Dr. Scott Sicherer: Being able to recognize the need for epinephrine and to actually self-inject in an emergency are beyond the capability of most children your son’s age. The readiness to self-administer requires the appropriate developmental level, understanding about symptoms of a reaction, and then the willingness to inject the epinephrine.

Before you consider the readiness of your child, speak with your allergist to be sure you are comfortable with recognizing symptoms and understand when and how to inject epinephrine. Since barriers to using the auto-injector include “needle phobia” and unfounded worries about side effects, have a discussion with the allergist about the safety of epinephrine, and perhaps practice with an old injector and an orange. Achieving your own comfort is the first step in preparing the right message to give to a child who will eventually take on this responsibility.

The notion of self-treatment can be taught early on, but granting full independence is a much more gradual process. For all children, I generally instruct that a responsible adult should be available to make treatment decisions and ultimately inject epinephrine. For teenagers, having their friends aware of the food allergy and how to inject epinephrine can add another layer of safety.

Gradually include your child in allergy management, with guidance from your doctor. Having him practice with an epinephrine self-injection trainer is a good first step. The road toward independence also includes having him play a part in reading labels on packaged foods, speaking up about allergy at restaurants, and eventually discussing when epinephrine would be required.

Dr. Sicherer is a practicing allergist, clinical researcher and Professor of Pediatrics. He is Chief of the Division of Allergy and Immunology, Jaffe Food Allergy Institute, at the Mount Sinai Medical School of Medicine in New York. He is also a member of the FAAN medical advisory board. Together with Dr. Hemant Sharma, Associate Chief of the Division of Allergy and Immunology at Children’s National Medical Center in Washington, he writes “The Food Allergy Experts” column in the American Edition of Allergic Living magazine.

To submit a question, write to ask@allergicliving.com. Write “The Food Allergy Experts” in the subject field, and keep your question brief.

Eight-year-old Devon used to love food, but no more. Following some upheaval in her little life – a move last fall from Toronto to scenic Woodstock, New York, and an allergic reaction in a restaurant in the new town – Devon has developed serious food “issues”.

The girl, who’s allergic to peanuts and tree nuts, no longer even trusts her mother’s cooking. Daily, she pulls food packages out of the garbage to triple-check the ingredients for allergens. She’s so fearful about what fellow classmates might eat that her mother, Anna Ross, must physically remove her daughter from the car when taking her to school.

“It’s a drama, it’s tears, it’s dragging her up the walkway and handing her off.” Sometimes, the girl will wear her gloves all day to avoid touching anything in the classroom.

But Ross doesn’t attribute her daughter’s obsession only to the restaurant reaction, which was moderate (swelling of the throat and lips), or the move. These were contributing factors. Ross suspects it was her own efforts to educate a new school community and classmates about the seriousness of food allergies and the need for vigilance that got the wheels churning in her daughter’s head.

During a quick session in front of Devon’s class, curious kids put up their hands to ask: “Could she die if she ate a nut?” While Ross played down the possibility, Devon, at the age of 8, was listening with a new attentiveness. Today, the girl expresses a fear of dying and is seeing a child psychologist, while her mother suffers guilt about whether she said too much in front of her.

In an e-mail Ross sent to Allergic Living she asked a heart-wrenching question: “should an 8-year-old have to fear her mortality like that?”

She is not alone in her worries. Increasingly, parents are noticing that what they say and do to manage a child’s food allergies, even their very demeanor on the topic, affects the child’s sense of security – or lack of it.

Through Anaphylaxis Canada’s e-mail registry, Allergic Living asked parents how they spoke to their food allergic kids about anaphylaxis, and if they had concerns that they might be scaring them, in addition to teaching them precautions.

The topic clearly struck a chord, with over 70 responses arriving in a few days. Many spoke of the tough balancing act of instructing a child to always be vigilant about avoiding allergens, to not eat unknown foods, to have an auto-injector at the ready at all times, to communicate concepts such as cross-contamination in food preparation, but not to tip the child over the edge into fearfulness and take away the joy of being a kid.

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