When Food Allergies Cause Anxiety in Your Child
Originally Posted on Pyschology Today on April 22, 2019, written by Kathering Nguyen Williams Ph.D.
Food allergies affect up to 6-8% of children and 3-4% of adults, and data shows that prevalence has increased 18% among children under age 18 years. Despite the increased attention and research in food allergy, and some promising early studies of allergist-supervised gradual exposures, a cure has been elusive and avoidance of the offending food remains the primary recommendation. Besides the risk of fatality and health care costs, food allergies have a profound effect on quality of life. Food allergic individuals and their caretakers must be aware of the risk of hidden allergens or cross-contamination at every meal and frequently special provisions must be made for these individuals. While often essential, this hypervigilance of food ingredients often have the unintended consequence of developing or increasing anxiety in the child with food allergy and their parents.
In fact, anxiety symptoms are common in children with food allergies, particularly those associated with anaphylaxis. Mild anxiety related to a food allergy may be protective as the anxiety often leads to the child being more cautious with assessing food ingredients prior to ingestion; however, in some cases, the anxiety becomes debilitating and results in significant impairment in the child’s daily functioning. In these cases, the anxious child with a food allergy often engages in avoidance behaviors that impact their educational, social, and daily functioning. They tend to avoid food stimuli, which is debilitating given the prevalence of food in our daily activities. For example, the highly anxious child with a food allergy may avoid going to restaurants, avoid eating or going to school, avoid going to a friend’s house for a playdate, and/or avoid engaging in social activities that may have food present (such as sports games). The child may follow a highly restrictive diet, which in turn, impacts their nutritional intake.
For some children and their families, the child experiencing an anaphylaxis reaction can lead to post-traumatic stress disorder symptoms. They may be triggered by reminders (e.g., ambulance siren, smell of the dish containing the offending allergen, seeing certain family members who were present during the life-threatening situation). This may lead to further avoidance behaviors from the child and associated stress with the family members.
Anxiety symptoms, such as feeling tense and restless and difficulty concentrating, may negatively impact a child’s ability to appropriately assess food ingredients before intake. The physical sensations of anxiety (e.g., difficulty breathing, increased heart rate) may be mistaken for anaphylaxis, which then further exacerbates the child’s anxiety level. This cycle of anxiety often leads to worsening of symptoms and functional impairment. In children, persistent anxiety and avoidance often lead to a poor developmental trajectory as they miss out on school and social development.
When a child’s anxiety related to a food allergy persists and results in symptoms that impair their daily functioning or highly restrictive diet, then immediate treatment is often medically and psychologically warranted. Studies have shown that in pediatric population, early intervention for anxiety can have great impact on the children’s developmental trajectory. While past studies on food allergy-associated anxiety have indicated the benefits of relaxation and deep breathing, these strategies are insufficient in content and intensity to treat anxious children who are persistently engaging in avoidance behaviors.
How to help your child manage their food allergy-related anxiety:
First and foremost, always consider the age of your child and talk to them in a developmentally age-appropriate manner. Start with an open-ended question about their concerns about their food allergy. Speak candidly to them about their fears, and validate their emotions. Once you have identified the child's emotions and the problem at hand, then you can help them to problem solve in order to reduce avoidance behaviors or fears. For instance, if a child is worried about not knowing how to use an EpiPen injector, the parent can help them learn and practice using a trainer EpiPen injector. A safety, or emergency action, plan is often helpful to keep in the home. With this plan, steps to take during an exposure to a food allergen is spelled out, and then reviewing the plan calmly with the child may be helpful.
What to do when you have a child with food allergy and resulting anxiety:
The gold-standard, evidence-based treatment is cognitive behavior therapy (CBT) in groups or individually, with a focus on the child's avoidance behaviors surrounding foods. In CBT, children learn relaxation and stress management, along with gradual exposure to situations (e.g., school cafeteria, restaurants) that make them anxious. In therapy, the child will learn coping strategies to reduce their anxiety, and of particular importance, how to "talk back" to their fears and replace negative or anxious thoughts with realistic counter-thoughts. If trauma symptoms are also present, Trauma-Focused CBT may be warranted. While CBT is often the first-choice treatment, medication may be needed in severe situations.
For resources on food allergy issues, contact Food Allergy & Research Education.
To find a therapist specializing in children and adolescents: Psychology Today: Therapist Finder