Q&A with Dr Karen Murphy

Dr Karen Murphy is a Clinical Psychologist, working at a leading teaching hospital in London.  As the UK is beginning to come out of lockdown and children are returning to school, The Allergy Team has asked Dr Murphy some questions on how best to manage this transition, and any anxious feelings we may have.

Dr Murphy:  The last year has been challenging for so many of us and parents understandably may have concerns about their child’s learning or lack of social interaction with others. For children and parents living with food allergies, the easing of restrictions may be adding to the complexity of the picture and some of the families I support in my practice are reporting an increase in anxiety. I have included some strategies below to help deal with these feelings.

Question:  I am nervous about the world opening up again after lockdown. At home, we have been in a very “safe” environment as far as allergies go and I am worried about that changing and children going back to school.

Dr Murphy:  Feeling nervous about restrictions being lifted is an understandable response. Our bodies have a flight or fight response which is activated when we sense a threat. So, for people living with food allergies, things like eating at school or in restaurants may activate that system and will increase anxiety. Whilst being at home may feel more comfortable for some people because they’re not exposed to social situations, we know that in the long term, this avoidance can actually maintain that anxiety which can have an impact on quality of life. Over time it’s important that children are able to engage in activities that they love and there are strategies to help them manage that.

I speak with families about gradual exposure to situations they feel anxious about. The plan for lifting lockdown restrictions is really going to help with this because it’s being done in a gradual way.

The first step is going to be the opening up of schools. There are general strategies that will help any child with returning to class; things like implementing routines and making space to talk about how they’re feeling about it. It can be helpful to name the emotion that they are feeling and supporting them to recognise how they can identify how they are feeling. Try not to make the assumption that they’re going to be feeling anxious because some children might be excited about going back to school.

There are things which can help a child’s anxiety around their food allergies and going back to school too. For example, you can help build their confidence around things like reading labels and checking ingredients, by practicing with them.  You can also plan their lunches with them, whether that’s discussing the school menu or/and going over packed lunches. You could also get in contact with the school if there have been any changes to their allergy management plans and hopefully that will give your child a feeling of increased safety. Make space to talk about each of those factors and see school as the first step.

After that the next step might be something like eating out at a restaurant for example – go to a restaurant that you feel most familiar with, where you can look at the menu before you go and think about any questions that you might ask. If your child is old enough, give them the opportunity to communicate with the staff about their allergies and make the choices they’d like.  If they’re not comfortable doing this then it is a great opportunity to model how you communicate the information about their allergies. We know that how parents cope is important in a child’s risk perception of their allergy, their anxiety and coping over time. It’s important to remember it has been a really challenging time.  Be kind to yourself.

Question: I have a teenager and I’m worried she’ll have forgotten how to manage her allergies because she’s spent so long at home. Will she forget to check ingredients or to take her emergency medication with her as it’s no longer second nature?  Do you have any advice on how I can make sure she remembers?

Dr Murphy:  Young people at this age tend to be taking more responsibility for managing their food allergy, so she might have thoughts herself on how to manage going back to school. You could spend time exploring this with her. It’s likely that she’s continued to check ingredients whilst at home, so hopefully, she’s still got that skill but if it is something that she’s feeling worried about you could read labels together, to build her confidence, and remind her what she’s looking out for. You could always role-play conversations, so for example, if she was having school dinners and was feeling worried about checking things with staff you could practice what she might say.

Young people I’ve spoken to have a range of strategies for remembering to carry their medication: things such as setting reminders, leaving the medication bag next to or in their actual school bag or leaving a note by the door. What we know is, routines will be re-established once young people start to go back to school.

Question:  My child has become quite angry and withdrawn over the last lockdown and I am worried about how he’ll behave when he’s back at school.  Is there anything I can do to support him and make this easier?

Dr Murphy:  Children can become quite angry and withdrawn for lots of different reasons, so it might be that they’re missing their friends, it might be that he’s missing school and is unable to engage activities that he enjoys and it’s been a really challenging time for everybody. Returning to school and managing food allergies may increase some of these feelings and some children find it hard to vocalise their emotions. Something that I have found to be helpful is developing a worry box: children can write down or draw their concerns and put them in the box, then make time to go through the box together. This can encourage children to express their concerns.

