Parenting multiple kids with multiple allergies
When Janeen Green was raising her first two children, she never worried about food allergies. Everyone in the family could eat any food she served. Concerns about “cross contamination” or “accidental ingestion” never entered her mind.
All that changed when baby Courtney was born. Green of Cary, North Carolina, was overjoyed to have another baby. But soon after she brought Courtney home, it became clear that her new daughter was suffering from symptoms her older children never had.
Courtney struggled with aggressive eczema and excessive spitting up. After many doctor visits and various attempts at modifying Courtney’s diet, a specialist finally diagnosed the little girl with food allergies. Courtney, by then a 1½-year-old toddler, was allergic to lamb, beef, pineapple, wheat, milk, egg and peanut.
For Green, the news was overwhelming.
“I was extremely upset and felt helpless about what to feed her,” she says. Her mind swirled with questions about Courtney’s safety. “What would I do when she was playing with other toddlers? How would I keep her safe in preschool or with sitters?” But her most pressing concern was this: “Should I change the whole family’s diet to match Courtney’s?”
In Bloomfield Hills, Michigan, Karen Schihl is raising three children with a total of five food allergies. Her oldest child, John, 12, is severely allergic to milk and sunflower seeds. (He was allergic to egg until he was 3.) Schihl’s middle child, Paul, 8, has no food allergies. Her youngest, Claire, 5, is allergic to peanuts, milk, egg and wheat.
When John was first diagnosed, Schihl’s adjustment was a challenge.
“I felt isolated. I knew of no one who had a child with severe food allergies,” she recalls. “It was a steep learning curve.”
Schihl and Green are not alone in balancing households with multiple food allergies. About 3 million children in the United States (6 percent of children under 3 years of age) have food allergies, many with an allergy to more than one food.
And the numbers are growing. More American families than ever before are experiencing food allergies, according to a new study by the Centers for Disease Control and Prevention (CDC). The study found that 1 in 26 children had food allergies in 2007—up 18 percent from 1 in 29 in 1997. The study also revealed that annual hospitalizations due to food allergies had jumped dramatically—from about 2,600 in the late 1990s to over 9,500 in 2007. Reasons for the spike remain unclear.
What is clear is that a child born into a family with a food-allergic parent or sibling has a higher risk for developing food allergies, says Tamara T. Perry, M.D., assistant professor of pediatrics at the University of Arkansas for Medical Sciences and Arkansas Children’s Hospital in Little Rock. A sibling of a peanut-allergic child is seven times more likely to have peanut allergy than a child born into a non-allergic family.
What can parents do to reduce the risk?
“This is a heavily debated question that’s being researched by investigators all over the world.” Perry says. “At this time, there is no scientific evidence that suggests that dietary avoidance during pregnancy or lactation prevents food allergies.”
In January 2008, the American Academy of Pediatrics (AAP) issued recommendations for children at high risk of developing food allergies. The statement replaced AAP’s earlier suggestions that pregnant or lactating women restrict their diet in regard to allergies. New recommendations include:
- Mothers should exclusively breastfeed for at least 4 to 6 months;
- If breast milk is supplemented before 4 to 6 months, a hypoallergenic formula should be used; and
- Solid food should not be introduced until a child is 4 to 6 months old.
Global guidelines about food avoidance beyond the age of 6 months to reduce allergic risk have not been substantiated by current medical literature, Perry says. Food avoidance may be needed if a child develops an allergic disease or shows signs of food reactions, she adds.
Allergist Perry has more than a professional interest in the topic—she has three food-allergic children. She discovered that her son Peyton was allergic to milk and egg when he broke out in hives after a bite of his first birthday cake. Peyton, now 8, outgrew the milk and egg allergies but remains allergic to tree nuts and fish.
In light of Peyton’s condition, Perry avoided peanuts and tree nuts while she was pregnant and nursing her second child, Parker. That was before AAP released its most recent guidelines. Her third child, Preston, was on hypoallergenic formula for the first year.
Despite these precautions, both boys developed eczema as infants. Testing revealed that Parker, now 5, is allergic to fish; he outgrew an allergy to milk and egg. Preston, now 2, is allergic to milk, egg, peanuts, tree nuts and fish.
Karen Schihl did not restrict her diet while she was pregnant with her two younger children. She ate normally, following her doctor’s advice at the time. She nursed all three children for at least one year, slowly introducing solid food beginning at 4 months. Because of son John’s allergies, Schihl was alert to the implications when daughter Claire developed eczema and a chronic stuffy nose. Turns out that Claire had allergies to milk, egg, wheat—and a peanut allergy so severe that it landed the little girl in the emergency room after an accidental taste of a peanut-flavored rice bar.
Managing at Home
While how to prevent food allergies from developing remains a mystery, how to prevent an allergic reaction is clear—strict avoidance. In a household with multiple kids and multiple allergies, this isn’t always easy. So how do these families manage?
“There are a lot of creative ways to deal with this issue. It’s important that each family find what’s comfortable for them,” Perry says. The goal is keep kids safe while keeping childhood as normal as possible.
