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.

Almost two years ago, I wrote a bit about my absent-minded nanny who I felt I was stuck with for life on account of allergizing myself out of the “good nanny” market.

In my painstaking efforts to find a new one to better meet my family’s complicated needs, I was outright rejected by a bunch of great candidates and downright depressed by the disproportionately bigger selection of, ehrm, not-so great contenders (yes, speaking English and showing up to work is a must).  So I held onto Absent-Minded Nanny through what was a slow and painful self-destruction.

I envied every mother in the schoolyard for what appeared to be their uncanny ability to employ good nannies and maintain strong, trusting relationships with them. I envied the kids with nannies I was sure wouldn’t forget to call 911 in the case of an emergency (as I believed mine would) or feed them French fries from a food court if they had life-threatening food allergies (despite repeated instruction about not to ever feed the children food from outside the house).

I just couldn’t trust Absent-Minded Nanny to get it right so, by the end, I had her almost entirely relegated to housework. This of course made it impossible for me to work, made her feel useless and pushed our mounting mutual resentment over the edge.

She had to go and I finally let her. But in retrospect the whole move was stupidly impulsive. As one wise friend advised, “you’ve gone this far, six more months is summer and your kids will be gone all day – a much better time to make a change.” Words of wisdom, but ones I didn’t heed when the premenstrual moment took hold. I dropped the axe, leaving myself high and dry in a world where top nannies aren’t looking for families with work-at-home moms and young children with multiple life-threatening allergies.

This was the end of November 2007. And I was back on the nanny hunt. A revolving door of interviews and nannies-by-trial ensued until I finally decided to forfeit the fight. It wasn’t worth my sanity, which I completely lost after nanny Number 9 didn’t show up for work – no warning, no call (and I thought she really liked us) ….

But here’s the silver lining. I decided to put Judah, then just over 2 years old, into a Montessori daycare around the corner. By some stroke of serendipity, it had a vacancy mid-year. Then, just as we’re about to overhaul the menu to accommodate him, the allergist discovered that he had out-grown his milk allergy. By end of March he’s in full-time and I’m thinking I’ve just discovered a new planet in the solar system. Daycare. Who knew?

Older brother Lucas, the really allergic one (peanuts, tree nuts, egg, shellfish), meantime, is still in SK. It only runs from 9 a.m. to 11:30 a.m., so my career is derailed for the time being, my expenses are as big if not bigger and my house is messier than ever. But I was LIBERATED.

No more nanny nightmare, but more importantly, no more leaving – fretting or freaking out about leaving Lucas in anyone else’s care but my own, aside of course from school and programs. After a few weeks, I felt like mother of the year. I could finally breathe, which I don’t think I had done for any prolonged period of time since the day Lucas was diagnosed four years earlier. It had become clear that I was unequivocally un-nanniable. And I wore that revelation like a badge of honour for months.

Fast forward to present.

I am now the proud, happy and well-adjusted employer of one fabulous new nanny. Shocking news, I know. But after feeling great about my tenure as the do-it-all mom; the economics, the yearning for my career, the domestic disarray (sorry, I’m a writer not a homemaker) got the better of me. So I caved in and sponsored a nanny from abroad. I interviewed a bunch of women over the phone, chose the one I liked most (great English, obvious sense of humour, excellent references, several years experience and the right reaction to my description of Lucas’ allergies) and a nanny agent did the rest.

I made this decision while I was not in a state of duress. My life was relatively under control – Lucas was now in Grade 1 and gone a full day, Judah still in daycare, so why not? We’d been paying just as much in cleaning and babysitting, and if we scare her off, well – oh well.

It has been four months now and so far so good. Capable Nanny is well aware of Lucas’s allergies and her level-headedness and good judgment assures me that she’d be adept at handling an emergency. She doesn’t have to manage much, as I still punch out at pick up. So, my reliance on her, the risks and my emotional investment in the nanny-mommy relationship have been lessened exponentially – three key ingredients to my newfound work life-domestic balance.

