Mother in Law Intentionally Feed Baby Allergic Related Food

• Journal List
• J Pediatr Psychol
• PMC5896635

J Pediatr Psychol. 2017 Mar; 42(2): 186–197.

Parents of Children With Food Allergy: Gender Differences in Perceived Impact and Perceived Food Allergy Severity

Jessica L. Hoehn

¹Department of Psychology, University of Maryland, Baltimore County

Lynnda M. Dahlquist

¹Department of Psychology, University of Maryland, Baltimore County

Amy L. Hahn

¹Department of Psychology, University of Maryland, Baltimore County

Mary Elizabeth Bollinger

²Department of Pediatrics, University of Maryland School of Medicine

Received 2016 Jan 17; Revised 2016 May 4; Accepted 2016 May 31.

Abstract

Objective To compare fathers' and mothers' perceptions of the impact and severity of their child's food allergy and their levels of involvement in allergy-related care.Methods One hundred parents of children with food allergy (50 mother–father pairs) rated the severity of their child's food allergies and completed the Food Allergy Impact Scale. A subset of 52 parents reported how often they engaged in food allergy-related care.Results Mothers reported more impact than fathers for meal preparation, family social activities, and stress and free time, and significantly greater involvement in allergy-related care. Fathers who reported more frequent medical appointment attendance perceived meal preparation as being significantly more impacted by food allergy than fathers who were less involved.Conclusions Fathers who are less involved may be buffered from experiencing the impact of their child's health condition. Differences in involvement rather than other gender differences may explain discrepancies in mothers' and fathers' illness perceptions.

Keywords: children, fathers, food allergy, gender differences, parents, paternal involvement.

Food allergy, or an abnormal reaction to a food protein, is a common chronic condition with an estimated prevalence of 4–9% in children and 2–3% in adults (Branum & Lukacs, 2008; Teufel, 2007; Pyrhönen et al., 2009; Caffarelli et al., 2011). Reactions to foods can range from isolated skin symptoms to respiratory symptoms, gastrointestinal symptoms and anaphylaxis (Sampson & Burks, 1996). Food allergy is the number one cause of anaphylaxis cases seen in U.S. emergency departments with an estimated 30,000 cases per year (Yocum et al., 1999). It is estimated that 150–200 people die per year from food-induced anaphylaxis (Bock, Munoz-Furlong, & Sampson, 2001). Strict avoidance of offending food proteins is essential to prevent reactions from occurring, but this can be a formidable task for families of children with food allergy. Food ingredient labels have to be read every time before the food is served and simple tasks such as grocery shopping become time-consuming and often expensive endeavors for families of children with food allergy. The planning required to attend parties or eat out makes these social events a source of anxiety and stress. Despite the best attempts of families to maintain a safe diet for their children, accidental ingestions have been reported to occur in about half of patients with food allergy (Nowak-Wegrzyn, Conover-Walker, & Wood, 2001). Some families may avoid attending many social activities, eating out at restaurants and in some cases attending school owing to fear of exposure (Bollinger, Dahlquist, Mudd, Sonntag, Dillinger, & McKenna, 2006). Thus, food allergy can have a significant impact on quality of life and family functioning.

Most food allergy research has been focused on pathophysiology, epidemiology, prevention and treatment with relatively little research investigating the psychosocial impact of food allergy (Bollinger et al., 2006; Pitchforth et al., 2011). However, recent studies show that food allergy can have a negative impact on children. For example, food allergy has been linked to poorer overall quality of life in school-aged children as compared with a general population (Covaciu et al., 2013; Teufel, 2007), with multiple allergies or more severe allergies related to poorer quality-of-life ratings (Wassenberg et al., 2012). Allergies (to both foods and nonfoods) have also been linked to a higher prevalence of symptoms of anxiety, depression, and other psychopathologies (Lyons & Forde, 2004; Patten & Williams, 2007; Shanahan, Zucker, Copeland, Costello, & Angold, 2014). Parents of children with food allergies (such as peanut allergy) have also reported that their children experience more daily disruption in their lives as compared with parents of children with other chronic illnesses such as rheumatological disease (Primeau et al., 2000). Finally, children with food allergies are more likely to be victims of bullying when compared with the general population (Muraro et al., 2014; Shemesh et al., 2013).

