Growth Mindset: Moving Forward After an Allergic Reaction

00:00:00
Matt Bomes

Good afternoon, wherever you're calling in from and welcome to Backstop’s community exploration event, how to manage food allergy anxiety moving forward after a reaction. My name is Matt Bomes. I'm the co-founder of Backstop and I created this community because I have had severe food allergies since I was a child, and I want this generation of kids to lead full, healthy lives. I also want their families to feel supported like they're on a strong team that will always back them up. For those of you who are unfamiliar, Backstop is a one stop shop, virtual care solution and app for parents with children who have food allergies. We believe that confident, well-informed parents make safer kids, and we have workshops, webinars and a whole online community to help you feel like you have backup. You can explore food allergy, anxiety and other issues with other parents and an expert today in our small group huddles. You can sign up, getbackstop.com/events, and today I'm excited to have food allergy experts. Dr. Fawn McNeil-Haber and Dr. Shelly Vaziri-Flais. Dr. McNeil-Haber is a licensed psychologist with over 20 years of mental health experience and founder of Brave Minds Psychological Services.

00:01:16

Matt Bomes

She's the parent of a child with food allergies, and she works with children, adolescents, adults and families and individual group and family therapy. Dr. Flais is a practicing pediatrician, mother of children with food allergies, parenting book author and spokesperson for the American Academy of Pediatrics. She is also assistant professor of clinical pediatrics at Northwestern University Feinberg School of Medicine. Dr. Flais will talk about what happens to our child's bodily symptoms when they have an allergic reaction and will review what to do in the moment and in the days and weeks after the emergency event to best support our child's health and well-being. Dr. McNeil-Haber will explore what exactly makes us anxious about emergency events like allergic reactions, and we'll share what we can do to limit anxiety in ourselves and our children after the event. Then we'll start the Q&A. Where both experts can answer your questions. You can type your question at any time during the presentation. Just use the Q&A box and I'll read it out loud to the group. You can upvote questions that you want prioritized as well. Now I will hand it over to Dr Flais.

00:02:28

Dr. Shelly Flais

Hi, everybody, thank you so much for being here. I'm so glad that you were able to take some time out to support yourself and your child and your family on this journey. Some of what my territory today is going to cover might be review for you, depending on where you are in your journey. And I think whether your child was recently diagnosed and you're still getting to know this whole allergy world and how to live with it, or if you're years into your journey, I think this is beneficial information to be aware of. You yourself, as a family member and caregiver, need to be aware, but also you're going to be in a position of educating others. Your child, as they grow, is going to be in the presence of different environments, different caregivers, grandparents, as we were talking about. As you're waiting for people to filter in, you will find yourself in a position to educate others. And so I'm going to relay some information that you yourself should know, but you'll find yourself educating others. I have four children. Two of my four have life threatening food allergies. Unfortunately, we've had cross-contamination issues. I have personal experience with the unexpected. We plan and prepare so that we're ready for when the unexpected happens. And reflecting back on our journey, I remember there was a new type of auto injectable epinephrine available. We were the first family in my child's grade school to use this type of epi.

00:03:50

Dr. Shelly Flais

And so our school nurses are amazing. They do such amazing things and the things they have to deal with, especially in a pandemic, are incredible. And I found myself years ago in the position of educating our school, and there's how to use this new type of auto injectable epinephrine so you might feel nervous or hesitant. You will gain confidence on your journey, and you'll find that helping others, whether it's teaching people who are in the care of your children or friends, family, neighbors or people you meet in the back stop huddles, you will pass on tips that will help bolster your confidence and ability to respond in case you need to. So to define some terms, there are allergic reactions and there's anaphylaxis. Allergic reactions are simpler. Usually only one system of the body is involved. A classic example is springtime is near, and in some parts of the country, trees are going to start blooming, grasses will start growing and those pollens will be dispersed in the environment and kiddos will get runny noses, congestion and wake up with a headache, things like that. Those are simpler allergic reactions that involve one body part. Anaphylaxis you can think of as the Super Bowl of allergic reactions. A key thing to remember as a parent is if you see two body systems affected. That means you've got to be aware that this might be a more serious reaction. Kiddos can respond to anaphylaxis due to different things.

00:05:22

Dr. Shelly Flais

I think a lot of us are here because of food allergies. We often talk about the big eight, you know, peanut tree nut shellfish egg. The list goes on, but insect stings or bites can cause anaphylaxis medication, so there are different causes. Typically, this reaction happens within five to 30 minutes of coming into contact with the substance, and you can think of it as the immune system gone amok. For whatever reason, the body's immune system thinks that this is poison basically, and puts out an APB and chemicals are released in the body that cause this chain of reactions. Every patient is different, every child is different. And so some kiddos might develop signs such as itchy skin hives, which look like mosquito bites or a rash. Your child, depending on their age, may tell you that their throat feels tight or that it's hard to get a good breath. Your child might start wheezing or having a hard time breathing, sneezing, coughing, or all signs that something could be happening. Facial swelling, lip swelling. Other parts of the body swelling tummy issues. Vomiting, diarrhea, change in stools. If your child feels dizzy or faints or passes out, that's a sign that things have definitely proceeded. And the thing that I always add to the list, when I talk to families in my practice is if you feel like something bad is happening, it's crazy to describe it this way.

00:06:58

Dr. Shelly Flais

But a lot of patients, children and adults alike respond, tell us later that they just have this impending sense of doom that something was going on and just speaking from personal experience. One of my son's accidental injections. He developed hives and he just felt terrible. He said this. I need my epi. He just knew. And as a parent, as scary as the situation was, I had to trust his instincts and something I tell my patients all the time is if you're thinking about using EPI. Go for it, use it. So those are some of the distinctions between a simple allergic reaction and anaphylaxis, but I can't emphasize that point enough. If you think that it's anaphylaxis, act quickly because seconds and minutes matter. So some of the things that we're going to talk about to prepare for the situation that we hope never happens is being prepared. I believe the next slide talks about the importance of carrying epinephrine. Matt, would you mind forwarding? Yeah. So being prepared, I was commenting on social media, my way of saying, I love you to my teenage boys. When I say goodbye, when they're headed out somewhere is, do you have your epinephrine? Yes, I love them. Yes. Have a good time. Yes, make good choices. But in an allergy family, that's how we say bye. And this is definitely evolved over time where your child spends time.

