Food Allergy and Bullying: The Implications for Parents of Children with Food Allergies

Chloe Mullarkey

There has been a surge in the prevalence of bullying due to food allergies, with an increase of 18% in children from 1997-2007 (Ravid et al., 2012). Bullies target children with food allergies in school because the child manages diet and medicine, which is a daily visible struggle. The special treatment children with FA receive can alienate them in school settings, allowing bullies the opportunity to tease and harass a child with FA in numerous ways. Bullying is a serious issue in cases of food allergies because a bully can not only cause psychological damage, but can also use the allergen as a weapon to cause physical harm. In serious cases, this type of bullying can be fatal. Bullying can include waving the allergen in the child’s face or touching the child with the allergen (Lieberman et al., 2010). Thus, the “inherent imbalance of power,” as Lieberman et al. (2010) coin it, sets children with FA at a disadvantage from the start. This is not the typical form of bullying that focuses on a child’s appearance, personality traits, or hobbies, yet it can have similar effects: feelings of embarrassment, humiliation, sadness and even depression (Lieberman et al., 2010). Children with FA, much like children with diabetes, must learn to manage and accept responsibility of FA, and bullying adds unnecessary stress to this lifestyle. Parents share the child’s struggle when meticulously planning the child’s diet and responding to skeptical parents or family without food allergies. It is, therefore a constant concern for parents who expect schools to protect their children, especially from bullying.

Parenting Concerns
Although the quality of life of a child with FA can be compromised, parents also experience stress managing their child’s diet and daily routine (Lieberman et al., 2010; Ravid et al., 2012). Findings suggest that parents experience much distress and are often protective, sheltering their children from some of the stress and anxiety that may be a result of managing a life with FA (Valentine & Knibb, 2011). Overprotective parenting in families with FA is a common coping method that can delay children’s selfmanagement and lead to emotional distress when dealing with their FA (Valentine & Knibb, 2011). Such behavior can be expressed by extreme concern for the child’s diet and insistence on allergen-free options in community or school bake sales. On the contrary, parents that do not have children with FA may complain about the allergen-free rule for bake sales and snack time. The negative feedback a child with FA receives from non-FA families can induce negative feelings and shame. Both the stress of maintaining an allergen-free diet and protecting the child from harm can create overprotective or hypersensitive parenting, which shelters a child from the realities of his or her condition (Valentine & Knibb, 2011). Valentine and Knibb’s (2011) study did provide hope, in that older children began to detect the increased meaning of FA in their lives as a consequence of the parents’ diminished micromanaging of diet and medication. There is still much to learn about the transition parents make when handing over responsibility to a child that could help new families struggling with FA. Future research should look more closely at this relationship and perhaps what style of parenting complements FA management best. It would also be beneficial to redefine the term management in FA to take into account mental health (stress and anxiety) and bullying, in addition to risk and avoidance.

Determining parenting style is not always intuitive or inherent because parenting operates on a trial-and-error method. Parenting is difficult to navigate without support, and for families dealing with FA, there are often more issues to tackle and less available support. Klinnert and Robinson (2008) note that “both overresponding and underresponding patterns of adaptation to children’s food allergies can place families at risk for poor outcome” and that some “struggle to achieve a positive adaptation with a balance between ensuring the child’s safety while achieving normative developmental and family functions” (Klinnert & Robinson, 2008, p. 195). In other words, children with FA often struggle to adjust to different social environments and situations properly. The way in which families raise a child with FA—particularly whether they are overprotective or neglectful—is harmful because the child does not learn how to effectively manage his or her FA and contend with possible bullying (Klinnert & Robinston, 2008). This is problematic because when children are not knowledgeable about their FA, they may not fully understand why they are being bullied and may, in turn, deal with this bullying in an unhealthy way. Alternatively, if children are raised to worry and overstress, the child may grow to resent their condition and may not be equipped to properly handle bullying. While finding a balance betweenoverresponding and underresponding may seem impossible, there are steps parents can take to move towards a middle ground. Parents can take a more holistic approach to management of bullying by keeping an open dialogue with a child and his or her siblings about FA. In these open dialogues, it is important to discuss management of FA: the risks in exposure to allergens, the methods by which to handle an allergic reaction, and the possibility of bullying (Ravid et al., 2012). Parents can also discuss the way in which a child approaches their FA in social settings and how and when they are disclosing to teachers, friends and classmates. Education, voice, and expression are key components to empowerment, and through empowerment, a child can find confidence, resilience and acceptance.