Food allergy during childhood also affects parents and the family as a whole. In general, most parents report that food allergy during childhood has a significant negative impact on daily activities and family functioning, with parents identifying significant impacts on meal preparation, activity planning, family outings, and other activities (Bollinger et al., 2006; Pitchforth et al., 2011; Stjerna, Vetander, Wickman, & Lauritzen, 2014). Parents of children with food allergies have also reported a general need to create "safe spaces" for their children and to take on a "protector role" to help their children avoid accidental exposure (Pitchforth et al., 2011; Stjerna et al., 2014). Parents and families of children with food allergy have also reported poorer quality of life when compared with parents of children without food allergies (Valentine & Knibb, 2011; van der Velde, Dubois, & Flokstra-de Blok, 2013). Caregivers also report psychological distress owing to worry and uncertainty about their children's allergy (Williams, Parra, & Elkin, 2009).

However, studies of parental reactions to food allergy during childhood are limited by the fact that the vast majority of parent participants are mothers, not fathers. For example, in Shemesh et al. (2013), 83.6% of caregivers who participated in the study were mothers, and Rouf, White, and Evans (2012) focused exclusively on the maternal experience of caring for a young child with severe food allergy. Thus, there is a dearth of research on paternal factors in food allergy. To our knowledge, only one published study to date examined both mothers and fathers in the context of a child's food allergy. King, Knibb, and Hourihane (2009) studied parental quality of life, stress, and anxiety in 46 mothers and fathers of 8- to 12-year-old children who had been diagnosed with peanut allergy. They found that mothers rated their quality of life as significantly worse than fathers; mothers also reported higher levels of stress and anxiety.

The paucity of research on fathers of children with food allergy (as well as other chronic health conditions) has been attributed, in part, to the ways that two-parent families historically have divided responsibilities to cope with a child's chronic illness (Pai et al., 2007; Mitchell et al., 2007). In general, mothers attend child's healthcare appointments more frequently than fathers, and mothers are more likely than fathers to participate in and manage illness-related tasks (Goldbeck, 2001; Mitchell et al., 2007). Thus, mothers are more easily recruited and studied for pediatric psychological research (Goldbeck, 2001; Mitchell et al., 2007).

Over the past 20 years, there has been an increased interest in the roles and experiences of fathers of children with chronic health conditions. For example, Clarke, McCarthy, Downie, Ashley, and Anderson (2009) reviewed 30 studies examining gender differences in parents' experiences of childhood cancer, and found that mothers were more likely to give up work and take on roles as a primary caregiver. Fathers were more likely to feel effective at covering expenses, while mothers were more likely to feel effective at dealing with medical/caretaking aspects of the illness. Fathers also were generally less likely to report psychological distress and parent relationship problems owing to their child's chronic illness as compared with mothers (Clarke et al., 2009; Pai et al., 2007). Similar patterns of findings have been reported in other chronic health conditions, such as asthma and diabetes, with mothers reporting greater caregiving demands than fathers, and mothers perceiving their child's health as worse than fathers (Svavarsdóttir & Rayens, 2003). This pattern of greater experience of burden and emotional distress in mothers has led some researchers to argue that fathers could be buffered from the harmful emotional effects of a child's chronic illness owing to their tendency to take on tasks that are traditionally designated for males, and thus outside the home (such as working longer hours) (Berge, Patterson, & Rueter, 2006). In addition, parents who report more psychological distress tend to perceive their child's symptoms and condition as more severe (Quittner et al., 1998).

However, more recent findings suggest that this highly gendered division of roles may be changing, with fathers more likely to be more involved in the child's direct care (Clarke et al., 2009, Knop & Brewster, 2016), and a few studies have found mothers and fathers demonstrate more comparable levels of psychological distress about their child's condition (Pai et al., 2007; Wijnberg-Williams, Kamps, Klip, & Hoekstra-Weebers, 2006). Indeed, when fathers who were primary caregivers for children with cancer were compared with mothers who were primary caregivers, Bonner, Hardy, Willard, and Hutchinson (2007) found no significant difference in reported psychological distress or parenting distress between mothers and fathers.

