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In case you haven't had a chance to read this initial post introducing The 6 Stages of Allergy Parenting, here's a quick overview of the key information before we jump into details from each stage:
The Six Stages of Allergy Parenting
Adapted from Ellen Galinsky's work, licensed family therapist and founder of The Food Allergy Counselor, Tamara Hubbard developed the Six Stages of Allergy Parenting after recognizing that allergy parents could benefit from parenting guidance specific to allergy parenting that incorporated emotional benchmarks, too.
This primary purpose of this framework is to offer guidance related to the emotional and mindset aspects of allergy parenting, which is often overlooked in allergy parenting guidance.
The 6 Stages of Allergy Parenting essentially offer parents a framework to help them develop their mindset and parenting choices during each stage of parenting, which directly impacts their child's ability to learn how to live confidently with allergies. While overall allergy management skills and goals are noted for each phase, the guidance is heavily infused with information related to the emotional tasks, which are helpful for parents to be aware of and/or develop during each stage of allergy parenting. (For more information on what to teach your child at each stage of their development, check out this Allergic Living article).
Stage 1 - The Image-Making Stage
The Image-Making Stage is the period before the baby is born, and is similar for all parents, with the main goals focused on preparing for changes and parenthood. Where differences might occur is if you're already a parent of a child with food allergies and/or allergic conditions, in which case, you may already be nervous about the development of allergic conditions in subsequent children. The most important parenting tasks in this stage are to be aware of these fears and concerns and to discuss them with your healthcare team to be sure you're receiving the most accurate and up-to-date information.
Stage 2 - The Nurturing Stage
The Nurturing Stage covers infancy and ends at toddlerhood. The hallmark of this phase is developing your connection with your child.
If your child is diagnosed during this period, the main focus for allergy parents is to adapt to life with the allergic diagnosis - which is usually a big adjustment! This adjustment includes the emotional work of processing so many thoughts and feelings, such as the loss, grief, and sadness associated with a parenting journey that is different than the one you expected, and even anger, guilt, and trauma. (See the image below for common post-diagnosis feelings and mindsets). It also includes working towards an acceptance of the diagnosis and learning to live with the uncertainty of allergic diseases. (Note: Acceptance doesn't mean you have to like something; it simply means you're willing to feel/connect with all the feelings that the unwanted situation brings).
Even though you may begin to process these thoughts and feelings, it doesn't mean they will go away - and that's one of the hardest parts about parenting a child with a medical diagnosis - the intensity of how we feel and what we think. They will likely resurface with varying intensity at later times, such as during major transitions (i.e. school transitions), and post-reaction. But, acknowledging them and noticing if/when they impact HOW you parent is a useful strategy to work towards your own well-being AND help you focus on that bigger parenting picture.
Given that safety is the parents' main responsibility during this stage, it's common to feel overwhelmed and anxious. Adjusting to life with allergies and developing a new workable mindset takes time and practice, so be kind to yourself during this stage. You may find yourself spending late nights researching allergies, telling yourself that you can't leave any stone of information unturned. While it's important to learn about allergies and adapt to life with them, it's equally important to aim to focus on what's most crucial to learn first so that you don't burn yourself out trying to learn everything at once. Focus on the current stage you're in, how to adapt to daily life, and how to care for yourself during this major transition, too.
A heavy dose of self-compassion goes a long way during this process! And it's not uncommon for newly diagnosed parents to feel like they need extra support, whether through support groups, more experienced allergy parents, or even therapy, so don't be shy about asking for help!
Stage 3 - The Authority Stage
Next is The Authority Stage. Here come the tantrums and desire for more independence, as this stage covers the toddler and preschool years!
If a child is diagnosed during this stage, it's still important for parents to work through the parenting tasks in the previous stage, as truly processing and adjusting to the diagnosis are tasks that should be addressed no matter when the diagnosis occurs.
The main focuses during this stage are helping your child learn the basics of allergy safety and assessing if your allergy approach fits with your lifestyle. This includes learning/teaching these safety rules within the home, as well as outside of the home, as future stages will require the child to navigate their allergies in school and social settings. As mentioned in the initial 6 Stages of Allergy Parenting post, children often learn through scaffolding, or building upon prior knowledge and experiences. Therefore, it's important to lay a solid foundation of allergy skills upon which to build. And while the skills they're learning are focused on a serious topic (safety with allergies), don't forget to get creative and make it fun and learn as fun and hands-on as possible so they're engaged! Red labels for "not safe" and green ones for "safe", playing with food items as a first step to introducing more foods (with your allergist's approval), and reading allergy-related books together can help.
Developing trust in others' ability to care for our child is another huge focus within this stage (if not already developed in the previous stage). As children continue growing, they will need to learn how to separate from their parents, which means parents need to learn how to separate from their children, too. This can seem hard enough without allergic conditions, so recognize that this is supposed to feel hard and doesn't necessarily mean bad things will happen when you're not there. Focus on developing trusting relationships with a few key people in your life by educating them on allergies and your family's approaches to safety. Don't have someone you feel you can trust? Connect with other parents in a local allergy support group to see if they have babysitters they trust! Start slow and small - with someone there while you're present. Remind yourself that this is a crucial development for both you AND your child!
Additionally as important as monitoring your own mental health, anxiety, and stress levels during these earlier stages in particular. It's very easy for excessive anxiety to throw parents off course because it feels safest to avoid doing new things that make us uncomfortable. But as this framework shows, it's important to remind ourselves of the bigger picture - the ultimate goal of raising a confident allergic kiddo, and that starts with us modeling the steps to our kids. So not only will you benefit from checking in on yourself, but so will your child!
