Food fears in children with food allergies

Abstract

Rationale Some children with food allergies (FA) develop food fears that limit food intake and that may cause malnourishment. The purpose was to assess the etiology of food fears with a view to future prevention. Methods Case studies of four children with FA and clinically relevant food fears who received medical nutrition therapy and a referral to a pediatric psychologist, plus follow-up after completion of interventions were reviewed. Results Four children with FA, 1.5 to 7 years of age, were identified with food fears. One had an allergy to a single food, 3 had multiple FA. One had a history of systemic anaphylaxis. Two subjects had co-morbidities: atopic dermatitis and asthma. Two were developmentally delayed and had failure to thrive. All had both parents living at home. All were referred to a pediatric psychologist after completing nutrition intervention. The causes of the feeding fears include: case 1 and 2 – anxiety about next possible allergic reaction; case 3 – fear of cross contamination; case 4 – prior discomfort associated with eating. The psychological therapy used was behavior modification and desensitization programs. Follow-up, 2-9 months after intervention, revealed continued improvement of food fears in all four patients. Conclusion Consumption of foods causing chronic allergic symptoms and/or fear of another unpleasant reaction can cause anxiety leading to food fears. A comprehensive medical team, including a dietitian and psychologist, can provide families the tools needed to avoid the allergen(s), correctly treat a reaction, and address inappropriate anxiety.