Food Allergy Meets the Teenage Brain
Practice, Practice, Practice
Steinberg is a big proponent of focusing on the development of behavioral skills, most of all self-control, as a way of not only reducing risky decisions but also enabling teens to grow up to be healthy, well-adjusted, and successful young adults. The adolescent years provide an exceptional opportunity for nourishing qualities such as self-control, determination, perseverance, and tenacity, which are highly influenced by social environments. Parents and schools need to support kids as they develop these abilities, and provide them with increasing independence as they learn to assume responsibility and do things on their own.
“Kids need to practice,” says Dr. Michael Pistiner, a pediatric allergist with Harvard Vanguard Medical Associates in Boston and co-founder of the educational website Allergyhome.org. “They can work on their skills and communication in a ‘safe space’. Practicing scenarios can be really helpful, for example role-playing how to order and communicate in a restaurant. Coach and guide them to think through managing anticipated situations, such as eating out,” Pistiner says. “Take baby steps, and gradually build them to having increased responsibility.”
This approach proved helpful for Carlin Hanley, 14, who has multiple food allergies and lives in the Boston area. She was shy when she was younger, and struggled with speaking up and reading labels. One spring when she was 10 years old, her family traveled to Maine, and Carlin ordered mashed potatoes at a restaurant. Although the staff said these were safe for her, they likely contained dairy – as she had a reaction. But Carlin credits this as a learning experience.
“It made me realize that I needed to speak up and have more of a conversation. After this incident, my parents told me to try making eye contact and told me to make sure I was specific about exactly what it is that I need.” She mentions realizing that there was “nothing to be afraid of,” and she became more open about her food allergies. Recently, she launched an allergy-friendly food blog and hopes to attract other teens to share advice and stories.
When I asked Carlin what she had been afraid of, she said she was probably afraid of someone yelling at her – though as she got a little older, she realized this fear was in her head and not based on reality. This comment drives home to me how hard it is for adults to know what it feels like to be younger. Although I still remember how terribly awkward and shy I sometimes felt in middle school, the related emotions and fears have subsided with age. Plus, I have the perspective of knowing that this was simply one stage in my life.
Kristen Kauke, a clinical social worker who has run workshops with food-allergic adolescents and is the mother of sons with food allergies, emphasizes this point. “If we assume we know an adolescent’s experience, we invalidate their experience and disrupt our connection with them,” says the expert, who has a practice near Chicago. Rather, we should try to understand how their experience makes sense to them.
“As a teen or tween, perhaps changing schools or sharing about a food allergy is the most significant event they’ve experienced at that point. Everything about teens is in flux – bodies, brains, peers – so feeling stable is a huge challenge. Of course food allergies feel like a big deal!” she says. Actively listening can enable adults to build better relationships based on empathy and validation.
While middle school is a good time for adolescents to learn how to eat away from home and advocate for themselves, high school is a time of brand new friendships, when teens need to develop new strategies for talking about food allergies. The way parents communicate about food allergies from a young age will help to prepare teens for these challenging conversations. Older kids may need to practice articulating thoughts, feelings, and needs.
In her work, Kauke teaches the “D.E.A.R.” strategy: “Describe the situation, express thoughts and feelings, ask for what you need, and reinforce.” For example, if a teenager wanted to enlist the help of teammates after a sports event, the conversation might look like this:
D: “So something about me you might already know is I have a severe food allergy to peanuts.”
E: “Sometimes I feel awkward bringing attention to me when we’re all out celebrating after a game.”
A: “It would be great if while I’m talking with the server, you all kept talking instead of staring at me.”
R: “I appreciate your understanding and help with this.”
Pistiner, meantime, recommends talking through potential scenarios. “We can give them the opportunity to bounce ideas off of us when the pressure is off. Together, we can work through their approach and explore different options,” he says. The allergist is a co-author of Living Confidently with Food Allergy, an online handbook that suggests steps to help teens plan ahead for social situations.
These include collecting menus from local restaurants and calling to speak with staff ahead of time, as well as problem-solving with your teen about how and where they’ll carry emergency medication. It’s also important to introduce several difficult but necessary topics in the context of food allergies – alcohol, drugs, dating and kissing.
“Having relationships is the issue that comes up the most!” says Charlotte Jude Schwartz, a teen ambassador for the Bay Area Allergy Advisory Board (BAAAB) who lives in San Francisco, adding that “it’s the most awkward thing.” Charlotte, who’s now 15, got “notes from my mom” and learned to explain how being exposed to peanuts and tree nuts would cause her to go into anaphylaxis, as well as what steps are necessary to help keep her safe.
She also can’t stress enough the importance of finding supportive friends and making use of a “buddy system” so that at least one friend is thoroughly versed in how to manage your allergies. “Talking to your friends in the best thing you can do. If they’re really your friends, they won’t want you to take risks,” she says.
For many parents, the hardest challenge can be summed up with two words: letting go. As difficult as this may be, we have to recognize that it’s ultimately our teens’ responsibility to begin to take care of themselves. “Realistically, I can only offer adequate education of allergy management, and give them room to apply the skills,” says Kauke. “The more I clamp down with control and fear mongering, the less freedom I allow them to develop life skills of their own. No learning takes place in fear.”
Older teens and young adults encounter situations where they have to make decisions in new settings, sometimes far away from home. When Kristen Lilley, a 20-year-old college student from North Carolina, had the opportunity to travel to Australia for a month-long study program, she was eager to go. She and her parents talked with faculty advisers, the airlines, and the travel agent about her food allergies (she has severe allergies to milk and peanuts) so that everyone was mindful of her allergies.
But no one could prepare Kristen for the bar scene in Australia, where the legal drinking age is three years younger than in the United States. Halfway through her trip, she went out with friends, giving her Benadryl to one girl who was carrying a purse and leaving her epinephrine auto-injector in her hotel room. (“I didn’t think I needed it, especially because I didn’t plan on eating anything,” she explains.) After one sip of a “surprise” drink another friend bought for her, she began to have trouble breathing – it turned out to have Baileys Irish Cream. “It was pretty terrifying,” she says. She took an ambulance to a hospital, where her breathing eventually normalized.
Her mom confesses to being “panicked” when she got the call about the incident. After it became clear that Kristen would be fine, she thought “for sure” her daughter would come home. But Kristen stuck it out. “We were very proud of the way she handled being on her own with these challenges,” says her mom. “But we certainly all learned some lessons.”
Next: The Kids Are (Mostly) All Right