Managing Your Child’s Anxiety During a Food Challenge

If your child has a food allergy, they may be encouraged to participate in an oral food challenge at Children’s Hospital of Philadelphia (CHOP). A food challenge is a definitive procedure to test if your child can tolerate a specific food. Testing includes eating small quantities of the food they are allergic to under medical supervision.

Food challenges can be stressful for patients and families but are invaluable clinical tools that can expand a child’s diet, offer greater nutrition, improve their symptoms and elevate their quality of life.

Clinicians from CHOP’s Food Allergy Center and Food Allergy Bravery (FAB) clinic offer practical tips to parents to better support their children before, during and after a food challenge.

Before the appointment

Maintain your parental authority

Your child may be fearful about an upcoming Oral Food Challenge (OFC), and their first response is natural and predictable: “I don’t want to!” Children may cry, throw a tantrum, or try to delay you from scheduling the appointment. They are trying to escape temporary emotional discomfort, but at the expense of potentially life-saving information.

At the Food Allergy Center, it is our belief that elementary- and middle-school aged children are not developmentally ready to oversee decisions about their own medical care – an OFC is medical care. Even teenagers may need parental guidance. Although teens often negotiate with the seeming skill of adults, their brains are still developing. They may not yet have the critical thinking skills to weigh short-term versus long-term consequences of their actions.

Think about it: If your child had any other serious health condition – but their quality of life could be vastly improved by a medical test or a medical treatment – would you allow your child to avoid it? What would you do instead?

Model calmness; “We’ve got this!”

Be mindful of the language and tone you use when discussing your child’s upcoming oral food challenge. If your child senses that you are anxious or uncertain, their anxiety may heighten further. Keep adult discussions between adults and out of the earshot of impressionable children as much as possible.

If your child is NOT anxious about their upcoming oral food challenge, this is perfectly OK too. There is no need to suggest that they should be anxious. OFCs at medical clinics such as CHOP are safe and well monitored so if any adverse reaction occurs, treatment can begin immediately. Your child may even be excited to find out the status of their food allergy. This is a good thing!

Plan a reward for when your child COMPLETES the Food Challenge

All children are motivated to succeed at a new task if they are made aware of the expectations and have something to look forward to if they meet those expectations. You can say something like this: “No matter the result, when you have completed the OFC, then we will … [positive shared event or reward].”

At every food challenge, a child life specialist is available to help motivate your child with activities, crafts and games. If your child is anxious, you may try to offer small rewards to help your child get through the doses and maintain their motivation.

Note: Be prepared to withhold the reward if your child does not comply with the medical team’s orders. The worst that will happen is that your child learns you mean what you say when it comes to their health.

During your child’s oral food challenge

Beware of the limits of distraction

Many parents bring screens or other toys for their child to use as a distraction during the food challenge. This may be helpful to keep younger children distracted while they are being fed.

However, if your child is refusing to eat, you may need to minimize their screen time or take a toy away. This can help your child focus on the task at hand and complete it quickly and with more confidence. Use when/then statements such as “When you have finished eating the food in front of you, then you can have your screen back.” Stay firm.

Remind your child about the larger reward when they COMPLETE the OFC

Bring a picture of the reward, a “coupon” for the reward, or the reward itself. Children are more motivated by a visual reminder of what they’ll get if they do what you want them to do.

Remain upbeat and positive, but don’t be afraid to ask for help

During your child’s oral food challenge, if you are feeling overwhelmed, need more information or simply need a break, please talk to your child’s healthcare team. We’re here to help you and your child succeed!

Resources for your family: Child life services

Children cope better with medical experiences when they know what to expect before, during and after. Child life specialists work with children receiving medical care at CHOP with the goals of:

  • Decreasing stress and anxiety
  • Promoting optimal growth and development
  • Normalizing the medical environment as much as possible

They achieve these goals using play, education, preparation and self-expression. Child Life Specialist Lisa Giordano, MS, CCLS, can help prepare your child for an oral food challenge by explaining what will happen in terms your child can understand.

After the oral food challenge

No matter the results of your child’s oral food challenge, parents should praise their children for participating and emphasize how brave they were in completing it. Children are emotional sponges and will soak up their parents’ reactions.

Tolerating the OFC is, of course, a desirable result. But reacting at OFC also provides families and clinicians with valuable information – that they should continue the same cautious procedures they’ve been using for years.

Saying things like “Great – now we have the information we need!” or “I look forward to what we find out at the next OFC; until then, let’s keep doing what we’re doing!” will allow your child to take pride in their accomplishment of completing the OFC and give them hope for the future.

Next Steps