Beyond Weaning: Wellbeing, Safety and Everyday Life

The psychological challenges of weaning a food allergic child

The psychological impacts of weaning a baby with food allergy can be difficult to manage for parents and carers, for example when a child develops food aversions or when parents are feeling isolated

In this section psychologist, Dr Christina Jones, provides practical tips and guidance to help reduce the psychological impact on the family.

My child is developing a bad relationship with food, what can I do to help?

Most of us will have certain foods which we enjoy eating more than others, and some which we refuse to eat entirely. However, food aversion and fear of food is a psychological response which might be due to a few factors.

Common experiences of children who have developed food aversion or fear of food might include frequent illness or hospital visits, feeding tubes, sensory issues and symptoms such as pain, bloating feeling or being sick. Children may have associated a negative experience with feeding, even if it was not the direct cause of their discomfort.

Parents may also experience an aversion to feeding their child certain foods, especially if they have had a negative experience with these foods in the past (e.g. perhaps they may have an allergy or intolerance to specific foods themselves, or weaning of a specific food did not go well with an older child).

There are several practical tips which can be useful in helping overcome food aversions/ fear of food:

Create a fear ladder/hierarchy

Depending on the age of your child, you could create a fear ladder/hierarchy. A fear hierarchy is a method of graded exposure used in cognitive behavioural therapy. With your child, you can create a ladder with scenarios (in this instance, regarding the food they are avoiding) from the least fearful to the most fearful.

For example, your child may rate looking at the food in question as a

• 3/10, smelling the food
• 4/10, touching the food
• 5/10, cooking with the food
• 6/10, watching someone else eat the food
• 7/10, touching the food with their tongue
• 8/10, all the way up to eating the food themselves 10/10.

The idea is to repeat the exposure to each scenario until the feelings of fear and anxiety are stable enough to move to the next step. This approach may also work well if you as a parent are the one with the fear or aversion [top tip, fear hierarchies can be helpful in overcoming other phobias as well as food].

Create a positive association with food

Remember that your child may have associated a negative experience with feeding, so a simple approach is to create a positive association instead. There are several ways you might go about this; encourage your children to help you prepare and cook food without the expectation of eating it, messy play (such as cutting whole fruit and vegetables into shapes and using as paint stamps) and role-play eating and mealtimes with pretend food. Creating a positive association could include pairing favourite foods and flavours with the food which is being avoided. Some research has also suggested that children may be more likely to try foods if their first exposure to it is paired with sweet flavours [top tip, try to ensure that sweet flavours are from healthy sources rather than processed foods]

Make sure they have a positive role model

Another way to help your child with their food aversion or fear of food is to make sure your child has a positive role model. Your child is more likely to eat foods if they see someone, they look up to eating it. This might include an older sibling, cousin, friend or any family member.

If you as a parent are the one who has an aversion or fear of a specific food, think about asking someone close to you to try your child with new foods to ensure your child has a positive experience if you feel unable to mask your fear [top tip, this approach is helpful with other phobias – e.g. if you are terrified of spiders but another family member loves them, ensure your child is introduced to them via that family member. Positive experiences can provide protection to developing phobias later in life].

Reward your child

For some, providing your child with a reward can be highly motivating. This could be an immediate reward which is negotiated (e.g. provide your child with their favourite treat upon trying a new food or a food which they are avoiding) or encourage more consistent eating (for example over a week, award stickers when your child has eaten new foods or foods which they are avoiding or create a game of food bingo which results in a more desired reward).

Avoid forcing food when unwell

It should go without saying but avoid forcing your child to eat and avoid giving your child with new foods when they are not feeling well (this may only serve to reinforce the negative associations you are trying to break).

How do I help my toddler/child understand their allergy without frightening them?

Knowing how and when to help your child understand their allergy without frightening them is a natural concern for parents and requires a balancing act between ensuring your child knows how to stay safe and allowing your child to live a normal life and not be overly fearful.