Interventions for Parents
Shifting away from practices parents can employ in the home, there are other mediums that may inform the parenting of children with FA that are bullied: interventions for parents new to FA. An intervention for families with FA should focus on educating parents about management, the dangers of bullying and how to help the child deal with bullying, perhaps similar to some of the ideas suggested above. Lebovidge et al. (2008) examined the effects of an intervention to increase competence, testing parents prior to the intervention and after the intervention. The Lebovidge study was successful in increasing parents’ level of awareness and understanding of coping strategies, while simultaneously decreasing “perceived burden” (Lebovidge et al., 2008, p. 163). While this study was effective in improving competence of coping and reducing perceived burden, it has yet to be replicated with more families with FA to show reliability and validity across groups. Awareness and understanding of food allergies are essential in creating a discussion and agreement with a child with FA, yet it does not specifically address the concept of bullying.

Mainstream Medical Approach
Perhaps researchers would create more interventions for parents and children with FA if practitioner detection of bullying and social and emotional problems was more streamlined. A typical visit to an allergy clinic for a child with food allergies or a child waiting to be diagnosed will show that allergists are primarily concerned with diagnosing and treating the food allergy, but little else. Clinical visits do not, however, always address mental health issues unless a patient or parent is open in bringing up any bullying, which children may not disclose to their parents (Ravid et al., 2012). The break in communication keeps the practitioner from diagnosing mental health issues in children with FA, and prevents families from receiving access to valuable mental health resources. Practitioners can overlook cases of anxiety and bullying because these experiences are not a part of the regimented checkup. Education is necessary for practitioners and specialists alike in regards to the harmful bullying that can occur in patients with FA to correctly diagnose mental health issues and inform parenting (Lieberman et al., 2010; Ravid et al., 2012). If practitioners were more aware and regularly evaluated for symptoms of bullying, the issues would be reported more frequently and perhaps addressed more efficiently.

Researchers are, however, beginning to notice the need for more awareness for FA bullying in the medical community. Klinnert and Robinson (2008) suggest regular medical evaluation as a powerful psychological intervention making parents and children aware of the risks and responsibilities while allowing the health care provider to assess for anxiety and emotional distress. Yet, these interventions may not be enough for children with FA if a parent is not proactive in voicing concerns implicating bullying and mental health repercussions. Health care providers should supply patients with information regarding support groups and access to psychiatrists or psychotherapy. Psychotherapy or other forms of therapy/counseling may help a child open up about his struggles with FA and the bullying he may experience on a regular basis. Therapy can also help a child put these thoughts into perspective and develop methods of coping with bullies and the difficulty of managing FA. Support groups are also a good way for children and families to feel like they are not alone. Children may find empowerment simply by talking to others with FA and discussing ways to handle bullying and methods of management. Parents will not receive access to these forums for support if they are not open with their children and encouraging of disclosure of bullying, which ultimately brings us back to the importance of the holistic approach: open dialogue.

Discussion
It is difficult to adopt a comprehensive perspective regarding the varying severity of FA and consequent bullying. Lieberman et al. (2010) admit that sampling is sometimes biased towards children with more severe cases of food allergies that express concerns about management. If researchers overlook the less severe cases of FA and parents/children who do not express concern about management, they may neglect important trends that speak to why children remain silent about bullying. Parenting can only be informed by a child’s disclosure and behavior, which has not yet been a topic of research in terms of FA.

