We're all familiar with the term self-esteem, but it can be hard to describe it in a concrete manner.
In the simplest of terms, self-esteem is a positive sense of self. Having self-esteem often fuels confidence, pride, belief in self, a sense of belonging, and a positive self-image. Kids with poor self-esteem tend to be more self-critical, focus on perceived failures, doubt their abilities, and believe they don't measure up to their peers.
Per psychologist Dr. Paul Foxman, we develop self-esteem in two ways:
The first point probably seems like common sense. When parents and caregivers acknowledge and celebrate a child's accomplishments, as well as their values and choices, it helps the development of positive self-talk within the child.
At first glance, the second point may also seem like common sense, but let's dig a little deeper to explore how parental fear may inadvertently become a factor in the development of a child's self-esteem relating to their ability to self-manage their food allergy.
TWO WAYS TO HELP KIDS DEVELOP FOOD ALLERGY-RELATED SELF-ESTEEM:
Remember....kids that develop confidence in managing food allergies become adults who are able to navigate life with food allergies. The opportunities you allow and approach you take to teaching them food allergy management skills directly impacts their self-esteem and internal self-talk about their ability to handle food allergy-related situations.
Those of us who are food allergy-knowledgeable licensed behavioral healthcare providers will inevitably get calls from parents seeking guidance on helping their child with food allergy-related anxiety at some point.
Signs of anxiety don't always present in kids the same as they do in adults. So what leads these parents to believe their child has elevated levels of anxiety? Some common reports are:
"My child will no longer eat at restaurants when we go out to eat as a family."
If you or your child exhibits elevated levels of anxiety that are negatively impacting daily life, I highly recommend seeking guidance from a licensed clinical counseling professional, preferably a food allergy-knowledgeable one. But even if you're not experiencing elevated levels, these five general anxiety reminders for parents may still be useful to incorporate to address and manage developing anxiety.
1. Aim to manage the anxiety, not completely get rid of it
Wouldn't it be great if we never felt anxious or worried? Sure, but that's not a realistic goal for anyone, so don't try to remove everything that produces anxiety for your child. The best way you can help your child navigate anxiety is to help them learn to accept its presence, understand it, and develop skills to manage it. Part of understanding anxiety is not only learning about the thoughts and feelings, but also the physiological sensations often associated with the emotions. By gaining this understanding, it allows for more personalized skills that will help your child manage their own anxiety. Focusing on managing the anxiety (rather than avoiding it) often demystifies these thoughts and feelings, which can lead to decreased frequency of anxiety over time. It's also important to remember that anxious feelings can also be a positive tool, reminding you to assess risk, and motivating you to cope in order to make it through an uncomfortable situation.
2. Avoidance can increase anxiety
Your natural instinct when you see that something makes your child anxious may be to remove them from the situation, and maybe even avoid similar situations in the future. While it's important to avoid unsafe situations when managing food allergies, if you find that you and your child are shying away from most activities, you may need to explore if all of them truly have high enough risk levels that they need to be avoided completely, or if you can reassess the risk levels for some. Why is it important not to simply avoid all situations that evoke anxiety? Because it can send a message to your child that the solution to anxious feelings is to avoid, leave, or simply ignore the feelings. Approaching anxiety this way robs them of the opportunity to learn to navigate these feelings, build tools to become more resilient, and gain confidence.
3. Be realistic, but positive
You can't promise your kids that they will never be faced with anxiety-provoking situations where they may come face-to-face with their allergen, or even experience a reaction. But you can promise them that you are prepared with your emergency action plans, epinepherine, have educated those around you, and that you won't put them in situations they feel unprepared to handle without their permission first. When they express fears or worries, promise them that you are there to approach these feelings together as a team. Remind your child that they will learn how to navigate their worry, and will likely become braver than it over time.
4. Don't reinforce fears; reinforce skills
When your child (or you, for that matter), feel a lack of control, it can fuel anxious thoughts and feelings. Therefore, it's crucial to emphasize the skills they have in their tool kit to navigate and cope with situations, rather than focusing on the fear. Practicing food allergy safety skills often with your child will increase their confidence that they can handle anxiety-provoking situations. If your child presents with the "what ifs" often, use this as opportunities to talk through the scenarios with them. By exploring situations ahead of time, it reminds them which tools they can use to navigate worrying situations, and which skills they have to manage their emotions.
Parents also need to learn how to reinforce skills and not fears in those crucial real-time moments. Rather than responding to your child's anxiety with phrases like "Don't worry" or "Everything will be fine", use messages that reinforce your child's ability to manage the uneasy feelings. When you're faced with that upset tummy, rather than trying to reassure with "I'm sure it's nothing" or even joining right in with their worry, use a skills-focused approach: "Upset tummies are no fun! Let's use our private investigator skills to figure out why it might be bothering you?" (And then follow up with a team investigation together). When your child won't eat at the restaurant, instead of focusing on, and inadvertently fueling the emotion by saying "Are you worried? Is your tummy upset?", focus on the skills by saying something like "I wonder if we should review our safe restaurant eating tools again to make sure we've used them all? Remember when we ate at [insert restaurant] - we used all of these tools and we ate safely." (Maybe even have a checklist handy for your child to actually use at restaurants).
