He says “young children understand ‘you could get hurt’ a lot better than‘you could die.’”
Child psychiatrist Dr. Jane Garland notes that most kids don’t fully grasp the concept and permanence of death until the age of 8 or 9.
Recognize anxiety spikes – There are three big “cognitive bumps” of brain changes within these years: ages 5 to 6; between ages 7 and 8; and just before adolescence, at 10 or 11 (older in some boys).
After the second “bump”, kids understand more about their allergies, and are more inclined to become anxious in trying to manage them. The brighter your child, the more they can contemplate abstract concepts, and the more anxious they may become.
Talk about fears – It will depend on maturity, but by about 9, Miller thinks parents need to start addressing (calmly) that it is possible to die of anaphylactic reactions – since an allergic child will hear this from other kids. “But you can discuss: ‘what’s the likelihood?’ and ‘everybody can die of something.’”
For instance, you might say that if a person was so frightened he never left home, that wouldn’t be a normal life, and that “there is a balance and risk we all take.”
She says to mention how few deaths there have been from anaphylaxis, and that most happened when the person didn’t have their auto-injector. “This is an opportunity to discuss, ‘what are you going to do [to stay safe],’ and evaluate his or her problem-solving skills.”
Self-protection – By the second or third grade, children need to be able to recognize and know how to avoid their allergens. You’ll need to explain: what an allergic reaction looks and feels like (you could feel really bad, get hives,have a stomach ache or have trouble breathing), and how to handle an emergency. Stress the importance of always carrying an auto-injector, and wearing medical ID.
Managing allergies, and anxiety – It is a lot on little shoulders. A stomach ache is the leading indicator of anxiety, and a sign that all may not be well with a child.
Sleepovers – Miller says research shows kids who take part in sleepovers at friends’ houses do a better job of managing their lives as adults. So ensuring your child participates in normal kid activities allows you to talk with him about managing allergies away from home, and provides practice.
Miller says the child should think: “I feel confident away from my parents and can manage my own feelings of distress.”
Let your child know the allergies are serious but manageable if they follow rules of awareness, avoidance, and are ready for an emergency.
Tougher love – Kissing, drinking and perhaps even drugs. Add allergies to this mix and it can be a volatile combination.
Experts suggest kids in their teens often fall into one of two camps: those mindful and even over-cautious about allergies, and those who display the adolescent penchant for risk-taking. The trick in either case is to keep the dialogue open.
Social worker Beth Goldstein finds that allergies present an opportunity to talk to teens about issues such as smoking marijuana and drinking. She told her son, “You can’t share bottles, you can’t share joints.” They also discussed kissing, and the need to ask a girl what she had eaten that day, and then decide if it was safe to kiss.
Chad avoids “death talk” with little kids, but with teenagers who stop taking food allergies seriously, it’s another story.
He speaks of a 13-year-old, with asthma, who he saw at an appointment and “who was taking chances. I told him, ‘If you don’t follow these rules, you could have a severe reaction, and you could die from this.’”
To teens who say aren’t carrying an auto-injector because they’re sure they can just avoid allergens, he’ll say: “That’s called famous last words.”