Allergy and Children
Suffering from a long-term illness, especially if it is severe and sometimes limits activity, can easily make a child feel different from other children, and ‘not good enough’. Children with allergies, especially those with severe asthma or food allergies, may also be very frightened and anxious. At the same time, such children often feel that they have to protect their parents by not revealing their fears.
Children may also think that their illness is a punishment for something they have done wrong. Their guilty feelings can be so powerful that they may not confide in you unless you spend time talking with them about their illness, and encourage them to share their feelings with you.
One of the most valuable things you can do for children with allergies is to build up their self-esteem. This is especially important when they first start school, because they have to adjust to other children there, and learn how to deal with questions about their illness, as well as some unkindness.
For children whose allergies limit what they can do physically, or restrict some normal activities, try to find other interests and hobbies that the child can do well. When talking with the child, always emphasise the positive things – the difficulties that you have overcome together in the past, the measures that the child can take to keep the symptoms under control (such as stopping scratching, applying creams, or using a preventer inhaler) and the areas of Iife where he or she is particularly successful. As the child gets older, introduce the idea that coping with illness makes you a stronger, kinder and more resolute person, one who can cope with any of life’s challenges. Show the child how much you value their maturity and perseverance.
Pay attention to what the child’s friends are
saying – a bit of eavesdropping is allowed – and be prepared to counteract any negative messages. Teach your child to be strong and self-confident about choosing their friends, and to prefer those who are sensible, understanding and supportive. Ask casually about what schoolteachers and other adults say when you are not around, because they can, without meaning any harm, undermine a child’s confidence with thoughtless remarks.
For children with problems that are potentially life-threatening, such as true food allergy, your natural anxieties as a parent can lead you to be overprotective. This can make the child feel smothered, but letting go is far from easy. You somehow have to find a middle path that works for you both.
With asthmatic children, focus on letting them live as normal a life as possible. Avoid saying ‘no’ automatically to things that might induce an asthma attack – such as running around outdoors in cold weather. Take some small risks, and let the child make the decision sometimes – he or she will gain a lot from taking the responsibility, especially if the decision is the wrong one.
This is the only way for children to learn how to manage their own condition. The sooner you can begin letting go, the better the child will cope in his or her teenage years, when it really will be necessary to make some difficult decisions without your help.
A pitfall for parents
In bringing up a child with allergies, remember that there should never be any ’secondary gain’ from illness – absolutely no advantages to having the eczema get worse (easily done by scratching) or starting an asthma attack (some children can bring one on by breathing in a particular way).
If your child has to take time off from school because of ill-health, ask the teacher for work that can be done at home, and check that it really is done. Children who are allowed to benefit from being ill can establish an unhealthy pattern for dealing with life’s difficulties (see pp. 94-5), which may be long-lasting. Such a mind-set can seriously limit a child’s development.
Incidentally, the ’secondary gain’ from illness may be quite altruistic in nature. It can include stopping parents from arguing, or from nagging a naughty brother or sister, as well as more obvious things such as getting a parent’s attention – so be aware of all the circumstances in the family that are affecting the child.
Sometimes a child realises, unconsciously, that attending to illness gives a parent welcome distractions from emotional problems and a comforting feeling of being needed and useful. The allergies can become part of the structure of a family, the glue holding everyone together.
Conversely, long-term illness can tear families apart: according to recent research carried out in the United States, divorce is more common in families where a child suffers from severe asthma.
Doctors frequently notice that severe eczema also can create a lot of tension in the home.
If you feel that a child’s illness is affecting the family badly – in whatever way – talk to your doctor, or someone else who you trust. You may need the help of a counsellor or family therapist to sort things out.
Children and medicines
Parents often feel very anxious about all the medication an allergic child uses. On the whole, the drugs prescribed for allergy are very safe, and only children with severe disease are at risk of significant side effects. These children will be carefully monitored by the doctor.
Needless to say, if you can cut down on the drugs by reducing allergen exposure, avoiding irritants (e.g. tobacco smoke) and implementing some of the other measures described in this book, you should do so. But if the child still needs drugs to control the symptoms, it is far better to accept them than to let the child struggle with all the discomfort, limitations and distress that the illness imposes.