Other studies have found links between greater paternal involvement and decreased maternal distress for families across a variety of situations, including soothing of infants (Dayton, Walsh, Oh, & Volling, 2015), parenting children with autism spectrum disorder (Laxman et al., 2015), for teen mothers (Lewin et al., 2015) and among cohabiting and married parents in general (McClain & Brown, 2016). Higher paternal involvement has also been linked to better adherence outcomes in diabetes and other conditions (Palmer et al., 2011; Gavin & Wysocki, 2006; Wysocki & Gavin, 2006). However, little is known regarding how gender differences in parental involvement could relate to the perceived impact and severity of the child's illness, and little is known regarding gender differences in perceptions of parents of children with food allergy.

The primary aim of the current study was to obtain a better understanding of how fathers perceive (a) the impact of their child's food allergy on daily activities and family functioning, and (b) the severity of their child's food allergy, and to compare these perceptions between mothers and fathers. Because meal preparation and supervision of children's social activities are still considered to be traditionally "female" tasks in many families, and because food allergy was expected to specifically impact meal preparation and the need for child monitoring and supervision (Bollinger et al., 2006), we hypothesized that mothers would report more perceived impact owing to their child's food allergy than fathers overall, and especially more impact on gender-typed activities, such as meal preparation and caregiver-supervised child social activities, than fathers would.

For a subset of the sample, a secondary aim was to compare the frequency of mothers' and fathers' engagement in food allergy-related care (e.g., attendance at healthcare visits, meal preparation, and food purchases), and to compare the perceptions of highly involved and less-involved fathers. In general, mothers were expected to be more involved than fathers. However, fathers who were more involved in their child's food allergy care were expected to report higher ratings of impact than fathers who were less involved.

Method

Participants

The current study made use of data from two different samples. Participants were 50 mother/father pairs (100 parents total) with one child between the ages of 1 and 13 years with at least one food allergy. Sample 1 included 24 couples (48 parents total) who were recruited from a local food allergy clinic as part of a larger study examining the impact of food allergy on autonomy development in young children (Dahlquist et al., 2015). Sample 2 included 26 additional couples (52 individuals total) who were recruited specifically for this study. The age range for children from the initial sample was between 3 and 6 years of age, and the age range was deliberately broadened for couples that were recruited specifically for this study in order to obtain a more representative sample.

For both samples, caregivers of children with potentially life-threatening, IgE-mediated food allergy (i.e., those with a risk of anaphylaxis) were included. Caregivers were excluded if their child also had a diagnosis of another serious medical condition, such as autism, severe sensory deficits (e.g., blind, deaf), significant intellectual or physical impairment, or serious chronic conditions (e.g., cancer, cystic fibrosis, immunodeficiency). Caregivers of children with less severe food allergy (e.g., gastrointestinal symptoms only) were also excluded from the study. Caregivers were also excluded if they were non-English speaking.

Recruitment was not limited to traditional family structures; any two caregivers currently in a romantic relationship and both living with the child at least 50% of the time were eligible. However, despite these inclusionary criteria, all caregivers who participated in the study self-identified themselves as either the child's "mother" or the child's "father." No couples who participated identified as same-sex couples.

Mothers in the full sample ranged in age from 24 to 49 years (M = 37.36, SD = 5.18); fathers ranged in age from 29 to 57 years (M =  40.20, SD = 5.89). The sample was predominantly White/Caucasian (78.0% of parents); approximately 11% were Black/African American, 7% were Asian American, and 4% endorsed "other" as their race. In terms of ethnicity, 3% of parents identified as Hispanic. The majority of parents worked full-time (69.0%), and the sample was highly educated (90.0% completed at least some college). See Table I for a breakdown of mother and father demographics by old versus new sample.

Table I.