00:08:25

Dr. Shelly Flais

I think in the pandemic, we've been somewhat spoiled as food allergy families because we've been home more and we've been home cooking more and we have more control over our child's environment. Schools were shut down. Now that the world is opening up again, these are things that we need to be careful about wherever our child spends time, even if it's a playdate at a friend's house. We need to make sure that apps are available and that there's adults in the situation who know how to use it. Next slide. Knowing your plan and this is where Backstop comes into play, because I think going through case scenarios as much as possible is helpful because it means in the moment should you need to use it, you're prepared and you're ready to go. When we were planning for this webinar, I drew an example. I'm a big Chicago sports fan and there's an amazing Chicago Bulls player who, despite setting records and he just passed a milestone of Wilt Chamberlain's, there was a game that wasn't so great a couple of months ago, and the game ended in uniform. He just threw free throws and he was just practicing practicing. And here's a professional NBA player, all star player who? Why is he a master at his craft? Because he practices so similarly with epinephrine and our food allergy families. If we know our plan, if we've got the system cold, if we know what the school will do or our date our child's daycare will do in case of emergency, it will help us feel more prepared.

00:09:55

Dr. Shelly Flais

Schools and daycares should have written plans, so make sure that you log on to your kid's school's website so that you get all the necessary forms. That is helpful because the schools will go through a protocol, and unfortunately, I've had situations with my patients in my practice, families where there's a protocol, but they may or may not go through that. So I think staying connected with your child's daycare and school, staying connected with those who spend time with your child. Making sure that everyone has the plan down. Key being, if in doubt, give epi and call 911. Next slide. Yeah. In practice, I kind of alluded to this already similar to standing at the free throw line and throwing lots of chats using the trainer devices that come with your auto injectable epinephrine. There's many different types of autumn injectable epinephrine. I don't have the same name brands as I keep saying auto injectable epinephrine. It rolls off the tongue when you say it several times, making sure that everyone who spends time with your child is familiar with it. Some are voice activated, and I remember when my kids were younger, we were practicing with a new prescription and they thought the voice activation was hilarious and the scene quickly descended into giggles. And as a parent, I was mortified because this is serious, life threatening.

00:11:23

Dr. Shelly Flais

You know, this is serious business, so I'm glad they were having fun. But I was like, You guys, no, no, no. So I had to, like, cut that session short. But it's a challenge as your child grows because ultimately they're in charge of keeping themselves safe. And that's one of the big hurdles. And I don't know if we're going to have time to cover it in our webinar today. But in the early days, if your child is young, the stress of it is on us as caregivers and as the adults in the situation. But it will be an age appropriate process to pass the torch on to our child, to identify their symptoms and to know when it's appropriate to give it and to know to carry it with them at all times. Because teenagers, young adults, it's a different set of circumstances and not as controlled as when they're younger, necessarily, so it's something that we need to pass on as time goes on. I didn't enjoy our accidental ingestion, but when I did send my oldest off to college knowing that he had self-administered with my observation, I was with him and we made the decision for him to self administer. And that was great peace of mind. Knowing, OK, he's living far from home, he's in a dorm environment. I know he knows what to do if and when it happens. Next slide. This is Fawn's domain.

00:12:52

Dr. Fawn McNeil-Haber

Oh, thank you so much, Dr Shelly. And I just want to reiterate just a couple of things that you said before I kind of dive into this. And you mentioned carrying it, of course. But this idea that if you think that you should, you should give epinephrine. And I tell the story that at one point my son was, we thought, having a reaction. He actually, in the end, had a migraine that ended up in vomiting and we gave him epinephrine because we thought that it could be an allergic reaction. And we went to the E.R. and the E.R. the doctor was pretty sure it was a migraine. The allergist later was pretty sure it was a migraine. And we went on and, you know, it wasn't the most fun evening, but always err on the side of if you think you need to, then it's better to go for it. And so I still think of that story as giving epinephrine for a migraine. But yes, absolutely, absolutely. And so I'm going to jump into nerves of steel. I'm going to go back to practice because when we think about trauma after a reaction, we always have to start before the reaction because there's a number of things that Dr. Shelly said that help us decrease trauma post reaction. And when I think about practicing, there are a number of things I think about as far as how our brain works. So first, I want to say, and I'm going to put this out there, that research tells us about 40 percent of children with food allergies are going to experience an anaphylactic reaction.

00:14:35

Dr. Fawn McNeil-Haber

But we know fatalities are very rare and coupled with preparedness, even more rare. And so it is so important for us to practice and to know what we're going to do so that when the time comes, we're able to do it. And when I think about how our brain processes these kind of stressful situations, our brain is so…when stress hits, it wants to know what to do. It doesn't want us to have to think. If you think about a car cutting you off on the highway, you're not thinking, OK, see that car coming over. Oh, they've gotten in front of the car now I need to press the brake. It's actually not until you press the brake, move yourself out of danger that you're bringing that sinking area of your brain catches up to understand what you've done. So part of practicing is really making it so you know exactly where the epinephrine is. You know what to do? Maybe if you have a small child, you've practiced how you're going to hold them and what that process will be. Or if with the teen that you've practiced them doing it versus you doing it, that all of these things are really in the mix. And so this is why practice is so important, because it really works with our brain to know what to do because in those moments that thinking part of the brain really starts to shut down because it just wants us to react.

00:15:56

Dr. Fawn McNeil-Haber

And so I'm going to move to talking about nerves of steel because I think it bridges this idea of our reactions that we have in our response and I'm going to grab from our previous conversation. Matt was talking about the importance of being able to create space between the kind of event that happens, our behavioral response and that space that we can create in between in order to respond to the event as opposed to just reacting. So we want to practice so that our brain really wants to just react that we have it all down so we can react. But we also want to create this space in between so that we can respond the way we want to respond, that we can respond to how we're feeling, we can respond to whether we need to calm down. We can respond to the situation that's happening in the moment. And I think that's a great place to frame this as we're starting to think about going into that because many times we go through life and many of the things I can talk about refer to lots of different areas of life. We just react, things happen and we react to our children, react to our spouse. We just react and we if we can create that space to respond.