Imagine that you are in a car with your child on the way to a family party. You are talking to your partner in the front of the car:

“I hate going to family parties. There is always so much food, none of it is labelled and there are always crumbs on the floor. It makes me so anxious, and I can’t relax or enjoy myself. I’m permanently thinking the children will be picking things up and putting it in their mouths, or other family members will be giving foods to the children which I haven’t checked. I really don’t want to go…I’m going to phone ahead and make up an excuse. I feel much better knowing that we can just stay at home”.

In this scenario, what do you think your child has observed and learnt about going to a party?

Answer: parties are scary, that they should be avoided and that making excuses not to go helps manage the anxiety. How might that child feel the next time they are expected to go to a party?

The key thing to remember is that children can learn to be anxious from an early age, so try to model positive and calm behaviours.

Infants and toddlers are generally too young to have a good grasp of their allergy. At this stage, responsibility and management of the allergy lies with you as parents. The key aspect at this stage in your child’s life is to raise awareness in your infant/toddler that not all foods are suitable for them to eat. Given their developmental stage, using brief and simple statements is best.

Some tips might be to identify “safe” and “not safe” foods or distinguishing between your child’s food or your food. You may choose to provide a brief explanation as to why (e.g. this will make you feel unwell). If you do not keep the allergens in your home, you could look at photos or pictures as examples so as to raise awareness as to what your child can and can’t eat.

How development milestones can impact managing allergies

Developmental milestones and how to negotiate these are frequently reported by parents as times in which they feel anxious and worried. Here are some key milestones to be mindful of and how best to manage them:

1. Hopefully following the steps above, your child will be aware of foods which are safe and unsafe for them. When your child can read, start looking at labels together [top tip, you can turn this into a detective game whereby you are investigating the different ingredients in foods].
2. Try to ensure from an early speaking age that your child can self-disclose their allergy. Enabling your child to have the confidence to self-disclose and feel comfortable in eating when you are not present is important too [top tip, for children with multiple allergies, they are better saying that they have food allergies rather than trying to remember a long list. Towards the older age group].
3. Equally important is for your child to have an awareness of what an allergic reaction feels like and how they might explain this [top tip, try to use words which your child would use when describing symptoms and make sure nursery/school staff know these, you could try drawing a body and getting your child to point out areas which might be affected during a reaction].
4. Having some unbreakable ground rules around allergy management might be helpful. Think about what is most important such as always carrying medication (e.g. antihistamines and adrenaline auto-injectors) and checking food labels [top tip, you could use behavioural rewards to incentivise your child if you are meeting some resistance].
5. If you think your child is feeling overly anxious or worried about their allergy, name the feeling and talk about it [top tip, try to see things through your child’s eyes as their biggest issues may not be the same as yours].
6. Practice role-playing situations in which your child may have to assess risk (e.g. ask about ingredients, explain their allergies, refuse food politely or ask for help). This is a sensible idea to improve their confidence in managing their allergies.

I feel very isolated and worry my child will too, how do I deal with this?

Another negative thought which parents of children with allergies face is that they are restricting their children’s lives and social activities which leads both parent and child to feeling like they are missing out and often leaves parents feeling guilty. There are a number of different strategies to use to avoid or overcome feelings of isolation:

1. Understand what is and what isn’t a problem – look at the worry tree to help you decide as to whether this is a current or hypothetical problem or whether you have control over it. [top tip, the worry tree can be helpful with other worries you may experience].
2. Consider hosting playdates at your house so you as not to stop your child from socialising with other children. Invite the parents too so you are not isolated and can speak one-to-one with other parents to educate them about your child’s allergies.
3. If your child is invited to a party, calmly explain to the parent about your child’s allergy. You could offer to prepare suitable food, help to shop or suggest some safe foods for your child. Alternatively, you could give your child some suitable snacks to take with them.
4. Consider social activities which may not involve food or eating (e.g. sports clubs, art and creative type activities).
5. Check in to see whether your concerns about your child being isolated are true. Try asking teachers at school about your child’s behaviour and how well they fit in with other children.
6. Speak to other parents; allergy is common and the chances are there are other parents who are feeling the same was you. If you are struggling to find others in your immediate network, consider joining an allergy support group.