Demographic Statistics by Parent Gender and Sample

	Sample 1				Sample 2
	Mother		Father		Mother		Father
Characteristics	Frequency	%	Frequency	%	Frequency	%	Frequency	%
Race/ethnicity
Asian American	0	0.0	0	0.0	3	11.5	4	15.4
Black or African American	2	8.3	2	8.3	3	11.5	4	15.4
White/Caucasian	21	87.5	20	83.3	19	73.1	18	69.2
Other	1	4.2	2	8.3	1	3.8	0	0.0
Hispanic/Latino	0	0.0	0	0.0	1	3.8	2	7.7
Education
At least some high school	0	0.0	3	12.5	2	7.7	4	15.4
At least some college	3	12.5	4	16.7	4	15.4	5	19.2
At least 4 years of college	9	37.5	7	29.2	12	46.2	6	23.1
At least 2 years graduate school	9	37.5	9	37.5	7	26.9	8	30.8
Doctoral, medical, or law program	3	12.5	1	4.2	1	3.8	2	7.7
Employment
Full time	11	45.8	24	100.0	10	38.5	24	92.3
Part time	2	8.3	0	0.0	6	23.1	1	3.8
Stay at home	11	45.8	0	0.0	9	34.6	0	0.0
Agea	36.21	(3.90)	38.92	(4.99)	34.83	(8.64)	44.67	(4.41)

Table II displays demographics for child participants across both samples. The identified child with food allergy ranged in age from 1.51 to 13.81 years (M =  5.73, SD =  3.07). Twenty-two (44.0%) of the children were female, and 28 (56.0%) were male. Parents identified 37 (74.0%) of the children as White/Caucasian, 6 (12.0%) as Black or African American, 5 (10.0%) as Asian, and 2 (4.0%) as "other." In terms of ethnicity, four children (8.0%) were identified as Hispanic or Latino. Thirty-seven children reportedly attended preschool, kindergarten, or first grade (74.0%), while eight (16.0%) children attended higher grades in elementary or middle school. Two (4.0%) children did not attend school owing to their age, and three children (6.0%) were homeschooled.

Table II.

Child Demographic Statistics by Sample

	Sample 1		Sample 2		Overall
Characteristics	Frequency	%	Frequency	%	Frequency	%
Gender
Female	9	37.5	13	50.0	22	44.0
Male	15	62.5	13	50.0	28	56.0
Race/ethnicity
Asian American	0	0.0	5	19.2	5	10.0
Black/African American	2	8.3	4	15.4	6	12.0
White/Caucasian	22	83.3	17	65.8	37	74.0
Other	0	0.0	0	0.0	2	4.0
Hispanic/Latino	2	8.3	2	7.7	4	8.0
Education
No school	0	0.0	2	7.7	2	4.0
Preschool	15	71.4	8	30.8	23	46.0
Kindergarten	3	14.3	6	23.1	9	18.0
1st grade	3	14.3	2	7.7	5	10.0
2nd grade	0	0.0	1	3.8	1	2.0
5th grade	0	0.0	2	7.7	2	4.0
6th grade	0	0.0	2	7.7	2	4.0
7th grade	0	0.0	2	7.7	2	4.0
8th grade	0	0.0	1	3.8	1	2.0
Agea	4.68	(1.21)	6.70	(3.88)	5.73	(3.07)
Number of food allergiesa	4.08	(2.28)	2.89	(2.52)	3.27	(3.27)

Parents reported that the child was allergic to between 1 and 10 foods (M =  3.27, SD =  2.44). Parents were also asked about support or social networking groups for families of children with food allergy; 24 (48.0%) mothers and 15 (30.0%) fathers endorsed that they belonged to a support or parent network group. From Sample 2, families also reported how frequently their child attends food allergy medical appointments; parents reported that their child attended a mean of 1.85 (SD =  0.96, range  =  0–5) food allergy appointments per year.

Measures

Demographics

All participants provided information on their age, race, years of education completed, marital status, and presence of other individuals with food allergy in the home.