00:17:10

Dr. Fawn McNeil-Haber

So I'm going to put that out there as I'm going into this idea of nerves of steel. And I use nerves of steel because it's kind of catchy. But it's this idea that in the midst of an anaphylactic reaction, we have to be able to react in a calm, cooled way. So there are a couple of reasons for this one. The calmer we can keep ourselves, the more likely we are going to be able to respond and react the way we want to react in the way that's best. But when we think about ourselves as parents, as caregivers, as spouses, as friends, we also. Want to remain cool and calm because the person who's experiencing the allergic reaction is paying very much attention to how we're reacting and if this is our child, children are very attuned to our emotional response as parents, so they are reading us. How serious is this situation, and our communication needs to be that there are things that we need to do in the sense that it's serious, that there are things that we need to do and we're going to need to do them now. But we don't want to push either our child or if we're dealing with a friend or a spouse into a panic mode. We don't want them to start to panic because this is counterproductive to managing the allergic reaction that they're having. So we don't want to create panic.

00:18:31

Dr. Fawn McNeil-Haber

As caregivers we want to be cool and calm, which helps. We're talking about anxiety and trauma. Post reaction. This helps us post reaction, and I can certainly say I've had situations where my child has had an allergic reaction and then he's vomiting, he's throwing up, and I am rubbing his back and saying, Oh, your body does not want this right now, wants to get rid of it. You just get rid of all of this. And yes, in the back of my mind, I am very aware. Ok, this is another system, and it's not just another system, but it's not stomach problems. It's not. I feel nauseous, but the system is rejecting what has happened. So, it's extremely concerning. And you know, I want to send them the message that clearly your body does not want what's in there. You let it all out because I just want my kid to focus on whatever his body needs to do to move to the next step. He had already been, I think, the epinephrine was in the process. I was actually in the doctor's office, so the epinephrine was coming. I'm rubbing his back, just let it all out. And so having those being able to be cool and calm. The other thing to think about, especially if you have other children, is siblings are watching. So if you have other children, siblings, cousins in the area, everybody's watching. And many times we talk about the child who has food allergies.

00:19:54

Dr. Fawn McNeil-Haber

However, siblings are very affected by food allergies. They're affected in many different ways. I'm going to focus on one of the particular ways, but they're affected in many different ways by having a sibling with a food allergy. And so if you have a sibling, they're paying very much attention to you as far as how you're reacting. What this means for their sister, their brother or their sibling and where they should be. On top of that many times, if you are going to the emergency room, they are not. They're not going to be able to come, most likely if there's another adult there. And so they are left wondering what's going on. And so we want to leave them there with as much as we can provide. As far as we've commonly reacted, we've done what we needed to do. Now we're off to the next step so that we can process this with them later. We and they really do. They're concerned about their sibling moving forward. So we want to keep those things in mind when I go further into nerves of steel, I try to think about what's happening and how we can reinforce and support the person having the reaction. So if your child is riding in an ambulance for the first time and they've already had their epinephrine and they're going on this ambulance ride.

00:21:16

Dr. Fawn McNeil-Haber

Wow, you know, I've never been on an ambulance ride before. All right, let's get in and see what's going on. So finding ways to kind of notice like to keep things as upbeat and positive as possible for the person having the allergic reaction, to keep them calm, to keep them focused on managing their own self and keeping them calm. And so once the then gets into, I'm going to move back and just reiterate that idea of responding versus reaction, because obviously you have to be able to create that space and have that mindset to be like, OK, how do I both do what I need to do, as well as keep things positive, keep things moving forward and make sure that I'm generating that we are handling this right now. So I'm going to move into something I always talk about with kids, but I think this is good for the adults, also the positive reinforcement, so it really doesn't matter how the person manages their reaction. They did a great job. If they did that epinephrine, they communicated the symptoms they were having. They went to the hospital. They let the E.R. staff watch them. They are a champ. They did a great job. You were crying when you got the shot. Of course you were crying. It hurt. The whole situation was a little scary, but you did a great job. You let the emergency people come and help you and monitor you.

00:22:46

Dr. Fawn McNeil-Haber

You had the oxygen. You did a great job. And so that reinforcement of anything they did was great. If you're talking about an adult, the spouse, thank you for coming and communicating what was going on and really that encouragement, because that helps buffer things that helps keep everything calm. But it also, you know, when you think of kids, kids really need that reinforcement. And so all of these things that we can do as this process is happening, as with the epinephrine going to the E.R., sometimes I talk about having knowing what you're going to bring so that you have the things that you're going to bring that's going to keep everybody occupied and not just in their head during that time. But I know what we want to talk about here is then what about afterwards? So the anaphylactic reaction has happened. You've gone to the E.R., you are back home. You are in that window after the reaction and kind of moving into the days after. And many times I think parents really get I think a lot of people, not just parents, get blindsided by the emotional reaction after that. So you've made it through kind of the really tough and scary part. And let's say you've had those nerves of steel, you've held it together. You gave the epinephrine, you went to the emergency room, you dealt with the staff and now you've had to hold it together this whole time. And now that things feel like, OK, we're safer, we've made it through the night.

00:24:28

Dr. Fawn McNeil-Haber

The body doesn't want to hold it together anymore. The body needs to express all of those emotions that they were being held at bay. This just tsunami of feelings come through, and I think people can be blindsided by that because it is so intense and there's so much there to it. And so I'm going to move into that in a few moments. But before I move into that, I'm going to talk a little bit about the days after for kids and when I think about how do we help them understand what happened? And kids can be interesting because they can run just like adults, but they can run the gamut from afterwards, they're ready to play and go about their business to being really anxious and traumatized about the experience. And so some of the things that I like to throw out there is one really being able to validate the other person's feelings: the person who had the allergic reaction. A lot of times when things happen, we want to really kind of just move on. It was fine. You're all better. Now, let's move on. Let's not dwell on this, but it's really important in those initial days to validate what the other person is feeling, whether it was scary, whether they want to tell their story over again, whether it was a sibling that was really sad that the family left.

00:25:53

Dr. Fawn McNeil-Haber

They're really worried about being able to validate that, that's how they felt. And the funny thing about validating the emotions is that sometimes we worry that if we validate them, it makes them bigger and stronger. But the funny thing about validation is it actually calms the feeling and helps it move through the body quicker. So validating is really helpful. The other thing is allowing kids and other people the opportunity to debrief and tell their story, and this could be journaling. There is a lot of research that suggests that writing down stressful and traumatic events helps the brain process them. So writing about what happened, whether it's a bullet journal, or with kids drawing pictures can be really helpful in just the process of telling their story. And however they need to get out what happened. A recent allergic reaction that we had was actually to something that my son had previously had an allergic reaction to, that we had been encouraging him to eat. And he had a reaction to it, and we gave him the epinephrine and I think it was maybe two months after this reaction. He started this thing where he would out of nowhere he'd go and he grabbed his neck and we'd run over and we'd ask him, what's wrong? And he's like, I can't breathe, I can't breathe, which wasn't part of the reaction that he had. But we figured out very quickly that our job was to go get the trainer and give him, through with the trainer, not a real epinephrine.

