Raising a Peanut-Free Kid: Managing Peanut Allergies in Children

Raising a peanut-free child means extra worry for parents. The need for constant vigilance can be exhausting, especially in the early years before children can begin to participate in managing their allergy.

If your child has just been diagnosed with a peanut allergy, read The First Four Steps: Newly Diagnosed with Food Allergies. Once your child's allergy diagnosis is confirmed, you will need to learn to manage his allergy.

While there are some promising new therapies, at this point in time managing a peanut allergy means:

• Completely avoiding peanuts in all forms
• Being prepared for future reactions, and
• Seeking support to help you help your child.

Avoiding peanuts at home

You have the greatest control over the food your child comes into contact with at home. Make sure that caregivers, family, and friends are all aware of your child's peanut allergy, and know how to manage a reaction if it does occur.

• Learn to read labels for hidden peanuts. Since 2006, foods manufactured in the United States are generally required to state on their label if they contain peanuts or ingredients made from peanuts. However, there still may be hidden peanuts in foods that do not fall under the FDA regulations.
• Avoid cross-contamination in your own kitchen. Depending on the severity of your child's reactions and the age of your child, you may decide to only allow peanut-safe food into your house.
• Teach your child to recognize peanuts in and out of their shells. Beyond a Peanut Flash Cards can help teach your child and child's caregivers the basics of managing a peanut allergy.

Managing peanut allergies at school, day care, and camp

Sending your child off to school or day care can be nerve-racking. Here are our suggestions for keeping your child safe away from home:

• Pack your child a great lunch, using one of our 9 Alternatives to Peanut Butter.
• Meet with your child's caregiver before school starts. For suggestions on what to cover in your meeting, read Preparing the school for your child with peanut allergies.
• Label your child. If your child has severe food allergies, she should wear a medical ID bracelet or shoe tag at all times. Label your child's lunch box or make use of allergy t-shirts, lunch boxes, or stickers to identify your child's allergies to caregivers.

Dining out without peanuts

You can eat out safely with your child if you do your homework and are cautious.

• Carry disposable wet wipes with you to wipe down tables in restaurants before eating.
• Avoid Asian and West African restaurants. Peanuts are major players in Chinese, Thai, Vietnamese, Malaysian, Indonesian and West African cuisines. Mexican food often is cooked in peanut oil, as are French fries in many restaurants.
• Call restaurants before eating out and ask about their menu options, ingredients, and their ability to prepare your child's food separately to avoid cross-contamination. Chain Restaurants can be good for kids with food allergies, because they generally have their ingredient lists available online.

Traveling peanut-free

Traveling with children is always a challenge. Peanut allergies add another layer of challenge. Some ways to make travel smoother are:

• Bring your own food. Pack a cooler of food that you know is safe and that your child likes to eat.
• Stay in hotels that have kitchenettes. Being able to cook something simple for your child will make life easier, and it will save money on eating out.
• Book peanut-free flights. Notify the airline of your child's allergy.
• Bring your prescription with you so you can take your EpiPen through airline security and on to the plane with you.
• Contact the special dietary needs office if you are planning a trip to Disney World. They are very accommodating of guests with peanut allergies. You might not even need to bring your cooler!
• Purchase allergy translation cards if you are traveling to another country. These are cards that can be handed to a server or chef to explain your child's allergy.

Being prepared for future reactions

• Build a medical team. Food allergies are a chronic illness. You need the support and oversight of a doctor (or doctors) that you trust. Depending on your child's diagnosis, you may need a pediatrician, an allergist/immunologist, and/or a gastroenterologist (GI doctor).
• Create a first aid kit. If your child has severe food allergies (anaphylaxis), you or your child's caregiver should carry an allergy first aid kit with you at all times. Your child's kit should contain:
• An epinephrine auto-injector (such as EpiPen), and a copy of the prescription
• An antihistamine, such as diphenhydramine in an easy-to-swallow form such as a liquid or melt strip
• An emergency action plan form, containing emergency contacts, instruction for what to do in case of various types of reactions, and a photo of your child. This should be signed by your child's doctor.
• Train helpers. You can't do it alone. Teach your extended family, your child's teachers, and all caregivers to recognize the signs of a severe allergic reaction and how to give emergency first aid.

Seeking support for yourself and your family

The most important thing that you can do as a parent of a child who is allergic to peanuts is to find support for yourself so that you can support your child. Studies report that children with peanut allergies and their parents show higher levels of anxiety than the general population. Peanut allergies cause more stress for the entire family and reduced social activities than other conditions that require restricted diets, such as diabetes.

• Find an allergy support network.The Food Allergy and Anaphylaxis Network (FAAN) has a search form for local support groups. Also visit our food allergy forum for online support.
• Locate an allergy-free summer camp. Many camps are now offering allergy-free weeks. The benefit is not just added peace of mind for adults. Children get to meet other children with food allergies, and form their own social support networks.
• Help your teen connect with other teens. Teenagers don't like to feel different from their peers, and face special challenges in managing their food allergies. Help you teen connect with other teens with food allergies in your local community or online through an organization such as FAAN's Food Allergies in the Real World, which offers teen-to-teen advice and support.

_Sources:

_{NJ Avery, RM King, S Knight and JO'B Hourihane, Assessment of quality of life of children with peanut allergy, Pediatr Allergy Immunol 12 (2003), pp. 378–382}

_{Branum AM, Lukacs SL. Food allergy among children in the United States. Pediatrics 2009;124:1549-55.}

_{Comstock SS, et al. Allergic reactions to peanuts, tree nuts, and seeds aboard commercial airliners. Ann Allergy Asthma Immunol. 2008 Jul;101(1):51-6.}

_{Jones SM, et al. Clinical efficacy and immune regulation with peanut oral immunotherapy. J Allergy Clin Immunol. 2009 Aug;124(2):292-300, 300.e1-97. Epub 2009 Jul 3.}

_{Primeau,MN, R Kagan and L Joseph et al., The psychological burden of peanut allergy as perceived by adults with peanut allergy and the parents of peanut allergic children, Clin Exp Allergy 30 (2000), pp. 1135–1143.}

_{Sicherer SH, Simons FE, Section on Allergy and Immunology, American Academy of Pediatrics. Self-injectable epinephrine for first-aid management of anaphylaxis. Pediatrics. 2007;119:638-646.}