Perceived Illness Severity and Food Allergy History

All participants were asked to rate the severity of each of their child's food allergies on a 1–7 Likert-type scale, with 1 being very mild and 7 being very severe. They were also asked to rate how worried they were about that particular allergy on a 1–7 scale, with 1 being not worried and 7 being very worried. Mean severity and worry scores were calculated across all of the child's food allergies. Researchers also examined the maximum severity and worry rating across all of the child's food allergies, with a range of 1 being very mild and 7 being very severe.

Perceived Food Allergy Impact

The Food Allergy Impact Scale (FAIS) (Bollinger et al., 2006) was used to measure parents' perception of the impact of their child's food allergy on family events and activities. This questionnaire was administered to all participants across both Sample 1 and Sample 2. The scale is composed of 32 items, with eight distinct content-based subscales: meal preparation (six items), family social activities (five items), caregiver-supervised child social activities (two items), family relations (three items), caregiver stress and free time (three items), school or structured activities (six items), autonomous child social activities (three items), and employment and finances (three items). Each item describes an activity or interaction (e.g., "meal planning for my child," "going to restaurants," and "parents' relationship"). Parents rated how much the child's food allergy affects each activity on a 7-point Likert-type scale, with 1 being not at all and 7 being very much. If a parent indicated that their family does not complete the activity, they were asked to indicate whether this is owing to food allergy or for other reasons. Activities that were avoided because of food allergy were scored 8. Activities that were absent owing to other factors were not included in the subscale mean. The mean of all items for each subscale was calculated. Higher scores on these subscales indicated higher ratings of impact from their child's food allergy.

Bollinger et al. (2006) reported adequate internal consistency values (approximately ≥0.70) for each of the measure's subscales. For the current study, Cronbach's alpha was adequate to good for several subscales, including meal preparation (α = .96), family social activities (α = .88), caregiver-supervised child social activities (α = .73), family relations (α = .79), stress and free time (α = .80), and school and other structured activities (α = .86). Alpha was poorer for the remaining two subscales, autonomous social activities (α = .55) and employment and finances (α = .60).

Parent Involvement in Child's Food Allergy-Related Care

Participants from Sample 2 were asked questions regarding their involvement in food-allergy-related care (participants from the Sample 1 were not asked this question). Twenty-six couples completed these questions. Participants indicated (a) how often they take their child to their child's food allergy-related medical visits, (b) how frequently they prepare food for the child, and (c) how frequently they plan food purchases for the child. Answer choices for these questions were: none of the time/very rarely, some of the time, or most of the time. Participants reported whether they were a member of the Food Allergy and Anaphylaxis Network (FAAN or FARE) or a local food allergy support group, and about how frequently they attended support group meetings.

Procedure

All study activities were approved by the institutional review board, and all participants provided informed consent.

Sample 1 Procedure

This sample was collected as a subset from a larger study, which specifically focused on mother's attitudes toward a child's food allergy. For the larger study, which involved a home visit, informed consent was obtained at the time of the visit, and mothers turned in questionnaires that they had received in advance of the appointments. Mothers received a $50 gift card for completing questionnaires and participating in a 2-hr home visit that included additional procedures. At the time of the home visit, the researcher asked the mother if the child's father would be interested in completing a packet of questionnaires for the study. If so, mothers were given a packet containing consent forms and a subset of the study questionnaires for fathers and a stamped return envelope. Families were responsible for mailing in the "father" packet of questionnaires. No additional incentives were offered.

Sample 2 Procedure

Of the 26 couples who were recruited specifically for this study, 19 couples were recruited from food allergy specialty clinics in an east-coast major metropolitan area. Families were not screened for eligibility ahead of time. The allergist introduced the study to parents; a research assistant discussed the study with interested parents, obtained informed consent from the parent present at the clinic visit, and explained the different options for completing study measures.