00:27:37

Dr. Fawn McNeil-Haber

And then he'd go, Oh, I'm all better, and he'd go about playing and this. I'd be in the middle of cooking. I'd be stirring a pot and he'd run over and he'd do this. And eventually I said to him, I was like, Are you worried that we're not going to give the epinephrine in time or that we need practice? And he looks at me and he says, I think you need some practice. I think you need practice. And this went on for I think about two months, every once in a while. And as the time went on, I certainly kind of tried to encourage him, you know, initially we do it whenever it would happen, but eventually I'm like, I'm in the middle of cooking, and I started to create some limits around it and eventually it faded away. But that was what he needed to do post reaction to just process what has happened and help feel safe again. That's like, OK, the important people in my life, they know what they're doing. And so looking for these and letting kids go through their process and letting them tell their story. The other thing I like to say is emphasizing what they did right is really important, and that goes back to our positive reinforcement, but really emphasizing the things that they did right.

00:28:50

Dr. Fawn McNeil-Haber

If you have a teen and they came and communicated with you about what was going on, you really want to acknowledge that and talk to them about how they did the right thing and pointing out all the things that you want to bring to their attention, that shows their empowerment, that shows their courage, that shows their communication, that shows all the qualities that you want to build for your child friend who has food allergies. And so you really want to do that and you want to do that before you start circling back to things that you could do different. So sometimes when we're in those moments, we really want to get into what we should have done. We should done this, we should have done that. And that's not where we start. We start with building up what was already going well so that the person feels them so that the child, the team feels empowered and then circling back to things we could have done better and even giving them the opportunity to share some of the things that they think could have went better. Rather than being the one to tell them or what we sometimes do as caregivers, we start ruminating on what we should have done, but we're doing it in a way that is kind of spraying it all over the rest of the family or all over the kids. And they're hearing all of this and feeling like the experience was one that was less than versus every experience where you move through and you take care of it is not something to feel empowered about.

00:30:22

Dr. Fawn McNeil-Haber

So coming at it that way and also being careful about not clamping down after reaction and becoming overprotective, which is there's a strong pull and I'm going to talk a little bit at a minute about caregiver reactions, but there's this strong pull to camp, down and become very overprotective. And this is really problematic. And so now this is very different from looking at what happened and attempting to integrate learning from what happened and changing things that need to be changed because sometimes there are things that do seriously need to be changed to make sure that that situation doesn't happen again. But what you don't want to do is suddenly become super overprotective, super controlling and really stop your child from doing things that they were safely doing before. And one of the reasons why this is really important is because it can backfire and it can really backfire horribly because when we take our child's control, when we take their ability to control and feel empowered and feel like they can do things, then what happens is on a subconscious or conscious level, kids will attempt to take back control, and they're not going to do this necessarily in the most healthy ways. And so this could turn into looking more obstinate or it could turn into forgetting the epinephrine. Oh, I forgot it, because as parents, we can't control.

00:31:52

Dr. Fawn McNeil-Haber

We can control many things, but we can't control everything our child does. And physically, really, we can't control them at all. And so if they're taking back their control by, you know, forgetting things when. It didn't feel like it or taking undue risks when they're out, then as a way to regain control, that's extremely problematic. So we really want to make sure we are giving them control that we can give them and that they have power. And this is why when we come back around to circling back to figure out, OK, what could we do differently, they have to be part of the process and feel like they have control and almost like they're telling you what to do. So this is what I think about when I think about working with kids and teens, but I always circle back to caregivers because. It's so important to be prepared for our own reaction in post anaphylaxis, and many times, like I said, it can be really blindsiding. And there are. Three experiences emotions that I find that caregivers speak of the most and one of the first ones is guilt following and you know, our job as parents, as caregivers is to protect their children. That's one of our big jobs that we hold very tightly to. And when an anaphylactic reaction happens, we feel like we have failed them and it hits us to our core and the guilt.

00:33:24

Dr. Fawn McNeil-Haber

So I think of a reaction that my son had where I think the initial reaction was his stomach hurt. And then we saw one sign, which I'll say, that's two systems right there, but it was a little bit of stomach trouble and one hive and we left where we were. We went out to the car. We were trying to decide what to do, and he coughed. We were like, OK, that's I guess that's three. We're going to drive to the emergency room and on the course to the emergency room, things ramped up a bit and it had ramped up by the time we walked in. They quickly gave him epinephrine, and the ER doctor said, you should have done that before you left. And he was not punitive. Not, but you should have done that before you left. And then the next day, when we talked to the allergist, we got another like we should have done that before we left like, Oh, but it's a stomach ache and a single hive. But after that, you know, you start and I'm going to talk about the what ifs you start going into the what ifs and how quickly reactions can happen and how the reaction did ramp up on the way to the emergency room and all those different pieces. And the guilt can be quite intense. And so it's really important to notice and acknowledge that guilt that it's there to acknowledge our feelings and let it be there.

00:34:43

Dr. Fawn McNeil-Haber

It's uncomfortable, but it's OK because the more we're able to accept the emotion, the more we can let it pass through us and take the learning that we need to take from the experience and leave what we need to leave. The guilt kind of moves into the what ifs and what if this happened? We start going through the different scenarios that could have happened. And while we can't control these thoughts, our thoughts come into our head. We can't control these thoughts and we can't dwell on them and ruminate with them. And so that's the second kind of intense thing that people talk about is these what ifs that come up. And the final thing I'll throw out there that a lot of people talk about is the fear, the fear of what could happen, the fear of a reaction happening again, the fear going into the future and this fear can lead to avoidance, can lead to shutting down and can lead to massive levels of control. Now there's a number of other emotions, and I know I've missed some. There's a number of other ones that come, but I like to highlight those because I think those come pretty intensely and people struggle the most with them and knowing that they're going to come because just because I'm talking about this doesn't mean that I experience all of these also and knowing that I have to let them go and they might take a day, they might take a week to move through my system.