How to spot the signs of an allergic reaction

Your baby may have already presented symptoms of allergy, so you’ll know some to look out for.

Before you start weaning, check this section for the kinds of symptoms which may be linked to food allergy.

Symptoms of food allergy can commonly affect breathing, digestion, eyes and skin. Allergic symptoms can appear immediately (IgE mediated), or in some cases allergies will cause delayed reactions (non-IgE mediated).

Symptoms can be mild, moderate or severe, but are rarely severe or cause anaphylaxis in babies.

On the next two pages you will find the common symptoms of an allergic reaction, if you’re caring for a child not yet speaking be alert for the visual signs and sounds, especially if it is unusual behaviour for your child i.e. fussing or refusing food at mealtimes.

Spotting these symptoms doesn’t necessarily mean your baby has a food allergy. A number of these symptoms are very common in healthy babies and can be due to teething and other developmental milestones. If you suspect your baby has a food allergy, particularly if symptoms are delayed, it’s important that you keep a symptoms diary (like the one available in this pack) to help you and your healthcare professional with a diagnosis.

It’s also important to remember that not all reactions to foods are because of allergy; for example, some acidic foods like strawberries, tomatoes, citrus fruits can irritate the skin and cause a red rash around the mouth after eating. This is more common in babies with sensitive skin and eczema. This does not indicate a food allergy and avoiding the food is not needed. Applying an emollient moisturiser around the mouth before feeding can help prevent this type of contact reaction.

If you’re concerned or anxious about your child’s health, speak to your GP.

Common symptoms of an allergic reaction

Nose, throat & ears

Runny/blocked nose

• Excessive dribbling
• Runny nose
• Snoring and snorting sounds
• Breathing through their mouth
• Disturbed sleep

Itchy nose

• Rubbing nose and face
• Redness on the nose and around that area
• Sneezing

Sore throat

• Refusing food
• Difficulty swallowing
• Fussing at mealtimes
• Touching neck
• Disturbed sleep

Swollen voice box

• Hoarse voice/cry

Itchy mouth/throat/lips/tongue

• Fussing when eating
• Touching mouth and throat
• Putting objects in their mouth

Skin

Hives and rashes

• Bumpy skin
• Itchy raised areas
• Red patches
• Itchy rashes can lead to skin infections

Eczema

• Cracked/dry skin
• Weepy broken skin
• Scratching at affected area
• Disturbed sleep

Swelling of the skin

• Red and tight areas of skin

Eyes

Itchy/prickly

• Excessive rubbing of their eyes

Watery

• Tears when not crying
• More rheum (watery fluid that collects/drips from eyes)
• More mucous that crusts and looks like ‘sleep’ around the eyes

Red

• Blood shot white areas of the eye
• Red looking lash line

Swollen

• Puffy eye lids

Dark under the eye

Digestion

Swollen lips/tongue

Stomach-ache

• Disturbed sleep
• Diarrhoea/constipation
• Squirming or tensing up muscles
• Squeezing eyes shut/grimacing

Feeling sick

• Refusing food and drink
• Appearing hot, pale or flushed

Being sick

Constipation/diarrhoea

• When constipated a baby might pass more gas than usual
• Chronic diarrhoea can lead to weight loss

Bleeding from the bottom

Reflux

• Spitting up/being sick
• Refusing food and drink
• Difficulty swallowing
• Wet burps/hiccups
• Frequent coughing
• Poor growth
• Gagging or choking
• Disturbed sleep

Poor growth, dropping percentiles (usually 50 or more)

• Chronic diarrhoea can lead to weight loss

Airways

Difficulty breathing/ shortness of breath

• Increased breathing rate
• Increased heart rate
• Around the mouth and inside the lips turning blue
• Skin turning pale or grey
• Grunting
• Nose flaring
• Wheezing
• Chest appearing to sink in just below the neck or under breastbone
• Sweaty/clammy skin, but cool to touch
• Changes in alertness, more tired
• Disturbed sleep

Wheezy breathing

• A tight whistling or musical sound with each breath

Coughing

• A constant cough
• Disturbed sleep