“We try to make eating—and life—as normal as possible for our kids,” Perry says. She makes sure safe foods, along with emergency medications, are always on hand.
Both Perry and her husband work and their household is very busy. Even so, Perry often cooks from scratch to modify meals to meet her family’s needs. She deliberately prepares more than enough so that there are leftovers to consume later.
Generally speaking, Perry does not advise her patients to restrict foods for everyone in the home. But it's important that each family determine its own comfort level. Some parents decide to maintain allergy-free households—for example, going peanut free when one or more children is severely allergic to peanut. Families also restrict if having the culprit food around causes too much anxiety, Perry says.
Janeen Green believes that home is the ideal place to teach kids the safety skills they’ll need to survive—and thrive—in the real world. After the initial shock of daughter Courtney’s multiple diagnoses, Green found a local support group and began talking to other mothers in similar circumstances. As she saw how other families managed, Green was able to get past her helpless feelings. She decided not to exclude foods in her household because of Courtney’s allergies.
Courtney, now 6, outgrew her allergies to wheat, lamb and beef before she turned 4; she remains allergic to pineapple, milk, egg and peanut. “I want to teach Courtney how to keep safe and be well adjusted in a home that represents the non-food allergic population outside our home,” Green says. “There is no place better than in the safety of your own home to teach your food-allergic child and non-food allergic siblings how to coexist in the world. It is a wonderful lesson in tolerance.”
Green routinely makes two meals, preparing allergy-free foods for Courtney that are similar to those consumed by older daughters, Caitlyn, 13, and Corinne, 11. How does she fit cooking into her busy schedule? Planning and preparation.
“Once you create a list of meals that work for your family and know the shopping list, you can rotate the meals from week to week,” she says.
Karen Schihl’s family also decided not to exclude allergens from their house. Schihl prepares multiple meals for breakfast, lunch and dinner for her children. For example, on any given day, John is eating peanut butter on wheat bread, Claire is eating sunbutter on her wheat-free bread and Paul is eating macaroni and cheese. Schihl cooks from scratch, baking and freezing food options for each child.
There’s an extra freezer in Schihl’s house packed with cupcakes, pancakes and other baked goods. Schihl can, for example, pull out waffles for Claire that are milk free, egg free and wheat free.
“To keep my sanity, I make double and triple batches when I bake and I freeze them,” she says.
“This allows us to all eat together in one sitting. I’ve always loved to cook and I’ve learned to like to bake. Because I do this, we can eat as a family.”
Mindful of the potential for cross contamination, Schihl is a stickler. “I cannot reuse mixing bowls, spoons, spatulas and cookie sheets when I cook,” she says. She also designates certain dishes and appliances for certain foods, such as keeping the outdoor grill allergen-free.
“That means no cheese on your burger until after it leaves the grill.”
The age of the children is a major factor in determining how to best manage multiple food-allergic kids, says Perry. If allergic children are older, well informed, and not likely to eat someone else’s food, it may be okay to have products in the house even if reaction history is severe. When children are very young, it is reasonable to keep allergenic products out of the home. Again, a family should operate within its own comfort level.
Helpful hints for households? Restrict children to the dinner table when eating. And assign seating so that contact risk is reduced. In the Green family, Courtney has her own spot at the table. The Schihl family does the same. The children can eat only at their designated place at the table.
Other house rules? Ask permission before eating and sharing foods. No toys on the dining table.
Some rules arise from bad experience. After eating ice cream as a toddler, Paul Schihl went to play on the piano. John then practiced his lesson and broke out in hives on his hands, arms and face. New rule: Wash hands thoroughly after eating.
Paul, who has no food allergies, says following the rules is fair because he knows it’s best for his brother and sister. Brother John’s response: “I’m grateful to Paul for being understanding.”
Education is key. Food-allergic children and siblings must know that food allergies are serious. They must be knowledgeable about what is safe for each family member to eat and they must be vigilant. They should know how to recognize signs of an allergic reaction and what to do.
Janeen Green has taught everyone in her family how to read and double-check labels to ensure that foods are free of milk, egg and peanut and safe for Courtney. The Schihls have done the same.
“I try to teach my kids to put all the safety buffers and nets in place,” says Schihl. “I won’t always be there.”
John Schihl says his ability to read labels for food allergens makes him a great babysitter for sister Claire.
Educating others is also a must. Perry makes sure everyone who comes in regular contact with her children is aware of their food allergies and knows what to do if there’s a reaction, particularly when she’s not around.
How to best strike the balance within the family between safety and providing a normal childhood is an ongoing concern for every parent who manages multiple food allergies. How do parents encourage a sense of adventure while playing it safe? Mutual respect and a positive attitude play a large role.
“The bottom line in our family is that we coexist with each other’s dietary needs and respect one another's allergies,” Schihl says.
“My husband and I tell the kids to focus on the things that we do have rather than on the things we can’t have,” says Perry. “We always remind our kids—and ourselves—of how lucky we really are.” LW