00:36:12

Dr. Fawn McNeil-Haber

But I just have to let them move through the system, tolerate the discomfort and experience those I like to call emotions vibrations in the body, letting them vibrate through our body until they've come. So then what do we do moving forward besides just experience these horribly uncomfortable emotions? Well, one of the things is being gentle with ourselves and allowing ourselves to recover, accepting that it's going to be a minute before we're going to feel like ourselves again and being gentle with ourselves in that time, taking some space, whether it's it's just moments that we can just kind of try to calm ourselves or be like, You know what, I'm wiping your calendar clean for the weekend. We are just going to be home whatever we had to do. You know what? Everybody's just going to get some emotional downtime and we're going to cancel plans and just be and sometimes you need to just do that and be gentle with yourselves. I talked about feeling those emotions. I'm going to add to that, feeling those emotions without judgment. So a lot of times we feel the emotions and we're judging ourselves. We are being really hard on ourselves, either with the guilt or being really hard on ourselves. As far as we're never going to be able to do this in the future or how am I going to move forward? How am I going through that and really trying to let ourselves feel these feelings without the additional judgment towards ourselves, trying to really just stay in the space of feeling? And if we see ourselves once again, we can't control thoughts, if we see ourselves experiencing these judgments, acknowledging them and then trying to bring ourselves back to a non-judgmental place.

00:37:58

Dr. Fawn McNeil-Haber

So, if I stick with feeling our feelings and trying without judgment, I have to go to also forgiving ourselves because with that guilt, sometimes there are things that we didn't do like I didn't give the epinephrine before we went to the E.R.. I didn't do it. And there may be a process of forgiving yourself for the things that you wish you had done and that you will do in the future. And I'm going to circle back to the previous talk that I did, it's on the website, about growth mindset. So if we're forgiving ourselves for the things that we didn't do, we're taking that learning and integrating it to what we will do. What we will do next time is I will give that epinephrine for my migraine. Like if I think it's happening, we're going to do this and really being able to integrate that learning and moving from just forgiving ourselves to integrating the learning to being stronger as a result of what we went through, even though we wish we hadn't gone through that. The next thing I like to think about is that idea of calming your body, if these vibrations are going through our body, many times we're trying to talk to ourselves.

00:39:08

Dr. Fawn McNeil-Haber

Sometimes we just need to do things that physically calm the body. This could be warm baths. This could be warm showers. This could be extra sleep. This could be anything that you find meditation, extra meditation, extra mindfulness, anything that you find that is going to physically calm your body. Lots of chamomile tea, things that are going to let those vibrations come down a little bit and being intentional about it. And so that's the other piece when I talk about moving forward, giving ourselves the week to be gentle, letting the feelings go through, all of these things need to be done in an intentional way. We can't just kind of roll through life. We have to stop and say, OK, I need to do these steps so I can move myself to the next place where I am that food allergy warrior and moving forward and advocating and communicating and educating and being able to trust my child and all of those pieces. So we need to calm our body in an intentional way. We also need to tell our story, and the story that we're telling is probably a little bit different from the one. We're helping our child tell the super empowered story where they did everything right. The story that we were telling our best friend or dad or mom, whoever, may be a very messy story and just finding that space to tell that story and to let those emotions out, not expecting anything necessarily from the other person that might include journaling that, that could include just telling it to ourselves, but being able to tell the story and getting support and connecting with whoever our tribe is and this could be our tribe in real life.

00:40:54

Dr. Fawn McNeil-Haber

This could be our tribe online. This could be in a huddle. This could be lots of different ways. But being able to get that support to move through this phase because it really is a phase, it is that phase that happens after an anaphylactic reaction. I've already touched on this, but being able to embrace and integrate what we've learned and so we want to give ourselves time to move through the feelings, we want to give ourselves time to calm ourselves and then we want to start integrating that learning, being able to identify the things that we want to do different and things that we may set up in the environment different. Now some of those things may have to come immediately. You may immediately be like, OK, this has to change and it has to change now so this doesn't happen moving forward. But many times there are things that we learn we can integrate over the course of the week that like, OK, here's what we could have done different. Here's when it was time to go to the E.R.

00:41:48

Dr. Fawn McNeil-Haber

I really wish I had had certain things easily, readily available to grab. And so I'm going to put those aside. Maybe I was really calm in front of my child, but I was a little less calm in front of their sibling because the child is five and the sibling is 12. And I, you know, they were able to handle more, except for maybe they weren't able to handle as much as they saw. And so thinking about how how can I integrate what I've learned about the experience to handling it in a different way in the future and to keep going, to keep moving forward. And so maybe I took that weekend off. Maybe you take two weekends off, but we don't want to fall into avoidance. We don't want to fall into overprotection. So now it's time to start moving back out there and it may be bit by bit, but it has to happen. So you have to move back into what you know is safe, what you know has worked, what you know you're capable of doing, what you know that your child is capable of doing and moving back out there. You can't stay in that protective space. That protective space is to help the emotions move through and then moving back into the world because really, it's about living with food allergies. It's about thriving with food allergies it’s about doing all of the things that we want to be able to do. And there's food allergies. So I think I'm passing the mic back to you, Matt.

00:43:16

Dr. Shelly Flais

I just wanted to normalize parent guilt as well. You were on a roll and there were so many times I wanted to chime in but your wisdom was on point, so I didn't want to interrupt. But I'm a pediatrician mom and I should know better and believe me, we've had accidental ingestion and to get over that guilt and to reframe it and turn it into a growth opportunity and a learning opportunity is huge. And to know that we will stumble and we will have episodes and that's OK. And it's part of our learning process. It's part of our child's learning process, but it's so hard and to make sure you have a safe space to verbalize that with others other than your child so as not to impact their anxiety level, it's huge. I also wanted to share a personal story of one of my son's reactions. He had an anaphylactic episode and he was approaching 66lbs, which is the cutoff for the junior .15 mg to the adult 0.3 mg. So part of the positive reinforcement of giving EPI is, it's like the analogy I make frequently, is it's like a light switch, like you're turning off a light switch. All of that chain of events is halted, so there's the ultimate positive reinforcement. It stopped it, which is amazing. For my son, I think he was like 62lbs or 63lbs at the time, we had to give two juniors and there was a moment of why isn't this stopping? It was horribly scary, and it's informed my own pediatric practice because I'm very careful when I'm renewing my patient's epinephrine prescriptions to make sure, OK, what's our weight? Gee whiz, if you're going to hit this weight this year, we should err on the side of caution and get you the higher dose. But that was something that I'm supposed to know this stuff and we screwed up, and that's OK and we learned from it. And now we do better, and now I help my patients do better. So it's so important to reframe it and normalize it.