Finally, there remains a lack of research addressing food allergy bullying and possible interventions or improvements. Many studies examine bullying prevention and intervention programs in schools, yet few directly address the issue of FA, which should be taken into special consideration. New treatment for FA may lead to better attitudes and decreased anxiety for children with FA, yet it remains unclear whether bullying would decrease as a result of a child’s treatment. Still, there remains a stigma for children with FA that is, in part, due to children receiving special treatment for FA within schools: sitting at a designated table, carrying and selfadministering medicine during the day, and increased attention from teachers or faculty. We must determine if this is a result of overresponsive/underresponsive parenting of FA children, or a characteristic that remains despite parent’s effort to normalize FA (Klinnert & Robinson, 2008).

In the future, researchers should observe interventions and therapeutic measures to determine changes that need to be made to school cafeterias, teacher awareness and sensitivity, and the prevention of bullying within schools. There should be a better understanding among non-FA cohorts of the dangers of allergic reactions in children and the damaging effects of bullying on these children. Family therapy is another option for families with FA, and can help the entire family understand the severity and seriousness of the FA while easing some of the negative feelings towards the child’s medical issues within his home (Klinnert & Robinson, 2008). In many ways, FA has become the new ADD in that non-FA parents make claims about the extent to which FA is “over diagnosed” and criticize parents that are struggling to deal with their child’s FA. Fortunately, the increase of awareness in schools and the medical community has driven the development of new forums for food allergy. FAAN (Food Allergy and Anaphylaxis Network) created Camp TAG, a summer camp specifically designed for children with FA who cannot attend camps due to the severity of their FA. Food Allergy clinics, like Mount Sinai’s Jaffe Food Allergy Clinic, are opening at major hospitals around the United States as the need for research into food allergies and the detrimental social and developmental effects on children grow. It is becoming evident that the most important aspect in maintaining the mental health of a child with FA is openness and awareness: if the parent is aware of the child’s bullying, the parent will more than likely react in ways to help support his or her child and effectively manage the problem. If the parent can normalize a child’s FA within the home, the child will more than likely feel comfortable in other social settings and handle bullying more effectively.

References

Klinnert, M. D. & Robinson, J. L. (2008). Addressing the psychological needs of families of food-allergic children. Current Allergy and Asthma Reports, 8(3), 195-200.

LeBovidge J. S., Timmons, K., & Rich, C. et al.(2008). Evaluation of a group intervention for children with food allergy and their parents. Annals of Allergy Asthma Immunology, 101(2): 160–5.

Lieberman, J., Weiss, C., Furlong, T., Sicherer, M., & Sicherer, S. (2010). Bullying among pediatric patients with food allergy. Annals of Allergy, Asthma, Immunology, 105(4), 282-6.

Ravid N., Annunziato R. A., Ambrose M. A., Chuang, K., Mullarkey, C., Sicherer, S. H., Shemesh, E., & Cox, A. L. (2012). Mental health and quality of life concerns related to the burden of food allergy. Immunology and Allergy Clinics of North America, 32(1): 98-95.

Valentine, A. Z., & Knibb, R. C. (2011). Exploring quality of life in families of children living with and without a severe food allergy. Appetite (Print), 57(2), 467-474.

Wang, J. & Sicherer, S. H. (2009). Immunologic therapeutic approaches in the management of food allergy. Expert Review of Clinical Immunology, 5(3), 301-310.

Author’s Biography

Chloe Mullarkey is a senior in the Applied Psychology program. She is a member of Dr. Alisha Ali’s research team and a clinical research assistant for Dr. Eyal Shemesh at the Mount Sinai School of Medicine. Her main research interests lie in food allergy and bullying, empowerment interventions and mental health in global public health. Upon graduating, she plans to continue working for Dr. Ali and Dr. Shemesh and pursue a Master in Public Health and Doctorate in Social Intervention Psychology or Clinical Psychology.