Managing Your Child’s Food Allergies
Food allergies are not just a nuisance. It can be unsettling to find out that a food your child enjoys can cause a serious illness or even death without the proper treatment.
There is no known cure for a food allergy, so strict avoidance of the food is critical to avoiding a potentially life-threatening reaction.
Know the Severity
A 2018 report from researchers with the Centers for Disease Control and Prevention’s National Center for Health Statistics estimates that 3 million children under age 18 (3.9 percent) in the United States have at least one food allergy. The biggest sources of food allergies are milk, eggs, peanuts, tree nuts (pecans and walnuts), fish, shellfish, soy and wheat.
“It can feel really overwhelming and really big,” said Dr. Michael Pistiner, pediatric allergist and instructor in pediatrics at Children’s Hospital Boston, Harvard Medical School. Pistiner is also author of “Everyday Cool With Food Allergies,” which teaches basic food allergy management skills to preschool- and early-school-age children. “It does involve maintaining food allergy management at all times and in all circumstances,” he said. “You want to prevent an allergic reaction and be prepared at all times to treat it.”
Sensitivity to an allergen food can range in severity from a mild headache to hives at the site of contact or life-threatening anaphylaxis. In some cases, a child may be able to eat a small amount of a particular food but will not tolerate larger amounts. For some children, simply touching or inhaling the allergen food will trigger a reaction. In these cases, parents should take precautions by reminding allergic children to wash their hands frequently and avoid allergen foods, either prepared or as they’re being cooked.
“The age of the child will play into it,” Pistiner said. “Little ones explore their environment with their hands and mouth. They can get the allergen into their nose, eyes and mouth. Older children can wash their hands and be responsible for self-preparedness.”
Although a parent’s first instinct may be to ban the problem food from the home, this may not be necessary. Parents should consider factors such as the severity of the allergy as well as the ages of other children in the home and how they will be affected by the ban. An allergen food such as peanuts can be banned completely without causing too much hardship for the rest of the family. Other foods that are diet staples, such as milk, eggs or wheat, may be more difficult to eliminate.
“It’s important to realize that the most severe food allergic reactions occur from ingestion,” said Dr. Todd Green, assistant professor of pediatrics with the Division of Allergy & Immunology at Children’s Hospital of Pittsburgh. “And with vigilance and appropriate steps taken to prevent ingestion, it should be possible for other family members to continue to eat a food that another member of the household is allergic to.”
In most cases, accommodations are easily made for the allergic child without interrupting normal family life. “Parents can prepare foods that most of the family can eat and supplement for the family member who is affected,” said registered dietician Debbie Mouser, the owner of Cook for Life in Dallas, Texas. “If the child has a gluten restriction, you can simply prepare your vegetables and meat without any bread coating and then everyone in the family can enjoy them. You can supplement a gluten-free bread or rice product for rolls.”
Keeping Safe at Home
Mouser recommends consulting a dietician to learn which foods can be substituted for the allergen foods, and then taking lists of those foods when shopping. She also suggests searching out products on the Internet.
Another important line of defense against unsafe foods is reading labels on all food products. “You’ll have to become a label-reading machine,” Pistiner said. Allergens can be hidden ingredients in foods, so label-reading is essential in the family’s prevention strategy, he noted. Children also need to be taught to read labels in age-appropriate ways. If they cannot read, they can be taught to ask an adult to read the label. Pistiner advises his young patients and their families: “If you can’t read it, then don’t eat it.”
Even the most minute contact with allergen foods can trigger a reaction, so cross-contamination must be avoided. Eating utensils, dishes and cups, measuring cups, mixing bowls and other food prep equipment must be thoroughly cleaned after use. Separate containers must be used to store safe and allergen foods. Tabletops, counters and high chairs must be wiped down with soap and water, commercial cleaners or commercial wipes.
Parents also need to have an allergy action plan from their child’s health care provider handy at all times and an EpiPen to treat serious reactions. Communicate with your doctor about exactly which emergency medications can treat reactions, and ensure that both you and your child understand exactly what needs to be done in the case of a reaction, and that you have exactly the right medications at your disposal at all times.
Tips for Caregivers
Whether it’s Grandma or a sitter, everyone who will care for your child must be educated about the seriousness of your child’s food allergy. Set up a time before your sitter starts working to review your allergy management plan in person.