00:45:22

Dr. Fawn McNeil-Haber

Absolutely. I can hear you, Matt.

00:45:31

Matt Bomes

Sorry. I was just saying perfect transition. But, you know, you both mentioned practice, practice, practice and I think, you know, as an adult patient diagnosed over a decade ago, you know, I practiced this stuff as frequently as I can. I think I was super grateful for working with Shelly to create, you know, videos on everything sort of baseline preparedness related to the auto injector. So whichever device you have, they all work a little bit differently. As Shelly mentioned, there's different doses for different weights, and it's challenging to understand when to use the auto injectors is a key topic, but I think personally and I've seen it with other families that just practicing that monthly or quarterly and just refreshing your skills and watching those videos, we put a lot of thought into those. And when you watch them, you have a sense of confidence that like, yeah, I know what to do and you can share them with friends, other caregivers and stuff. And I think a lot of the stress and anxiety that I've seen in some of these questions sort of stems from that. Just having that confidence that you know what to do and have your plan and know how to do it.

00:46:37

Matt Bomes

So those videos are free inside the Backstop app, you can search Backstop in the App Store. We can also get them to Android users. You can just send me a chat message on our website, getbackstop.com and we can help you get access to those. To ask a question again, use the Q&A box and I'll read your question to the group. Hover over your mouse over the menu at the bottom of the screen and select the Q&A box. So I've got some great ones here. I think a lot of these come up frequently. Again, they're all really excellent questions. I think I'll start with this one, which is that, my daughter is the only one with food allergies in our family. And that being said and joining different support groups, I'm now worried when my non-allergic child will have his first reaction, or me. I'm worried that allergies are just a ticking bomb and one day is going to affect my entire family. How should I deal with this fear?

00:47:41

Dr. Shelly Flais

There's been a major addition to our arsenal of knowledge in the food allergy world this decade, and that's the concept of early introduction. And if you can tolerate a food or a peanut protein, for example, to continue to make sure your body sees it so as you don't develop an allergy. And this is a huge shift because when my now college student was young, they said, Oh, if you have family history of allergies, wait until there are two or three to introduce peanuts, eggs, et cetera. That didn't work, by the way. We were wrong, but that's medicine. Every five 10 years, we get smarter. And so in the case of early introduction, there's been major research showing that the earlier kids are exposed to peanut, it can prevent a peanut allergy from developing in the first place. So in the case of siblings, family members, if they have tolerated peanut protein as an example in the past, they should continue to have it at least three times a week in order to prevent it from developing. And this is so hard and I am not practicing what I preach here. I have four kids, two have the life threatening allergies.

00:48:46

Dr. Shelly Flais

My other two, including one of the kids, identical twins, I'm supposed to be giving him peanut protein. We have a nut free house. From a safety standpoint, I've been so worried about that when I have them alone or if it's Halloween and we're making sure all the food is safe. I have one child alone and I'll be like, here, eat this. And in emotional solidarity with their allergic siblings, they won't. They see it as the enemy. They're not interested. If they have something that has nuts, they'll later tell their brother it didn’t taste good. So I don't know that we have a healthy dynamic going on. And in my patients, in my practice with patients, I have families where the older child has allergies, and now here they're introducing foods to their infant. I've had families introduce the food in a car seat in the parking lot of the ER because then if something happens, they're ready. But the goal, the advice is yes, you should give it. Now, is it easy? No.

00:49:51

Dr. Fawn McNeil-Haber

And I always like to start anything when it comes to food allergies with always centering it on medical advice, so in order part of kind of that psychosocial piece is keeping you grounded in what is realistic, what is known, what is probable and preventing you from going too far into the what ifs, the super duper rare thing that could happen. So you always want to initially ground yourself in what we know as of now, what your pediatrician, what your allergist is telling you. So if they are telling you to introduce different things, finding ways to do that, I also have a peanut free house and it does introduce these challenges and you figure it out. So one of the things that I want to encourage in that particular situation is being mindful of the different things that you're telling yourself. And so. One of the things that comes with anxiety is this need to try to control and really acknowledging pieces that we have in our control and what we can do and pieces that we don't have in our control and may need to release. And not that I'm saying, OK, I should just completely release the worry that someone could develop a food allergy. Well, no. However, many times those worries drive certain behaviors that we're doing, and we want to make sure that we're noticing kind of what we're thinking about and how it's driving our behavior so that we can manage those different thoughts. And so what ifs. And after we get grounded in kind of that knowledge and thinking about the what ifs and bringing them back in the previous webinar, I talked about turning what ifs into even if, so even if this were to happen, especially if you have young kids, even if this were to happen, my guess is you have those EpiPens with you everywhere and you have those young kids with you most of the time.

00:51:53

Dr. Fawn McNeil-Haber

And so you are prepared, probably more prepared than most families. And this is, you know, when my child developed his third allergen, we already had epinephrine and it feels good to have it even when I'm with my non-food allergic child. So looking at your thoughts and trying to hone back and not dwell on those things that you cannot control and even writing it out, you may have seen online or memes. You can draw a circle and you can put the things you can control in the circle, the things that you can't control outside of the circle and try to focus on what you can control and trying to let go of the different things that you can't control and focusing on that in the way that there are multiple areas of our life and develop and growing our kids that we have to do that we have to kind of let go of things that we think could happen. And so that would be one of the things that I would encourage to be doing to notice that not dwell on it and attempt to ground yourself in what we know and refocusing thoughts as opposed to what could happen to what your values are and how you want to live your life. What are the things that I want to focus on? Do I want to focus on my child being able to go out on playdates? What can I focus on that also gets me more around, how can I move towards empowerment and thriving as opposed to dwelling on a piece that might be rare and that you can't control?