5. Model healthy anxiety management
There's no way around this one - your child watches how you manage (or don't manage) your own fears, worries, and anxiety. They key into your words, your tone and body language, and your actions. Most kids are typically skilled enough to pick up on the discrepancies, too. If you say you aren't worried, yet your child always overhears you talking to a friend about how anxious you are that a reaction will happen, it sends mixed messages. Does that mean parents aren't allowed to have anxiety or fears? Absolutely not (refer back to #1, which applies to kids and adults alike!). Parents, especially those managing food allergies, often have elevated levels of anxiety, especially in certain situations. It's okay to be honest about being anxious or worried as a parent, but learning how to cope with these emotions and practicing what you are preaching is absolutely crucial. Showing your child that you're tolerating/accepting your own stress, and using healthy skills to manage your own anxiety will help them learn and adopt these skills, too.
-(If you feel you're not managing your own anxiety and fear well, please consider reaching out to a counseling professional for support, as it's important to practice good self-care as parents. You can locate a food allergy-knowledgeable one via the Food Allergy Counselor Directory)-
RECOMMENDED ANXIETY/WORRY TOOL:
I like to recommend the follow workbook for kids, as they can work on it with their parent at home, or with a counselor. It's an interactive workbook geared towards kids ages 6-12, which guides parents and kids through common Cognitive Behavioral Therapy (CBT) techniques that help with worry. It's part of a series of workbooks, which cover a variety of topics.
What to Do When You Worry Too Much: A Kid's Guide To Overcoming Anxiety
by Dawn Huebner, PhD
*(You can also find this book via other sources, such as Amazon, but the APA site offers additional related resources, such as puzzles and word searches)*
(If you're reading this, you've likely already read Part 1, Part 2 and Part 3 of the "4 Things Counselors Should Know About Food Allergies" series. If not, I'd suggest you read those first).
In the previous three posts, I covered topics focused on the many layers of food allergy-related anxiety and fear, food labeling concerns, and the lack of support that many find from schools and family. The final post in this series has to do with the counseling considerations that counseling professionals should be aware of when working with clients managing food allergies.
#4 - A Collaborative Team Approach Is Crucial....
And Be Mindful With Exposure Therapy Techniques
A Collaborative Team Approach is Crucial
Ideally, those diagnosed with food allergies would routinely see their allergist, as well as their GP doctor, but they would also be given referrals to allied healthcare professionals in case they may be useful. This list might include counseling professionals, dietitians, dermatologists, gastroenterologists, and even educational consultants w/food allergy knowledge.
Some larger medical hospitals and institutions already take a true collaborative team approach within their food allergy departments, including having a counseling professional on staff. However, you'll typically be working with food allergic clients in your own office and therefore, will need to create your own collaborative team approach with your client's medical doctors and other allied healthcare professionals.
Food allergic clients typically visit their allergist annually (or more often, if necessary). Allergists will determine or confirm food allergy diagnoses, and help their clients establish emergency action plans and safety guidelines. Therefore, at the very least, you'll want to connect with your food allergic client's allergist for continuity of care if the client allows. Sometimes perceptions and statistics don't align when it comes to evaluating risk factors. Therefore, especially if you're not well-versed in food allergies, being able to reach out to their allergist will prove useful in situations where you may want to clarify the likelihood of reactions or other food allergy facts, as they pertain specifically to your client. Additionally, the allergist will find it useful knowing what may be causing the client increased food allergy fears, anxiety, or emotional distress, as well as the progress being made and overall goals for counseling.
A Few Words on Specific Counseling Concepts and Goals
While exposure therapy type of techniques may benefit many clients presenting with specific fears and anxiety, even those with food allergies, you'll need to be mindful of one very important point: The goal of counseling should never be to work up to exposing the person to their allergen in order to eliminate food allergy fears! Any allergen exposure needs to be determined by the client and their allergist together, not the counselor. After all, the core of food allergies lies within the medical realm.
With that being said, a counselor can still be very helpful in guiding the client through the progression of food allergy appointments, testing, treatments, and fears. For those managing food allergies, appointments can include skin tests, blood draws, and even food challenges, where people actually ingest their allergen if deemed appropriate (this is typically based on lab results and determined by the allergist). Many, especially kids, may have fears or anxiety about these appointments, so helping them develop coping strategies and tools to navigate these scenarios is a great counseling goal.
Clients managing food allergies would benefit from Cognitive Behavioral (CBT) work, which will help them identify and manage stress, acknowledge unhealthy (and healthy) thoughts and behaviors that may play a role, and learn how to challenge them and establish new ones. However, CBT isn't the only type of counseling that will help clients with food allergies. A variety of counseling theories and techniques may be useful in working with food allergies, as long as they're proving effective with the client.
Here is a sampling of other clinical counseling goals you may establish when working with food allergic clients (goals will vary widely depending on the client):
Living with food allergies can be an extremely emotional experience, so there will be many opportunities where you'll need to help the client reality test to find a balance between emotions and facts. Balance is a key necessity for living with food allergies, since it's a marathon and not a sprint. Balance of emotions, balance of facts, balance of coping strategies. As food allergies threaten to throw that balance off kilter, sometimes on a daily basis, it's crucial to think about the bigger picture when working with food allergic clients. The work will be hard and gut-wrenching at times, but extremely rewarding, especially when you see a child or its family learning how to live an empowered life with food allergies as a direct result of the work you've done together.
If you're working with a client who has food allergies and feel you need more information to educate yourself, check out the following resources, in addition to the links within this post:
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