“Be very clear about what the allergy is and what foods contain those allergens,” said Kelly Bailey, a registered dietician in Mount Vernon, Ohio. Educate the caregiver on which symptoms to look for, such as changes in breathing, hives and vomiting, she noted.
In case of an accidental ingestion, the caregiver needs to know how to administer the EpiPen or any other doctor-prescribed emergency treatments. Caretakers should be instructed to call 911 in the case of an emergency, and also have all pertinent doctors’ phone numbers at their disposal on one clearly marked, simple-to-read index card.
Communicating with Schools and Beyond
As your child gets older, the allergy management skills learned at home must be extended to school and social activities with peers. Many states and school districts now have guidelines on food allergy management in schools. Parents must still take the lead to inform the school personnel about their child’s allergy prevention, notifying the school administration, the school nurse and the child’s teacher.
“You have to teach your child to not share or accept food another child gives them. They can only eat what Mom and Dad provide for them,” Bailey said.
Food celebrations are common in classrooms, with parents sending cupcakes to celebrate birthdays or holidays. With more children having food allergies, prevention becomes an issue for the entire class. More day-care centers and schools are now banning certain food items.
Bailey recommends teachers send a letter home to parents informing them of the allergies children have and requesting that they send safe snacks such as pudding or fruit.
If a child is involved in sports, the same rules of prevention and preparedness apply. “They can bring their own snacks and medicine, and the coach must be fully aware,” said registered dietician Mary Ellen Caldwell of Dallas, Texas.
While the allergy management strategies learned at home will give your child the skills he needs to feel safe wherever he is, there may be moments when your child feels different. “Encourage your child to share their feelings if they feel bad or frustrated,” Pistiner said.
Although it requires some advance planning, finding a restaurant that can accommodate your food-allergic child, and providing a pleasant dining experience for all, is becoming easier. Restaurants are increasingly responding to growing concerns about food allergies and are training their staff and including allergy information on menus.
Parents should call in advance of their visit and speak to a manager with their concerns. It’s also best to visit a restaurant at non-peak hours so you can get more attention. And make sure to bring an EpiPen as well as all other prescribed emergency medications.
As for what to order? “Keeping it simple is best,” Pistiner recommended. “Avoid sauces, fried foods and combination dishes.” He added: “If there is any doubt that a safe meal can be served, then politely leaving is the best and only thing to do.”
Dinner with Relatives: Planning Ahead Will Ensure a Good Time for All
An invitation to dinner at your favorite aunt’s home or hosting an anniversary celebration for your in-laws need not cause anxiety. With careful planning and a little creativity, family gatherings can be a safe and enjoyable experience for the entire family.
If you are the host, involve your allergic child in the menu planning, and encourage her to assist with the shopping and preparing of safe foods. This will help alleviate some of the disappointment that may be associated with eating different food.
If you are not the host, communication with the relative or friend about your child’s condition is key. “Be open about what your child’s needs are,” said Dr. Michael Pistiner, a pediatric allergist and instructor in pediatrics at Children’s Hospital Boston, Harvard Medical School. “Parents should not feel guilty for taking care of their children. If I am visiting my sister and she cannot provide a safe meal for my child, then I should feel comfortable enough to bring my own.”
Establishing non-food activities is a good way to help the allergic child feel included. “Given the importance of food in many celebrations, families can try to encourage non-food-related activities and crafts at celebrations,” said Dr. Todd Green, assistant professor of pediatrics with the Division of Allergy & Immunology at Children’s Hospital of Pittsburgh.
“Let the child plan games and select decorations,” suggested Mary Ellen Caldwell, a registered dietician from Dallas, Texas. “There can be a poem-writing contest with the best poem winning a prize — anything that doesn’t involve food.”
Find out what types of foods will be served and if food will be served in more than one area of the house. Foods from bakeries and restaurants are frequent sources of cross-contamination exposures. Discuss the importance of keeping unsafe food items away from safe foods you will bring.
The severity of the allergy is an important consideration. “If a child is going to get a runny nose or a mild headache from eating chocolate, they might be willing to suffer that to have the food,” said Debbie Mouser, a registered dietician from Dallas, Texas, and the owner of Cook For Life. “But most kids who have serious allergies will want to stay away from those foods.”
Finally, as always, Green noted, a food allergy action plan and all prescribed emergency medications should travel with a child to the celebration.