00:53:29

Dr. Shelly Flais

Right. Fun. I love your point about having the epi. Knowledge is power. Not only do we have the analogies of food allergy family, but we've got the tools we're ready to go. I'll just share a personal story that went one of the summers that my oldest was in high school. We did a mission trip to Panama, and for three of those days we were away from all medical facilities no running water, no electricity. It was part of the experience that we knew was coming. It was very important to me that he lives his life in a way that he knows he can do these things. We went, we did it. We had a blast. We had epinephrine everywhere. And in fact, the other people on the mission trip were laughing. They're like, Well, if we get into trouble, we got these people right here. And that was such peace of mind to know that we were prepared in case something happened. Because, sure enough, on the mission, one of the daily items at breakfast was peanut butter. And so we packed our own food. We were prepared. But it was a huge stepping stone for us because as you envisioned your child's future and what you want them to be able to do when they're teenagers, when they're in college, beyond it's all stepping stones to get from A to B to Z, and baby steps you take now will help you on your journey. You may not believe your child can do an international mission trip in high school, but baby steps now and in middle school will get you there, and it's such an important message to empower our children.

00:54:57

Dr. Fawn McNeil-Haber

Absolutely, and I think that's such a great example about taking those those steps and being focused on like, what do we need to achieve? And I frequently tell individuals that for things like this, behavior becomes before the emotion. So you may not feel confident going in, but you will feel more confident coming out because you've given them those tools and that you've accomplished something.

00:55:26

Matt Bomes

Do any of you have thoughts on how many EPIs to have, where to store them and who in the family should have them. So for everybody listening, I think it was really inspiring for me. Everybody on our team is a parent of a kid with food allergies, and I'm filling in for somebody who usually facilitates these sessions, who is traveling for the first time out of the country with their families. So she actually learned that from Shelly, and I think it was really cool to see her eyes light up when Dr. Flais told that story a couple of months ago to realize that they can do this with their 10 year old. So that was one answer. It was the, I think, the extreme case. But personally, I also always carry a number of devices when I go out and I'm meeting new people and stuff. And funny enough, in the last maybe 90 days, I've met one or two other people, like every other couple of weeks, that also has, you know, as an adult with allergies, and I'll be surprised if they have them or if they oftentimes they don't. But I always have like three or four when I go out, and it's just a confidence thing of like having it like, there's no stigma to it. And I always joke that, you know, I have enough for all of us. You know, people always ask about it and it's but there's no stigma around it. I think just if you have it with you, you feel more confident.

00:56:42

Dr. Shelly Flais

I have personal friends who went to a baseball game in St. Louis and went to the bathroom. They witnessed an anaphylactic reaction. The family didn't even know they had food allergies. They had epi on them. The Busch Stadium was working on getting EMS involved. They gave their epi. They saved that kid's life. And so when you think about the power that we have to educate others and to help, and in this case, they literally saved someone else's life because they were prepared because they had epi. So we can't emphasize the importance of carrying epi with you at all times. When you get new prescriptions, make sure they don't expire within the year. Sometimes the pharmacy is trying to get rid of old stock. There's been many times as a parent where I picked it up, didn't even drive away, looked at the expiration date, said nope, and they’re like well we have to order it, it'll take a while and I'm like, that's fine, because this is a just-in-case medication. I need it to last all year. Depending on your insurance, they may not cover refills. We don't even want to get into that. So make sure you advocate for your family and make sure they're current and the more the better. And in fact, this may not be medically sound advice, but I keep expired EPI in a safe spot because after our episode where my son was like 63 pounds and needed two doses, I don't want to leave anything to chance and I figure the expired is better than nothing. So you can also practice on oranges and you can help your child administer it to an orange just to get that sense of what it. Yes, the trainer devices are great, but then you could use the expired ones, but then collect the used needles, give it to either your pediatrician or a lot of pharmacies have the used medication drop off bins, so just an idea there.

00:58:29

Dr. Fawn McNeil-Haber

Absolutely, and I think, like you said, it depends on your insurance, it depends on how easy they are to get. For myself, the school nurse has one and it just stays at school. I always have one in my purse, whether I'm with my child or not. It's just because I'm the one that's usually taking them. So I always have it. And then we have another one that's like, his that goes with him and dad’s goes with him wherever he needs to go. So I think you have to think about what works with your family, your lifestyle, how it works. Maybe you have one and that one just constantly goes with your child and everybody's very aware. So think about like what works for your family and how it works with you as far as your insurance and financially. But those are the constraints. Otherwise, it's about what works for you.

00:59:21

Matt Bomes

The EpiPens, which are a little larger, I carry two of those that are fresh and then I have a clip on the back of my phone for an AUVI-Q which just slides out of the case. So that's just one, but I usually carry three. So I have sort of, you know, if I have two that are left in a backpack and I'm at the gym and those are in a locker, I have the one with me or, you know, different scenarios. So thank you. How do they fit into your lifestyle is important.

00:59:48

Dr. Shelly Flais

There's a common misconception that they come in two packs because one is for home and one is for school. No, you need the two pack because there are biphasic reactions, meaning after the initial reaction, you hit a honeymoon period and within 20 or 30 minutes, there might be a second peak to your child's reaction. So depending on how quickly EMS is getting involved, how quickly you're getting to the E.R., you need to have the ability to give two doses. So that point is very important. And thank you to the person in the chat who said that.

01:00:18

Matt Bomes

What tools can a parent use to overcome the worry and stress about our child having a reaction at the hands of others, i.e. restaurants, other adults, et cetera? I struggle with trusting others since my daughter Anna to dairy and egg has had reactions eating out and we rarely eat at restaurants.

01:00:41

Dr. Fawn McNeil-Haber

Go ahead. Go ahead, Dr. Shelly.

01:00:42

Dr. Shelly Flais

Yeah, I will say we love cooking and we've used it to empower. We love cooking anyway, but in the case of food allergies, we like to emphasize, yeah, you can't eat x y z, but look at the 99% of foods that you can eat. We've even held chopped challenges. If you guys know that Food Network show where you have a mystery basket and you have to, like, create a meal. We'll do our own version of it. And when you cook at home, it's safe and it's such an important life skill. And as a pediatrician, child health expert, I'm always trying to convey to families like this isn't just, you know, fun in the kitchen. This is important life skills. Your sons and your daughters need to be able to feed themselves moving forward. So again, I'm all about flipping the script, reframing it to be positive. I do think it's great to eat at home. It's funny because eating clean is a trendy phrase these days, but it's just eating real food that you can get in the produce department. And you know, you don't have to read labels because it's broccoli, you know, as an example. I will say personally, and Fawn, I'm eager to hear what you have to say, but when we dine out, we love food,

01:01:51

Dr. Shelly Flais

So of course that's going to happen. Ultimately, I feel we have the Epinephrine, and if something happens, we know what to do, and that might be a little bit fatalistic, but it's all in the spirit of helping my children live their lives and to know we are going to be selective. And when I introduced myself, I talked about how you're going to educate school nurses grandparents. Remember that your child is watching you when you teach those other people. And those are the many scripts that help your child advocate for themselves. So when they hit 12 or 13 and they’re living lives that you're not standing at their side, you want them to have the language, the terminology, the questions to advocate for themselves, including, and there's been many times at restaurants where we're just ordering and my sons are the ones who stop and say I have a life threatening peanut peanut allergy. I want to know if this is safe. The best restaurants that only go back and ask the chef. Is it a false layer of comfort, perhaps, but it's I think to us, the life skill of the child advocating for themselves in an age-appropriate way is huge and sending that message that we still want to live our lives. And it's hard, no doubt about it. It's hard.