Parents who are very concerned about drugs should talk openly to the doctor about their fears. If there are differences of opinion about drugs within the family, try not to expose the child to the disagreements. Sort out a joint policy in advance and always present a united front to the child. Be consistent and reassuring about drug use, otherwise the child may feel confused and anxious about the situation – or may even learn to manipulate it.
The asthmatic child
Children with asthma should have a management plan (see p. 96) and may benefit from using a peak-flow meter (see p. 97). Once your child is old enough to comprehend the difference between preventers and relievers, explain that using the preventer regularly keeps asthma under control, which means no sudden attacks and less need to use the reliever in public — something which most children find intensely embarrassing. You should oversee the child’s treatment closely until the age of seven or eight, then gradually let the child take over some of the responsibilities.
Coping with food allergy
The following concerns true food allergy (see p. 62), which can be life-threatening, not idiopathic food intolerance (see p. 74).
Protecting a child with severe food allergies is a major task. You will find it enormously helpful to be in contact with other parents who are facing the same challenge. The practical details are everything here, and you can benefit from other people’s ingenuity in solving day-to-day problems. Several support groups exist (see p. 255), offering a wealth of advice.
For very small children, the main task is to ensure that everyone who looks after the child understands exactly what can and can’t be eaten. Child-minders and baby-sitters should spend time with you as ‘apprentices’ seeing what is involved in preparing food for the child – this is far better than just giving verbal instructions. Also make sure that everyone knows how to use the adrenaline auto-injector (see pp. 98-9).
Once children start going to parties, you should always stay at the party for the whole time, and supervise your child closely. Take food that your child can safely eat, but which other children can also share. Some parents put a label on toddlers warning other adults that certain foods are taboo – for children under reading age this is probably acceptable, and does allow you to relax a little, but with older children the dangers of being teased or stigmatised should always be borne in mind.
Plan ahead all the time. Keep a snack box in the car containing food that the child can safely eat. Whenever you go on a trip, however short, have some safe foods with you, in case you get stuck somewhere and the child gets hungry. If you go out to eat, exert maximum caution about the restaurant food (see p. 111). Some parents take along a guaranteed-safe, but super-delicious sandwich or burger, and ask the restaurant to warm it up in a microwave (where appropriate) and serve it at the same time as the other food. If you do this, be sure the staff understand that the food must not touch any other food.
At home, some parents opt for everyone eating the same allergen-free food, on the basis that this makes for being ‘a real family’. Others, finding this too problematic or expensive, make a virtue out of the allergic child having a different meal. ‘I try to make her feel special about having her own food. The allergen-free dinner or cake always looks and tastes really good.’
As children get older, and more independent, you need to educate them thoroughly about avoiding the offending food. Equip them for difficult situations by role-playing. Act out being offered a tempting item of food by another child, and being jeered at for refusing. Act out suffering an allergic reaction to food and getting help quickly, even though people around don’t understand and are uncooperative.
Allergies and schools
When your child starts at a new school, creche, or kindergarten, request a meeting with staff and teachers to talk about the child’s allergies if there is any likelihood of these becoming a problem. Do this well before your child starts at the school, so that any necessary changes can be made. If your child has a serious food allergy or severe asthma, you may have to make several visits because there are usually a number of different people you should meet, and follow-up sessions may be needed with some staff. If all this sounds daunting and ‘not my style’ then you need, for the sake of your child, to develop your skills in dealing with people and being assertive. Talk to a counsellor, or look for suitable training courses.
In addition to ensuring that the school takes good care of your child’s health (see below), you should also discuss wider issues of adjustment to school life. Teasing or bullying can be a problem for children with any kind of health problem. Ask the teacher to keep an eye on your child and ensure that he or she is coping well – for example, that there is no difficulty about using an inhaler in front of other children when necessary.
Eczema
Ensure all staff realise that the skin rash is not infectious, and that they are aware of the need to communicate this to other children. The appearance of the skin can create a lot of problems with class-mates, and teachers need to be alert for taunting remarks or hurtful nicknames.
