December 2010 Issue

Allergy Abuse — What to Do When Kids With Food Allergies Become Victims of Bullying
By Maura Keller
Today’s Dietitian
Vol. 12 No. 12 P. 8

In light of recent news events, bullying and its profound impact on people’s lives is a topic that has taken center stage. Many issues appear to instigate bullying, but one issue that has taken hold within the food allergy community is the bullying of children with life-threatening food allergies during school.

According to statistics from the Food Allergy and Anaphylaxis Network’s (FAAN) 2009 C. S. Mott Children’s Hospital National Poll on Children With Food Allergies, 3% of parents report having a child with a life-threatening food allergy, and 25% of parents with a son or daughter in elementary school report knowing a child with a food allergy.

“With these statistics, though the child may be in the minority, it is definitely not a rare occurrence to have food allergies/sensitivities/intolerances or to be on a special diet these days,” says Lara Field, MS, RD, CSP, LDN, a pediatric dietitian in the pediatric gastroenterology, hepatology, and nutrition section at the University of Chicago Comer Children’s Hospital.

Children with food allergies can experience verbal abuse from their peers, such as being called names for not being able to eat certain foods. “Kids can call each other many names and hurt one’s feelings,” says Sarah Koszyk, MA, RD, a dietitian with the national Eating Free program. “I also had one experience where a bully threw peanuts at a student who was severely allergic, causing a serious commotion and an allergic reaction.”

Teachers or staff may show indirect signs of bullying by barring a student from certain functions or school activities that may involve a food to which the child has an allergy. For example, a child is allergic to peanut butter. His or her schoolmates are celebrating a birthday during class, and a parent brings peanut butter cookies. The teacher excludes the child from the celebration, and he or she feels “different” and ostracized.

Aleasa M. Word, a certified food allergy educator at the Food Allergic Multi-Cultural Society of Delaware, says food allergy bullying is becoming more prevalent, as many unaffected parents and children don’t view it as causing any real harm due to their lack of understanding about the health implications.

“In many states, bullying constitutes a crime, but perhaps some kids may feel this is a way of getting away with the age-old routine of teasing,” Word says. “Due to this issue, I’ve recently begun receiving more and more calls to do assemblies for the children, but not until after there is a problem.”

Many younger children with severe food allergies with whom Word has worked already feel a sense of isolation and a feeling of being different from their friends. “My own child has experienced this feeling of being left out, and it has caused some anxiety, sadness, and stress,” Word says. “There have even been statements made like ‘Nobody is ever going to want to sit with me because if they have something I’m allergic to, I’ll get sick.’ Sadly there are a lot of food allergic children who are only homeschooled because the parents couldn’t find a safer alternative.”

Long-Term Effects
Although Field has not seen any issues with it in her practice, she believes bullying has serious implications and may cause children with food allergies to consider cheating on their diet or feel pressure to push the envelope.

“When it comes to gluten-free diet management, many celiac patients do not have any symptoms and pressure to veer off the diet has very harmful side effects, including destruction of healthy intestinal villi, which leads to poor growth, vitamin and mineral deficiencies, and potentially can put the child at risk for other autoimmune disorders, including type 1 diabetes,” Field says.

Koszyk adds that children with food allergies can develop so much anxiety about going to school that they may opt to skip. “I’ve seen children get themselves sick so that they don’t have to go to school and face the bullies and other students,” Koszyk says. “I’ve also experienced children developing digestive problems or complaining that their stomachs hurt when they eat food due to all the anxiety and stress they’ve had from bullying so that eating food becomes a fear.”

Additionally, children who are bullied because of their food allergies sometimes stop eating during school, which can result in lower grades if a child cannot concentrate without the proper brain fuel.

“Children who also stop eating during school due to bullies can experience weight problems by either overeating once they get home and gaining weight or undereating so much that they can have failure to thrive due to lack of adequate nutritional intake,” Koszyk says. Children who are bullied can also become picky eaters, developing many food aversions, something that can present challenges for RDs when it comes to ensuring children are eating enough and the appropriate foods.

Besides the physical effects that bullying can have on children dealing with food allergies, professionals must also consider the mental component, which can be just as severe. Children who are bullied can develop a poor self-image as a result of name-calling.

“Other feelings of depression and sadness can occur and even result in the child disengaging from interacting with other children, and the child becomes more reclusive and alone,” Koszyk says. “Bullying can have serious implications and effects on both physical and mental health.”

Steps to Take
Dietitians, parents, and teachers are crucial players in helping children deal with food allergy bullying.

Field begins food allergy counseling by discussing the medical reasons why an individual must avoid specific foods and the consequences of not following the diet.

“But most importantly, it is important to come up with a myriad of allergen-free food suggestions to ensure no child feels left out,” Field says. “There are so many delicious allergen-free foods available, today’s allergy sufferers have many options to fit in like their peers.”

But not feeling left out may be very difficult for children with severe food allergies, such as those who must avoid milk, eggs, soy, wheat, fish, shellfish, peanuts, and/or tree nuts.

“This can be a very daunting task for children and adolescents and comes with great pressure to want to eat everything their peers are eating,” Field says. “However, I have found most kids are motivated to abandon symptoms that are present with a diagnosis, [including] recurrent vomiting, diarrhea, skin rashes, reflux, poor growth/development, in addition to others.”

Field recommends that dietitians provide children with tools to manage their diet (eg, how to read food labels, alternatives to allergic foods, expected dilemmas or challenges with food) to help them feel more confident and less insecure about their food allergies or intolerances.

“The more confident these children are, the less susceptible they will be to teasing,” Field says. “Also, making sure they are prepared [for] all occasions is important. Securing allergen-free options in the nurse’s office or in the school locker or backpack helps prevent kids from feeling left out and makes for an easy transition to an allergen-free lifestyle.”

When working with her patients, Sharon Richter, MS, RD, CDN, a certified dietetic nutritionist, comes up with intelligent ways to respond when someone makes a negative comment about a food allergy. “The goal is to be educated to avoid contact with the food, accept the food allergy, find other foods to enjoy, and to understand that we all have things that are different about us—that’s what makes us unique and wonderful.”

What’s more, by providing education to the school about the effects of bullying on kids with food allergies, everyone can begin to understand the severity of a food allergy and take action to reduce the possibility of a child getting sick or being bullied.

“Most importantly, remind the child how special and important they area and how so many people have many food items they cannot eat, and these people are still able to enjoy life, food, and friends,” Koszyk says. “Making sure the child’s self-esteem and positive relationship with food stays elevated is important and can be done through counseling sessions with a registered dietitian.”

— Maura Keller is a Minneapolis-based freelance writer and editor.