The truth is, my nanny nightmare was no coincidence. Like with everything in this high-risk, upside-down allergic life, we, allergic moms, must prepare ourselves and the path before we enter. It wasn’t enough for me to train my nanny or to try to find a better one. I needed to pave the way to having one in the first place. So I can now admit I sabotaged myself for good reason.

Because sometimes it’s just safer to allergize ourselves out of things than take challenges we’re not quite ready for. And most of the time, it requires taking the rough road to finally get it right.

It’s February, the dead of winter. The gloom is in full effect and I’m desperate for something to keep my spirits afloat. Then it dawns on me: Honey is turning 40 in less than a year. This is the perfect excuse to book a fabulous trip we can’t afford, take off time we don’t have and capitalize on my mother’s generous offer to give us one week a year to go away, without the kids.And so, Amsterdam and London it is. The clouds have parted and I’m over the moon (and the gloom).

Of course with nine months until takeoff, the stress of leaving my two babies so far behind has yet to sink in. It won’t be until the final stretch that I even let my mind go to that place that tells me I should never be more than a mile away from Lucas, my 4-year-old wunderkind who could go into anaphylactic shock from the most minute exposure to a peanut, tree nut or, worse, to the unknown trigger that caused a life-threatening reaction last year.

So I have bought myself several months of excitement to fantasize about the trip. Amid lingering thoughts of cobblestone alleys, quaint coffee shops and my big fat euro shopping spree, up pop sneaky images of peanut butter sandwiches, peanut butter cookies, Pad Thai drowning in peanuts and all the rest of the forbidden fruits we dare not even utter the names of in real life.

But as the months pass, anxiety supplants fantasy; it occurs to me that autumn’s arrival means that JK soon begins, not to mention a whole new slew of drop-off programs.

Then, with the trip just 12 days away, it hits me: Lucas is starting two of his fall programs the week we leave town. This means that The Mama will have to do the initial allergy tutorial with his new instructors and disseminate all my literature (including his allergy action plan, my safe snack document, my how-to-read ingredients page and my letter to the parents imploring them not to feed their children nuts or peanuts before class). I also like to stick around before and after class to make face-to-face contact with parents and caregivers to drive the point home. The Mama will have to do that, too.

To make matters more daunting, I give my mother an allergy management refresher only to find out that she thought the EpiPen was administered cap down (OY!) and that the vital ‘click’ comes when the epinephrine is finished (OY, OY OY!). As it also turns out, the nanny, despite repeated training, forgot about removing the cap altogether. Somehow she also believed the first thing she’s to do after administering the EpiPen is to lay Lucas down on a hard, flat surface and not let him move (AHHHHHH!). What ever happened to 911? I retrain them on everything, but still.

“Maybe I should just start his new programs when I get back,” I think as I lie awake night after night. Of course, if I were a good mother, I would have already taking care of least half these tasks in advance. In fact, if I were a good mother, I’d never be leaving in the first place.

Guilt, insecurities and second-guessing take hold of my entire being.

The next thing I know, I’m boarding the plane: Honey, magazines and pillow in tow. What a liberating moment. We’re directed to our seats and for the first time in as long as I can remember, I don’t have to hang back to compel the head purser to make an announcement about Lucas’s allergies, I don’t have to comb the aisles looking for suspicious treats, I’m not concerned about sanitizing the arm rests and tray tables, and I’m not carrying a 30-pound carry-on filled with six EpiPens, antihistamines, puffers and snacks for a year. I don’t have a care in the world.

Then, once the novelty of traveling weightlessly wears off, it happens. The ‘what ifs’ return in full force and the guilt comes back like a secondary infection. This begs the question: Is traveling without Lucas as stressful as traveling with him?

I’m still undecided. But one thing’s for sure, leaving home with or without our anaphylactic children will always feel like an insane, anxiety-riddled, guilt-laden gamble, worth every second of the ride.

Europe, naturally, was amazing. Honey and I got some much needed away time. The Mama decided of her own accord not to take Lucas to those programs and everything was fine on the home front. Next stop: Florida with the kids.