Survey: Pandemic school shutdowns reduced bullying among kids with food allergies
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Children who are bullied because of their food allergies at school saw some relief from their torment during the 2020 COVID-19 pandemic lockdown, according to a study published in Annals of Allergy, Asthma & Immunology.
Kaitlyn A. Merrill, an undergraduate research assistant in the department of biochemistry at University of Winnipeg, and colleagues collected data from the year prior to the COVID-19 pandemic and from May 1 to June 30, 2020, when schools largely were closed.
The pre-pandemic cohort included 65 patients (50.8% boys; mean age, 6.9 years) recruited from a tertiary pediatric allergy clinic during follow-up visits related to food allergy, as well as 53 controls (56.6% boys; mean age, 7.4 years) recruited via convenience and snowball sampling. These participants, who all hailed from the province of Manitoba, and their caregivers completed similar questionnaires based on the Food Allergy Economic Questionnaire.
The pandemic cohort — recruited from across Canada via convenience sampling through email and social media advertising — included 62 children (72.1% boys; mean age, 9.2 years) who were the oldest in the family and who had one or more food allergy and 40 controls (40% boys; mean age, 8.7 years) who also were the oldest in their family but did not have any food allergies. These participants and their caregivers completed an online version of the questionnaire.
The most common food allergies in the pre-pandemic cohort were peanut/tree nut (81.5%), egg (29.2%) and fish (21.2%), and those in the pandemic cohort were peanut/tree nut (51.6%), milk (32.3%) and egg (27.4%).
In the pre-pandemic and pandemic cohorts alike, the patients with food allergy and controls had similar frequencies of patient-reported anxiety and depression as well as bullying and isolation.
The prevalence of anxiety appeared comparable between the patients and controls (19% vs. 29.4%) in the pre-pandemic group. Those percentages increased among both patients and controls (67.2% vs. 59.5%; P < .005) during the pandemic.
In effect, the researchers wrote, rates of childhood anxiety doubled between the year before the pandemic and the early months of the pandemic.
However, rates of bullying decreased for children with food allergy between the pre-pandemic and pandemic periods (31% vs. 6.9%; P < .008) but remained consistent for controls (20% vs. 16.2%).
Similarly, children with food allergy did not report a significant change in social isolation between the two periods (31% vs. 5.7%), whereas the children in the control groups did (19.6% vs. 48.7%; P < .005).
Because children with food allergy experienced significantly less bullying during the pandemic, the researchers concluded that these children tend to be bullied more substantially on school grounds.
The researchers said that these findings underscore an urgent need to address bullying related to food allergies in schools, which they said abruptly and significantly decreased once the pandemic began.
Noting that children with food allergy did not report any differences in isolation between the pre-pandemic and pandemic periods, the researchers also suggested that such children feel less food-related pressure during virtual events.
The researchers further recommended that schools adopt and enforce zero-tolerance policies for bullying that involve food-allergic students.
Perspective
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Social well-being and mental health concerns have increased among children during the COVID-19 pandemic. The literature on these observations is growing, and this study provides a novel perspective on the experiences of children with food allergies.
Rates of anxiety doubled among this sample from pre-pandemic to the early months of 2020, which may reflect the uncertainty and rapid changes to daily lives. Children with and without food allergy reported higher rates of anxiety, suggesting that providers should discuss new or worsening mental health concerns with all patients.
It is notable that children with food allergies reported lower rates of bullying during the pandemic compared with pre-pandemic. Our own research found that food allergy-related bullying most commonly occurred at school, and children perceived the bullying to be because they received special treatment (eg, sitting at an allergy-free lunch table), carried medications and were unable to be with the group.
These and other necessary food allergy management tasks such as reading food labels can make a food allergy diagnosis more visible to peers and open to remarks or teasing. During the virtual learning that has been common during the COVID-19 pandemic, many of these tasks would not have been necessary or could have been conducted off-screen.
The researchers also found that children with food allergy did not report differences in social isolation during the pandemic compared with pre-pandemic. In this sample, children with food allergy were reporting higher levels of social isolation compared with the control group to begin with.
Allergy providers are encouraged to facilitate discussions with families about strategies that promote safe inclusion of children with food allergies in social events. Some strategies were commonly encouraged during the COVID-19 pandemic and could be used to keep children with food allergy safe, such as hand washing and discouraging food sharing.
Researchers should continue this important work while many schools transition back to in-person learning. For children with food allergies, the transition may generate new sources of anxiety when anticipating eating around others and the potential for allergen exposure. Future research could also investigate different types of bullying and specifically ask about the prevalence of cyber-bullying, both related and not related to food allergy.
Perspective
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The results of this study are significant but not necessarily surprising. School can be an extremely stressful environment for children with food allergies, and this research points to the need for better policies and practices to keep children feeling safe and secure while attending school in person. For instance, looking to nonfood alternatives for treats, rewards and class activities can help to make children feel included without drawing unwanted attention to their food allergies.
Although I am not a health care provider, I am a food allergy parent, advocate and social scientist, and the findings from this work align with my experiences in these realms. We know that about one-third of children with food allergies are bullied, so it makes sense that attending school virtually would offer a reprieve for some children.
I think doctors can take two approaches to improve care. First, they can prepare patients and parents for facing the challenges of managing food allergies in school settings. Second, they can advocate for better policies and practices in their local school systems. In particular, encouraging nonfood alternatives in the classroom as a first-line practice can ensure that students with food allergies are included and that their peers do not feel that they are missing out because they happen to share a classroom with someone with food allergies.
It would be interesting to see how the research centered on bullying contradicts or coalesces with other work suggesting that the COVID-19 pandemic increased stress and anxiety for food allergy families, especially those who faced difficulty accessing reliable food brands due to supply chain issues.
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