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Listening To Mom

Originally Posted: July 28, 2011

Dr. Paul M. Ehrlich

Amagansett - In "Asthma Allergies Children: A Parent's Guide" we talk about the Designated Parent Theory. I have learned in many years of practice that in families with severely food allergic or asthmatic children, one parent taking responsibility for management issues works better than being very egalitarian, and that Moms are better at this than Dads.

It's not that two parents can't become equally authoritative, but it's hard work, and this initial job of acquiring expertise will absorb a disproportionate amount of a parent's time. Someone has to attend to other parts of the family's lives during this first, intensive phase of adjustment. Two parents focused equally on allergies and asthma can mean equal neglect of other children and the marriage itself.

The child needs a coherent authority, one voice he or she can go to get the straight story. The other adults in the process should have the information funneled through the same channel. If the other spouse or the grandparents become avid participants, there can be misleading, possibly contradictory directions for the child, potentially ending in the emergency room. The designated parent will be the one who has been to the doctor's office, sat in the support groups, read the newsletters, and so on. She will also likely be the one who has seen the effects of the allergen, not just learned the cause.

The single-authority model is contrary to the idea of cooperative, involved parenting that is now the norm, although in reality most parents complement one another rather than function as true equals. Dad may be the better Little League coach. He may be the better barbecue chef. But there are fault lines in any marriage. Usually they are harmless, like Dad taking his kids to action movies, when Mom thinks they're too violent. In the case of food allergies, however, subtle differences of temperament or philosophy can have the potential for disaster.

In one case, a Dad let his mother feed his son Grandma's special banana cream pie, even though they were under explicit instructions not to let him have bananas. The key word for Mom was "banana"; for Dad and Grandma it was "pie." Dad got religion after spending a few hours in the ER with his son.

I teach my patients very early, usually before the age of three, that they should never eat anything unless Mom tells them it's all right first. This will help protect them from temptation from friends and grandparents, but also allow for the fact that kids do outgrow their food allergies. Among the kids, too, there are gender differences in how they receive this information. As they get older, I will sometimes say to a kid, "How would you feel about trying some (peanut, milk, egg, whatever)?" The boys say, "You're the doctor. I guess so." Then I repeat the lesson about Mom. The girls say, "Not unless my mother says it's OK."

Still, the boys do learn their lesson.

A little boy grew up with peanut allergy, and as happens about 20% of the time with peanut, he did outgrow it, but before Mom could tell him, she passed away. The next time I saw him, I told him he could now safely eat peanuts. At the appointment after that, I asked him if he had done so. He said, "No. My Mom never told me I could."

Then a couple of months later, I got a call from Dad. He said his son had started eating peanut butter. Why was it OK now? His mother had appeared to him in a dream, and told him it was all right. You can bet that I had tears in my eyes when I hung up the phone.

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