Something else you could do is provide practical information about the return to school. Prepare them for any changes: if there is a new teacher, a new class layout, if there have been changes to play times; have a conversation about how their food allergy is going to be managed and if they’re old enough, remind them of their care plan. Other things that might be helpful are re-establishing a routine and offering your child opportunities to re-engage with activities he enjoys.

Speak to teachers about your concerns but if you continue to be worried that your child is withdrawn then I think it would be worth speaking to your GP and seeking further support.

Question:  The constant communication about food allergies when socialising can be exhausting.  What can we do to prepare because friends may have forgotten?

Dr Murphy:  It’s important to consider the information you want to communicate.  The information that you want to share with friends will very much depend on what the situation might be, for example, if you are going to a party or a playdate and you are going to be there the whole time, the information will be different to if you are planning to leave your child at their friend’s house overnight.  Depending on the age of your child, it’s worth getting them involved and asking them what they want their friends’ parents to know.

Parents I’ve supported have said they find it helpful just to write one message that they can send to people, whether that is by WhatsApp, email or text.  Having it written down allows you the time to think about what you want to communicate, communicating it in a very clear way and it then provides your friends with something to refer back to.  This can easily be adapted depending on the event you are attending.

If you wanted to, and felt comfortable to do so, you could also share your child’s allergy management plan.  This includes the foods that your child’s allergic to, the symptoms to look out for and how to treat your child if there were to be a reaction.

As we haven’t had social events for some time it might be worth starting things gradually, firstly by sharing the information, but also you might want to stay for that first event to build up your confidence, your child’s confidence, and the confidence of your friends and then over time you can spend less time there.

If you’re speaking with friends about your child’s allergies and your child is present, involve them as much as possible.  It’s a really positive opportunity to role model, by communicating that information in a clear and calm way.

Question:  Can you recommend any useful strategies to help manage anxieties caused by my child’s food allergies?  For both me and my child.

Dr Murphy:  As I’ve already mentioned, anxiety is our natural response to stress and we can experience it in very different ways: some people might feel restless or nauseous, others may find it difficult to concentrate and have racing thoughts.  One strategy that can help with managing our anxiety is to regulate our breathing.  For younger children, we can pretend to blow bubbles or we could go outside and actually blow bubbles. We can also pretend to blow candles out. Another breathing technique which can be used for older children is square breathing. This involves inhaling while you count of four, holding for a count of four, exhaling for a count of 4, and holding for a count of 4.  While you’re doing this it can really help to draw a square with your finger. For adults, there are a range of apps that are available that can support them with breathing exercises.

Another strategy that can be helpful is distraction. This involves moving our attention away from our anxious thoughts and feelings that we might be experiencing.  Distractions can be lots of things: like listening to music, colouring,  drawing, playing in the garden, reading, talking to a friend, watching a movie. Anything that you enjoy, and that is going to move your focus away from any anxious thoughts.

Another strategy is exercise.  We are all aware of the benefits of exercise for our mental health and it works to reduce anxiety too. With children you can try things like star jumps, kangaroo hops, and frog leaps. For adults it might be things like yoga, going for a run or a walk.

One final strategy that is really useful and helps you stay in the present moment is the five senses exercise. This involves taking notice of our 5 senses and counting down. So it would be five things that you see, four things that you hear, three things that you can feel or touch, two things you can smell and one thing that you can taste.  This is a really helpful technique to bring you back to the present and ground your thoughts.

These are all great general anxiety strategies which can help with lots of situations.  There are also specific strategies for anxieties around hospital appointments, especially those which include skin prick testing, blood tests and food challenges.  If these are areas you want to support with then it’s worth getting in touch with your allergy clinic or your GP.

 

You can follow Dr Karen Murphy on Twitter @drkarenmurphy1

Date: 4th March 2021

Disclaimer:  All information provided by The Allergy Team Ltd is general information only.  Please contact your GP or other qualified health professionals for specific advice.