Unfortunately, children with eczema are very susceptible to infections caught from others, such as impetigo (see p. 44), but you can’t really protect children from such infections without isolating them socially. The best way to tackle this problem is to deploy all the available treatments so that your child’s skin becomes stronger and more resistant.
Food allergy
If your child has food allergy, go and see the catering manager personally. It may be helpful to take some printed material on food allergy with you, plus lists of synonyms for food ingredients (see pp. 172-4) where appropriate. Concentrate on building up a good relationship with catering staff, while ensuring that they understand how dangerous certain foods can be to your child.
Many parents feel more relaxed if they supply their child with a packed lunch that they know is allergen-free. This is often a good strategy, but don’t be complacent. Most allergic reactions in schools involve food given or traded by another child with entirely good intentions. Some schools with food-allergic children have set up a ‘no trading food’ policy, which seems to work well. Other schools establish milk-free or nut-free tables in the canteen, so that friends can sit together and trade food safely. (The mothers of the other children sitting at these tables need to be well versed in food avoidance, of course, so that their packed lunches are as safe as your own.) In the United States, schools have sometimes tried banning nuts or peanuts altogether, where there is a nut-allergic student, but this does not work well.
Some parents prepare a printed information sheet about their child’s food allergy, with a photograph of the child, and put these up at strategic points around the kitchen and canteen area. This information can include instructions on how to deal with anaphylactic shock (see below) and who to contact in an emergency.
Finally, include the art teacher in your rounds – foodstuffs are often used in art and craft projects.
Anaphylaxis
For children with severe food or insect-sting allergies which can lead to anaphylaxis, check that everyone at the school understands the potentially fatal nature of this condition. Key staff must know how to recognise anaphylactic shock and exactly what to do: show them how the adrenaline injector kit works. You could take along an old one, so that they can practise (see p. 150). Injector kits and adrenaline inhalers must be within easy reach, never locked in a cupboard.
Repeat this educational process at the beginning of each new school year, and before school trips. As an additional precaution, your child should wear a bracelet or pendant (see box on p. 95) that informs medical personnel about his or her allergies –this is also vital for children with latex or drugs allergies.
Asthma
If your child has asthma, ask what arrangements are made for inhalers. Children who can take responsibility for their own treatment should keep their inhalers with them. For younger children, the inhaler should be in the classroom, somewhere that is easily accessible (never locked away) and should be taken along during breaks and mealtimes. The child must always be able to get to the inhaler quickly: even a small delay in using it when an attack occurs can have dire consequences. Make sure everyone at the school understands this, that they know how to recognise an attack, and how to react. Assure the teacher that there is little danger of an asthmatic child overdosing, and if other children take a few puffs they will come to no harm.
If the teacher seems to believe that asthma is a psychological problem (some still do), go and see the head. Suggest that a local asthma nurse or doctor comes in and talks to the staff and pupils about asthma.
Ensure that the teacher knows about the effects of cold air and exercise on asthmatics. Talk to the games teacher or sports coach, and the playground attendants. It is vital that the games teacher is encouraging but understanding towards asthmatic children. They should never be told to continue exercising if they feel breathless.
Allergens and irritants in school
Schools today often have soft furnishings and carpets – these may be full of dust mites. If your child is allergic to mites, and if allergy symptoms are frequent at school, have a look around the classroom and see if this might be the cause. Before discussing the problem with the school, learn all you can about dust mites (see p. 114-117) so that you can assess whether proposed solutions to the problem would actually work.
Pets are common in classrooms and they can cause allergic reactions in sensitised children. Moulds flourish in many school buildings, and will affect a child with mould allergy. Poor ventilation is sometimes a major problem in school buildings, especially those where windows cannot be opened.
Irritants in school air include glue, paint, the solvents from felt-tip pens, disinfectants, air fresheners and the fumes produced during science lessons. Make sure the science teacher is aware of the risks and always uses a fume cupboard if irritant gases such as nitrogen dioxide or sulphur dioxide are likely to be given off during an experiment.
Applying sunscreens to children’s skin is now routine in many schools and preschools. Teachers probably won’t think to ask permission, so if your child is sensitive to any common ingredients of creams or sunscreens, let them know in advance.