Tips to Help Children with Food Allergies Adjust to In-Person Activities

As COVID-19 vaccine distribution continues and pandemic restrictions are eased, many children are returning to in-person activities. Schools are expanding in-person learning, sports teams are practicing in community fields and children are safely socializing with friends. While returning to in-person activities has many benefits, for children with food allergies and their families, it can also bring certain challenges following a year of social isolation.

Many children with food allergies experienced less anxiety related to eating during the pandemic lockdown. Families ate in their homes and typically prepared their own meals. Challenges related to eating at school cafeteria tables, attending friend’s birthday parties and spending holidays with extended family were rare occurrences over the past year. These factors significantly reduced the number of challenges associated with navigating safe food choices.

Below are tips to help children with food allergies resume in-person activities:

Review and practice allergy self-management skills.

Limited time outside of the home over the past year has reduced the need for children to use allergy self-management skills (skills people learn and use to manage their food allergies). For example, young children may have fallen out of the habit of asking which foods are safe to eat, while older children may be out of practice reading ingredient labels.

Here are some ways you and your child can review and practice their allergy self-management skills:

• At-home practice and coaching by caregivers will help to strengthen children’s skills such as reading food labels and identifying which foods are safe for them to eat. Rehearsing and role-playing assertiveness skills (such as informing others about their food allergies) may be helpful to revisit.
• Review how and who will be carrying epinephrine auto-injectors outside of the home.
• Discuss when and where it is safe for children to eat foods outside of the home. For example, if a child with a tree nut allergy attends a nut-free school, they will be able to eat school lunch.

Plan ahead

Helping children learn what they might expect in different situations can reduce stress related to returning to activities outside the home, such as school or summer activities.

Here are some tips for planning for activities outside of the home:

• Make a list of questions to ask teachers, camp counselors, sports coaches or other activity leaders prior to your child’s return. For example, will children be eating in their classrooms? Will they sit physically distanced in the cafeteria or sit outside?
• Visit or drive by the school or location of the activity to which your child will be returning. If possible, take a walking tour and play a game (such as “I Spy”) as a way of re-acquainting your child with a place they have not been for a long time.
• Check the school or camp website with your child to view photos of teachers and counselors to help them become familiar with the adults who will be caring for them when they are at school or camp.
• Practice making predictions (educated guesses) with your child about what things might be like. For example, predict that your child will need to wear a mask for all activities, except when eating or given a mask break.

Consider organizing or hosting safe get-togethers

With warmer springtime weather, there are more opportunities to see friends and family outside while practicing physical distancing.

Here are some tips for organizing safe, food allergy-friendly and physically distanced gatherings:

• Plan outdoor activities where people can gather and stay physically distanced. For example, take a hike or nature walk or invite your child’s friends over in the backyard. This can help your child reconnect with peers and practice socializing.
• Include food as part of the activity. This will give your child a chance to readjust to being around peers and eating safely and comfortable in social settings.
• Consider theme-based gatherings to add an additional element of fun and structure. For example, ask everyone to wear a silly hat or create an obstacle course.
• As always, it is important to follow the CDC COVID-19 and local government recommendations for gatherings.

Anticipate anxiety

It is normal for children to express worry about returning to in-person school or activities after not having done these things for more than a year. This may be particularly concerning for children who experience separation anxiety or social anxiety.

Here are tips to help your child cope with anxiety about returning to in-person school and other activities:

• Review past times when your child did something even though they were scared. Recalling previous experiences in which a child has been brave, is a reminder that they have done challenging things before and can do them again.
• Offer rewards for practicing small bravery steps. For example, if your child has anxiety about returning to school, practice walking or driving to school. Rewards are helpful and concrete acknowledgements of bravery successes make it easier for your child persist in their progress.
• Create a transition plan. Caregivers and children will experience less worry having a clear plan in place for drop off. For example, creating a special drop off ritual, such as having the parent tell their child silly joke, will help with predictability at the point of separation.
• If needed, coordinate with school counselors or activity staff to develop a drop-off plan. Sometimes using an object to help bridge the transition can be useful. For example, a parent might hand their child an envelope containing a surprise (such as stickers or special note) that the child passes on to the teacher or counselor to open and share with the child. This strategy will create some excitement for the child, easing the anxiety about the drop-off.

Prepare for imperfection

Expect transitions to be bumpy. Caregivers and children alike will experience anxiety or uncertainty related to re-engaging in social situations. This is normal and to be expected.

Here are some tips to prepare for imperfect moments when returning to in-person activities:

• Prepare for separation difficulties that may include tears or clinginess.
• Remember that repetition (such as attending camp or school several days in a row) tends to increase comfort and familiarity, and reduce anxiety.
• Be patient with yourself and your child.

Rev. 4/2021. Mass General for Children and Massachusetts General Hospital do not endorse any of the brands listed on this handout. This handout is intended to provide health information so that you can be better informed. It is not a substitute for medical advice and should not be used to treatment of any medical conditions.