01:03:10

Dr. Fawn McNeil-Haber

Absolutely. I think the peace around trust, I think, goes hand in hand with preparedness. And so as you go through your process of understanding food allergies, you are going on a journey. And one of the things that can happen with us as food allergy parents is we forget that we're taking other people on the journey also. So sometimes we expect that grandparents or family relatives, we tell it to them once and they get it. And it's done. Except for it's a journey. It's a journey of understanding just how multifaceted the food allergy world is. I mean, labor reading sounds so simple. We all know that label reading is not simple, that it is quite complicated, and some of the allergens are called other things. And you have to learn what whey is. You don't want the Gatorade with whey and having to then communicate that to everyone. I had the conversation with grandparents not too long ago that we don't do Gatorade. They didn't buy Gatorade. They didn't ask about Gatorade. It was just now I'm going to tell you about Gatorade, and they sat there and they listen to my speech on Gatorade because that's what they do. And they were like, we will not buy Gatorade, as we have never done in the past. And I was like, Great job.

01:04:37

Dr. McNeil-Haber

And so there is that preparedness of you having to take people on that journey with you and them understand not just don't do this, but some of the background around “don't do this.” I'm talking about whey in Gatorade because I read something about someone having a reaction to whey in Gatorade and how all of that works. And so I know dairy and egg, dairy and egg are big. We have dairy and wheat. We don't have egg, but these are the big ones that are just everywhere. And so really taking people on that journey with you and paying attention to who actually gets on this train with you because there are going to be some relatives or some close people that aren't going to get on the train with you and that you decide that maybe my child being with them is not the safest bet. I need to be there and I need to be very involved in the food situation. And then there may be other people that get on the train that are like, I'm not giving your kid anything that you didn't give me, that you didn't OK. And you know, I love when parents send me pictures of ingredients. Here is what we're going to have. Like that is a glorious thing. So really taking people on that journey, communicating what you want. I want pictures of ingredients. I don't want you telling me what's on the ingredient list.

01:05:52

Dr. Shelly Flais

I'm sorry. I don't trust that you knew how to read it, and I don't care that you about any of your feelings around that. Take a picture, send it to me, and we will be cool. So knowing what makes sense to you, communicating and looking to see whether the person gives it back to you because someone who is fully on board is going to take it in and they're going to go that extra mile and someone else, you may decide, OK, that's not where I want to leave my child. And so really, that preparedness picking the relatives because you know what? Your kid needs to spend time without you sometimes. And it's a good, you know, we talk about those stepping stones. That's a good piece. But finding those same people the same thing with schools, with nurses, with all of those things being able to find those safe people playdates, I had one of my kids' friends was like, Oh, I was like, Oh, here's a video about you. Talk about the videos on Backstop. You watch a video of how to give the epinephrine. Oh, I watch the video like that means something to me. The fact that you watch the video, you've now seen how to use this device. My kid knows how to use the device. And so really, thinking of that trust as a process, a communication and a journey that everybody's going on with you.

01:07:04

Dr. Shelly Flais

And regarding your kids birthday parties and events, my oldest was also egg allergic, and most kids outgrow that by kindergarten. He was 15. That's a lot of birthday cakes, and I just cooked them from scratch because I did not trust at any bakery to handle egg free. Vegan is everywhere now, so it seems easier. But also I like to cook. I have twins. That meant two birthday cakes at the same time and we did it. And honestly, a lot of times my kids preferred to bring our treat because it was better than the store-bought whatever that was at the party.

01:07:37

Dr. Fawn McNeil-Haber

I had to make cupcakes for my non allergic child, like you're not even like, you know how much this cake mix, this gluten free cake mix costs, but you do it right?

01:07:49

Dr. Shelly Flais

Exactly.

01:07:51

Matt Bomes

And you “get to” read the food labels, you don't “have to.”

01:07:54

Dr. Fawn McNeil-Haber

Yes, you “get to” I love that. Yeah, it's all about language. I love that. Thank you. You “get to.”

01:08:00

Matt Bomes

It's been awesome seeing in the huddles moms coming and just sharing, and dads too, have tips in little word changes like that that they've learned from your past webinars on what ifs to even ifs and get tos and have twos, and we're here to help you navigate that journey. So thank you, both of you, Dr. Flais, Dr. McNeil-Haber for your time and wisdom. Today's session gave us a lot to think about if you want to figure out how to fold some of these concepts into your everyday life, go to getbackstop.com/events. You can sign up for small group parent huddles to explore food allergy, anxiety and other issues related to the food allergy journey with other parents, like-minded families. And they're all led by therapists, pediatricians, nutritionists, allergists, other experts who live and work in food allergy professionally. So thank you again for joining us today. We look forward to connecting with you again and hope you have a great rest of your day.

01:09:04

Dr. Fawn McNeil-Haber

Talk to you soon. Thank you.

01:09:06

Dr. Shelly Flais

Thanks, everyone.

Up next

Food Allergies at School: What Your Pediatrician Wants You to Know

Course Lessons

Food Allergy Anxiety in Kids: What Parents Can Do to Address It
Food Allergy Anxiety in Kids: What Parents Can Do to Address It
How to Find Your Footing: Reducing Anxiety as a Food Allergy Parent
How to Find Your Footing: Reducing Anxiety as a Food Allergy Parent
Navigating Anxiety in Food Allergy Parenting Today
Navigating Anxiety in Food Allergy Parenting Today
Growth Mindset: Moving Forward After an Allergic Reaction
Growth Mindset: Moving Forward After an Allergic Reaction
Food Allergies at School: What Your Pediatrician Wants You to Know
Food Allergies at School: What Your Pediatrician Wants You to Know