[Noticing picky eating habits or avoidance of foods? Episode 17 of the Exploring Food Allergy Families podcast may be helpful, as gastropsychologist Tiffany Taft, PsyD shares insights into the differences between developmental "picky eating" and Avoidant Restrictive Food Intake Disorder (ARFID)].
Stage 4 - The Interpretive Stage
The middle childhood years fall into The Interpretive Stage. Because of the increase in time spent outside of your care, it's important to focus on teaching your child basic self-advocacy skills and how to navigate various social situations. If your child was diagnosed as an infant or toddler, you may find yourself hitting cruise control during this stage - with things going more smoothly once they transition to elementary or primary school. However, it's important to continue to practice and develop allergy skills. Remember, the skills learned in this stage will be built upon the allergy management skills you've taught them in the previous stages.
Role-playing and discussing hypothetical scenarios can help kids practice their allergy management and safety skills at home before ultimately trying them out at school or activities. They'll need guidance understanding and navigating social experiences, so it's a great stage to also build an emotional health toolkit that includes calming/coping strategies such as belly breathing and 5-4-3-2-1.
Parents may also notice their own increased anxiety during this stage, as they continue to shift their trust to others to care for their child's safety on a daily basis. Therefore, it's important to continue to monitor your own thoughts and feelings, especially during these transition periods, as you continue to engage in new experiences that are likely outside of your comfort zone.
Stage 5 - The Interdependent Stage
The Interdependent Stage is the parenting stage that probably keeps most parents up at night! It's the one that newly diagnosed parents find themselves worrying about even though their child is still an infant because it's a MUCH bigger step towards independence, with less time spent with family and more time spent with friends.
This is the stage that all the previous stages prepare us and our children for. It's not uncommon for parents and teens to find that there are knowledge gaps that need to be filled before both feel confident in the teen's ability to stay safe. Especially if you've avoided allergic reactions for years, the seriousness of the allergy may be lost, so it may be time to do a deep review of all things allergy. After all, you not only need to learn to trust your teen, but your teen also needs to work towards earning your trust by showing they can be responsible and trusted!
If you've noticed similar feelings to the ones you experienced when your child was a toddler, don't be surprised, as the teen years can trigger intensity. Prepare for power struggles and not seeing eye-to-eye, which only increases parental anxiety and fear. But being willing to listen to their input and ideas will help immensely! Open and calm communication shared decision-making, and a team approach to problem-solving are your greatest tools during this stage.
If you and your teen just can't get on the same page (or even in the same book) about allergy safety, consider getting your allergist involved. Parental emotions, as well-intentioned as they are, can complicate things, so take yourself out of the equation momentarily by setting up an appointment for your teen and their allergist. It may be helpful for them to have a candid talk where your allergist can share information that may help your teen change their perspective.
It's also helpful to take a step back in this stage and assess what other skills they may need to learn to help them bridge to the next stage: young adulthood as an allergic individual. Do they know their medical history? Have they learned how to speak up at doctor's appointments? Have they taught their closest friends how to use their epinephrine autoinjector in case of emergencies?
When our anxiety and worry spikes in this stage (as it likely will), ask yourself: WHAT DOES IT WANT ME TO KNOW? Sure, it may remind you about risks, but it may also help to guide you towards focusing on ways you can positively impact outcomes, such as identifying other helpful skills to teach your teen.
And just like with previous stages, monitoring your own anxiety levels and mental health is crucial. Without doing so, our ability to remember our bigger parenting goals decreases and the likelihood of getting thrown off course grows.
[If your teen is doing oral immunotherapy (OIT) during this stage, you may find Exploring Food Allergy Families podcast episode 8 helpful, as two allergy-informed therapists explore power struggles and decision-making with OIT. You might also benefit from the OIT Mindset Guide packet and preparation worksheets, which you can find in The FAC's Shop].
Stage 6 - The Departure Stage
The Departure Stage is the final stage of our allergy parenting journey, as this is when our young adult child fully transitions out on their own. This stage IS the bigger picture we've been working so hard to reach, and our hope is that we've taught our child the skills and provided them the tools necessary to live confidently with their allergic condition!
Our parenting job doesn't end here, but the level of our involvement in their allergy management changes. Therefore, this is your time to reflect and process the parenting journey, which may not have been the journey you envisioned while back in stage 1, but hopefully is still one you feel proud and honored to have traveled. And there's always a new generation of allergy parents welcoming your guidance!
Final Thoughts...
Find the FREE 6 Stages of Allergy Parenting handout which is useful for both those managing allergies and healthcare/mental health care providers supporting them.
I hope that the 6 Stages of Parenting framework helps guide allergy parents through each stage of their child's development but with guidance to enable them to keep the bigger picture/bigger parenting goals in mind. By doing so, it becomes an anchor to help parents assess their progress, their pace, and their own anxiety, overwhelm, and stress levels.
It may also feel reassuring to know that so many allergy parents have stated that they feel that their ability to develop allergy confidence has been hindered by the pandemic. Those who were newly diagnosed during or just before the start of the pandemic haven't been able to practice allergy skills as freely, and therefore, may be addressing these tasks in different stages than initially expected! This is also true of allergy parents and allergic individuals in other stages, especially in the preteen/teen years. All of this delay does have an impact on how we feel about navigating life with allergies. So make note of this as you continue to try new experiences now - and remind yourself that the more we practice safely being outside of our comfort zone, the more confidence we can build!