Mental Health

10 Strategies to Manage Anxiety About an Oral Food Challenge

Topics covered:

What is an oral food allergy challenge?
What are some scheduling tips?
How do I prepare, and what should I bring?
How do I manage my anxiety before or during the challenge?
Preparing younger children
Preparing older children
Coping strategies for any age
We have the results, now what?

What is an oral food challenge?

So, you’ve just learned your child needs an oral food challenge. During this test, your child consumes the food or drink you think they may be allergic to. They’ll start by consuming small amounts – and slowly increase the portion – within a specific time under the care of a nurse and allergist trained to treat a reaction if one happens. This test takes a while to do – often 3 to 6 hours.

  • If your child has no symptoms during the allotted time, then they’re not allergic to that food or drink.
  • If symptoms arise, your child will immediately receive the treatment that’s right for them (for example, use of an epinephrine auto-injector). Then, the challenge stops, and the care team asks you to stay for a certain amount of time so they can watch your child.  Later, you’ll create a plan with your allergist. This is when it’s also important to connect with your Backstop coach for support.

You may also be wondering: why does my child need more than just a blood test and/or skin test? Blood and skin tests only help your allergist see if your child’s body recognizes a food protein. Oral food challenges are considered the gold standard and most accurate for diagnosing food allergies. This test actually tells us if your child can eat the food safely.

What are some scheduling tips for an oral food challenge?

  • Know that it might impact your work schedule. A challenge is usually scheduled early in the morning and can take half of the day to complete. So, you may need to take an entire day off of work or a half-day, if you can.
  • Find child care if you need it. Since the challenge takes a good portion of the day – and will require your help in getting your child to eat the food – it’s best to find child care for siblings, if possible.
  • Ask if Child Life specialist support is available during your visit. Child Life specialists are trained to provide therapeutic support to children. For example, they can help distract your child or explain the procedure in a way your child understands

How do I prepare for the oral food challenge, and what should I bring?

Your doctor will give you specific instructions on preparing for the challenge, what to expect, and what to bring. For example, you may have to stop giving your child certain medications ( such as antihistamines like Benadryl® or Zyrtec®) several days before the test. Also, your child cannot be sick (like with a cold, fever, flu, or diarrhea) within at least 24 hours before the challenge; otherwise, it will be rescheduled.

On the day of the challenge, we recommend that you bring:

  • The food or drink you think your child is allergic to: Your doctor will give you specific instructions on how much to bring and how to prepare it.
  • Items that comfort your child or keep them busy: Like books, arts & crafts, toys, music, or a tablet with movies and games.
  • Epinephrine auto-injectors: Have at least 2 with you, just in case a delayed reaction happens on the ride home. Check the expiration date on these devices when packing them.
  • A change of clothes for your child – and yourself: Just in case your child gets sick and throws up.
  • Some safe food to eat after the test: Your child will likely be hungry (and hopefully not cranky), so a safe snack is good to have on hand when the challenge is over.

During the challenge, the care team will not force your child to ingest the food or drink – so you may also want to bring items from home that makes these things more appealing to your child.

Keeping your child’s age in mind, you may want to:

  • Take your child’s favorite cup, dish or silverware from home
  • Bring your child’s favorite beverage or condiment (like ketchup, mustard, or syrup) to mix with the substance they may be allergic to
  • Bring your child’s favorite bread, cookie or cracker to put the food they may be allergic to on
  • Feed your child a version of the food or drink they’re not allergic to a few weeks before the challenge to get them more used to the look, texture, and taste

How do I manage anxiety before or during the challenge?

It’s normal to feel anxious or scared, especially if your child had a bad allergic reaction in the past. You may even feel disappointed if they have an allergic reaction during the test. However, it’s important to view the oral food challenge as just that – a challenge that you and your child can learn from. Look at it as a way to help your child recognize and respond to an allergic reaction. And it may even boost your confidence, empowering you to help your child when they need you most.

Preparing Younger Children

  • Try medical play or role-play: Medical play introduces your child to a procedure, test, or health-related issue using play. In this instance, you may explain the challenge to your child’s teddy bear and pretend to slowly feed them small pieces of bread with fake peanut butter.
  • Use easy-to-understand language: Tell your child this will help them feel better by finding the foods that make them feel sick. Prepare them for how long the visit will be, saying you’ll be spending a lot of time at the doctor’s office but will have fun toys and games to play with!

Preparing Older Children

  • Get them to agree to the test: It’s important that you and your child feel sure that you need, want, and are ready to do this challenge. Your child shouldn’t feel forced to do something terrifying, especially if they don’t understand why it’s needed.
  • Educate and empower them: Talk to your child about their feeling and worries. Then, have them talk to their allergist to make sure their questions and concerns are addressed. Ensure they know each step of the process, and what to expect along the way, so there are no surprises.

Coping Strategies For Any Age

  • Draw from past experience: Maybe this isn’t your first oral food challenge. If it isn’t, tap into that experience, whether the last challenge was a success or not. You have done this before; you can do it again. You were brave before; you can be brave again!
  • Combine tough things with fun things: Give your child something to look forward to after the challenge. For example, tell them they can celebrate completing the challenge by playing for the rest of the day when they get home. This may make them eager to go and distract them from the anxiety surrounding the whole ordeal. Celebrate and reinforce your child being brave.
  • Breathe: If we breathe hard, our brain thinks something is wrong and tries to figure out what’s wrong. Slowing your breathing helps calm your body, and in turn, your brain. Help your child practice breathing in to the count of 4, holding for a moment and breathing out to the count of 5. This can help calm the brain.
  • Have a mantra: A mantra is a phrase or saying that brings you comfort, bravery, and/or strength. Find a mantra that works and repeat it when you feel anxiety. You can help your child choose a mantra that they can easily remember and relate to. Examples include, “I am braver than I feel, I am stronger than I think. I can do this!” or “Just because I feel nervous does not mean I am unsafe.”

Meditate: Meditation is a useful tool to reduce anxiety and feel calm during a stressful moment. Use a meditation app on your phone to calm the body. Apps like Headspace, Calm, and Yeti Mindfulness (for kids) can help walk beginners through guided meditations for calming the body and mind.

We have the test results: Now what?

Once the challenge is complete, your allergist will talk about the next steps with you.

  • If there wasn’t an allergic reaction, your child doesn’t have to avoid that food or drink and can regularly have it in their diet.
  • If there was an allergic reaction, your child should avoid that food or drink in their diet from this point forward. Your doctor may also recommend your child take certain medications. Even if the allergic reaction during the challenge was mild, it could be more severe the next time your child consumes that substance.

Overall, an oral food challenge is a powerful tool in helping to diagnose a food allergy and identify the appropriate treatment. If your child has an allergic reaction, try not to respond negatively and refer to it as a “fail.” There are no bad outcomes, only learning opportunities as you navigate life as a parent to a child with a food allergy.

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