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Those of us who are food allergy-knowledgeable licensed behavioral healthcare providers will inevitably get calls from parents seeking guidance on helping their child with food allergy-related anxiety at some point.
Signs of anxiety don't always present in kids the same as they do in adults. So what leads these parents to believe their child has elevated levels of anxiety? Some common reports are:
"My child will no longer eat at restaurants when we go out to eat as a family."
"My child complains of an upset tummy often, especially before or after eating."
"My daughter won't ever go to her friend's house to play, even though she says she would like to hang out with her friend over there."
"My son reads food labels over and over again, sometimes 5-10 times, before feeling like he can eat a food."
"My child says she feels like her stomach hurts and her throat is closing after almost every meal she eats."
If you or your child exhibits elevated levels of anxiety that are negatively impacting daily life, I highly recommend seeking guidance from a licensed clinical counseling professional, preferably a food allergy-informed one.
But even if you're not experiencing elevated levels, these five general anxiety reminders for parents may still be useful to incorporate to address and manage developing anxiety.
1. Aim to manage the anxiety, not completely get rid of it
Wouldn't it be great if we never felt anxious or worried? Sure, but that's not a realistic goal for anyone, so don't try to remove everything that produces anxiety for your child.
The best way you can help your child navigate anxiety is to help them learn to accept its presence, understand it, and develop skills to manage it. Part of understanding anxiety is not only learning about the thoughts and feelings but also the physiological sensations often associated with the emotions. By gaining this understanding, it allows for more personalized skills that will help your child manage their own anxiety. Focusing on managing the anxiety (rather than avoiding it) often demystifies these thoughts and feelings, which can lead to decreased frequency of anxiety over time. It's also important to remember that anxious feelings can also be a positive tool, reminding you to assess risk, and motivating you to cope in order to make it through an uncomfortable situation.
2. Avoidance can increase anxiety
Your natural instinct when you see that something makes your child anxious may be to remove them from the situation, and maybe even avoid similar situations in the future. While it's important to avoid unsafe situations when managing food allergies, if you find that you and your child are shying away from most activities, you may need to explore if all of them truly have high enough risk levels that they need to be avoided completely, or if you can reassess the risk levels for some.
Why is it important not to simply avoid all situations that evoke anxiety? Because it can send a message to your child that the solution to anxious feelings is to avoid, leave, or simply ignore the feelings. Approaching anxiety this way robs them of the opportunity to learn to navigate these feelings, build tools to become more resilient, and gain confidence.
3. Be realistic, but positive
You can't promise your kids that they will never be faced with anxiety-provoking situations where they may come face-to-face with their allergen, or even experience a reaction. But you can promise them that you are prepared with your emergency action plans and epinephrine, have educated those around you, and that you won't put them in situations they feel unprepared to handle without their permission first.
When they express fears or worries, promise them that you are there to approach these feelings together as a team. Remind your child that they will learn how to navigate their worry, and will likely become braver than it over time.
4. Don't reinforce fears; reinforce skills
When your child (or you, for that matter) feels a lack of control, it can fuel anxious thoughts and feelings. Therefore, it's crucial to emphasize the skills they have in their toolkit to navigate and cope with situations, rather than focusing on the fear. Practicing food allergy safety skills often with your child will increase their confidence that they can handle anxiety-provoking situations. If your child presents with the "what ifs" often, use this as an opportunity to talk through the scenarios with them. By exploring situations ahead of time, it reminds them which tools they can use to navigate worrying situations, and which skills they have to manage their emotions.
Parents also need to learn how to reinforce skills and not fears in those crucial real-time moments. Rather than responding to your child's anxiety with phrases like "Don't worry" or "Everything will be fine", use messages that reinforce your child's ability to manage the uneasy feelings. When you're faced with that upset tummy, rather than trying to reassure them with "I'm sure it's nothing" or even joining right in with their worry, use a skills-focused approach: "Upset tummies are no fun! Let's use our private investigator skills to figure out why it might be bothering you?" (And then follow up with a team investigation together). When your child won't eat at the restaurant, instead of focusing on, and inadvertently fueling the emotion by saying "Are you worried? Is your tummy upset?", focus on the skills by saying something like "I wonder if we should review our safe restaurant eating tools again to make sure we've used them all? Remember when we ate at [insert restaurant] - we used all of these tools and we ate safely." (Maybe even have a checklist handy for your child to actually use at restaurants).
5. Model healthy anxiety management
There's no way around this one - your child watches how you manage (or don't manage) your own fears, worries, and anxiety. They key into your words, your tone and body language, and your actions. Most kids are typically skilled enough to pick up on the discrepancies, too. If you say you aren't worried, yet your child always overhears you talking to a friend about how anxious you are that a reaction will happen, it sends mixed messages.
Does that mean parents aren't allowed to have anxiety or fears? Absolutely not (refer back to point 1, which applies to kids and adults alike!). Parents, especially those managing food allergies, often have elevated levels of anxiety, especially in certain situations. It's okay to be honest about being anxious or worried as a parent, but learning how to cope with these emotions and practicing what you are preaching is absolutely crucial. Showing your child that you're tolerating/accepting your own stress, and using healthy skills to manage your own anxiety will help them learn and adopt these skills, too.
(If you feel you're not managing your own anxiety and fear well, please consider reaching out to a counseling professional for support, as it's important to practice good self-care as parents. You can locate a food allergy-informed one via the Food Allergy Counseling Directory)
***[This article was published in the Fall/Winter edition of Coping with Allergies & Asthma Magazine, both online and in print]***
RECOMMENDED ANXIETY/WORRY TOOL FOR KIDS:
I like to recommend the following workbook for kids, as they can work on it with their parents at home, or with a counselor. It's an interactive workbook geared towards kids ages 6-12, which guides parents and kids through common Cognitive Behavioral Therapy (CBT) techniques that help with worry. It's part of a series of workbooks, which cover a variety of topics.
What to Do When You Worry Too Much: A Kid's Guide To Overcoming Anxiety by Dawn Huebner, PhD* (You can also find this book via other sources, such as Amazon, but the APA site offers additional related resources, such as puzzles and word searches)
RECOMMENDED ANXIETY/WORRY TOOL FOR PRETEENS/TEENS:
The following two books are great for those in the preteen or teenage range: