Food Allergy Resources

Anxiety in Children with Food Allergies

May 2008

Anxiety

Five-year-olds and kindergarten go together like peanut butter and jelly — that is, unless they're allergic to peanuts. For parents of food allergic children, the kindergarten conundrum presents challenges beyond public vs. private, teacher to student ratios and flexible curricula. Susan* and her husband faced these barriers and more when they enrolled Chloe, their food allergic daughter, in public kindergarten.

At the insistence of Chloe's allergist, Susan made sure the school created a peanut-free table, staff members disbursed hand wipes after lunch and Chloe's teacher altered class projects to avoid allergens.

By the time Chloe reached second grade, school remained a safe place despite her life-threatening allergies to the top eight foods: milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat. But around this same time, Chloe encountered numerous family changes, including moving across the country, living in a transitional apartment, and being without her father for a short time, since he moved before the rest of the family.

These factors triggered Chloe to have an excessive fear of unsafe food and the fear of an allergic reaction imprisoned her. "I received a call from the school secretary who said that Chloe had come in from lunch thinking that peanut butter was everywhere. She was repeatedly washing her hands and refused to go back to class," recalled Susan.


So she picked her daughter up from school and brought her home to a calm and quiet environment. With a soothing tone, Susan told Chloe that many people get anxious, "even Mommy and Daddy." In another room, she scheduled an appointment with a therapist.

Unfortunately extreme anxiety can be common in children with life-threatening food allergies, but it is treatable—and sometimes reaching out for professional counseling is the best way to calm a fearful child.

Mary Klinnert, PhD, a pediatric psychologist in the Division of Pediatric Behavioral Health at National Jewish Medical and Research Center in Denver, CO, evaluates and treats many children with food allergies. Doctors and family members usually request a consultation with her when they are concerned about the child's (or the family's) adjustment to food allergies.

Dr. Klinnert strongly believes that children with food allergies experience different emotions depending on their age:

Young children

Young children generally go along with what their parents tell them; anxieties at this age are usually on the part of the parent.

School-age children

Dr. Klinnert noted a shift from the time children start school through age seven or eight. "Some children become fearful, typically of being exposed to the food to which they are allergic," she explained.

This can range from a mild anxiety to an extreme fear that affects their schoolwork and/or their peer and family relationships. When this age group is teased because of their food allergies, they feel different, excluded and blamed. "Their self-esteem may suffer and/or their fears may increase, and they may become clingy and unwilling to engage in normal peer activities," said Dr. Klinnert.

Teenagers

From what Dr. Klinnert has seen, teenagers follow a different pattern of response to having food allergies. Their concerns are often related to feeling different from peers and to resenting restrictions that are imposed by their food allergies. "In general, teens are more likely to take chances and ingest food that they are allergic to, either accidentally or purposefully," she said.

In order to overcome anxiety, Dr. Klinnert advises parents to teach children about their food allergies at an age-appropriate level. Children should also be involved in decisions and plans for managing their allergies. "One study demonstrated that although children with food allergies were fearful of eating away from home, they felt safer when they ate at familiar restaurants and when they had their medications with them," she noted.

But when anxiety about food becomes overwhelming, or when it interferes in normal, age-appropriate activities such as playing with friends and attending birthday parties, children and possibly their families should receive professional counseling.



Once Susan's daughter started experiencing extreme anxiety, she and her husband met with the therapist alone to educate her on their family story, their daughter's emotional history and food allergies.

Then Chloe joined her parents and met with the therapist for the first time. After that, the therapist treated Chloe alone. On a few occasions Susan's husband met with the therapist alone since he was the primary caregiver. All told, the therapist's involvement lasted close to six months.

Dr. Klinnert advises parents to maintain a balance between ensuring their child’s safety and helping their child to engage in activities normal for their developmental stage. If a child is involved in planning for their activities, they can learn the process of keeping safe while engaging fully in social and academic activities. She also suggested parents become aware of their own anxiety level. "If the parents are feeling overwhelmed by anxiety, their child will pick up on this and may experience increased anxiety," she explained.

Although it is possible to maintain normalcy under these circumstances, the challenges families face shouldn't be underestimated—and sometimes sitting down with an expert is essential to maintaining the highest quality of life.

"Having gotten to the root of the issues made a world of difference for Chloe, and helped her to blossom into a well-adjusted 9-year-old," Susan said.


Beth Puliti is a professional writer for a national healthcare trade magazine.

This article first appeared in the Spring 2008 edition of Support Net® (download now).

Approved by KFA's Medical Advisory Team March 2008.