Procedures for these participants were designed to make participation more accessible to both parents, especially parents who do not attend food allergy doctor visits (by allowing for completion of surveys online, communication via email, etc.). Couples were required to complete the study questionnaires in similar environments (i.e., either both at home, or both in the clinic), to control for environmental influences on their responses. Thus, if both members of the couple were present at the appointment, participants were given the option to both complete the study questionnaires independently while in the clinic setting. If only one parent/caregiver was present at the appointment, then both parents were required to independently complete study measures at home. For families approached and deemed eligible at food allergy clinics, nearly all (40 of 43) were recruited with only one parent present for the appointment; thus, only three couples completed the questionnaires in the clinic. For the other families wherein only one parent was present at the appointment, parents were given an instruction page with inclusionary criteria and a link to online versions of the questionnaires hosted at www.surveymonkey.com. They were encouraged to complete the survey at home, and to ask their significant other to complete the surveys as well.

Seven couples were also recruited from online community message boards, food allergy support groups, from flyers distributed at a local food allergy conference and university, and word-of-mouth from previous participants. Interested parents were instructed to email or call the principal investigator for more information. Parents were then screened for eligibility via phone or email, and directed to complete consent forms and study questionnaires online.

Responses to survey items were kept secure via encryption, and stored in a locked and secure server. Participants were also given the option of completing hard-copy packets and mailing them to the researcher, or completing electronic forms and returning them to the investigator via email. One parent opted to complete electronic versions of the study measures and return them via email; no participants opted to complete hard copies. The principal investigator provided 1–2 email prompts to families if study materials were not completed. After both parents completed study measures, a $10 check for participation was mailed to each participant.

Recruitment for Sample 1

See Figure 1 for a breakdown of recruitment rates for both Sample 1 and Sample 2. Of the 125 families who were eligible to participate from both samples, 50 (40.0%) completed all questionnaires and procedures. For Sample 1, of the 68 mothers who agreed to participate in the initial larger study, five families had no father in the home. The 63 remaining families were eligible to receive questionnaires for the current study. Thirty-seven of the 63 families (58.7%) agreed to participate in the fathers' survey (i.e., mothers agreed to ask fathers to fill out a packet of questionnaires), and 23 of the 37 (62.1%) returned packets of questionnaires completed by the father. Parents did not provide information on why some fathers did not return packets.

Flowchart for recruitment of the new sample. For this figure, n refers to the number of families, not individuals. This flowchart is an adaptation of the flowchart offered by the CONSORT Group (Moher, Schulz, & Altman, 2001).

Recruitment for Sample 2

Of the 88 families approached to participate for this sample, 26 were deemed ineligible or declined interest in participating before procedures could be explained fully. Parents declined to participate for a multitude of reasons, including not meeting eligibility criteria (i.e., there were not two parents in a romantic relationship), or lack of time to complete questionnaires. However, several participants did not provide a reason for declining to participate. Sixty-two families expressed interest and were deemed eligible; these families either completed questionnaires in the food allergy clinic, or were provided with information on how to complete questionnaires online at home. Of the 62 families who expressed interest and were deemed eligible, 29 families completed at least part of the surveys online. We did not obtain information on why 33 families expressed interest in person but did not complete any online questionnaires. Of these 29 families, 3 families had only one parent complete surveys (and thus these three couples were excluded from data analyses).

Analysis Plan

Data were first analyzed to determine whether they violated any of the assumptions of Pearson correlation and paired-sample t tests. Data for all variables were first examined for normality, and age was correlated with all outcome variables to determine whether it was a potential covariate.

Pearson correlations were then conducted to determine the level of congruence in parent ratings of food allergy impact. Parental scores were correlated for the different subscales of the FAIS. Paired sample t tests were then conducted for all FAIS subscales to determine whether parental ratings also significantly differed from one another. It is possible that parental ratings could be correlated, but still be significantly discrepant. For Sample 2, paired sample t tests were also conducted to compare mothers' and fathers' reports on how often they attended their child's food allergy visits, prepared meals for their child, and purchased food for their child. Parents' endorsements of food allergy visit attendance frequency, meal planning frequency, and food purchase frequency were also correlated with FAIS ratings.

Results

Assumptions and Transformations

All variables were assessed for significant skew and kurtosis using Tabachnick and Fidell's (2007) guidelines regarding normality and transformations. Z-scores were calculated for both skew and kurtosis. Six subscales were significantly kurtotic and skewed; these variables were then transformed according to Tabachnick and Fidell's recommendations. The moderately skewed FAIS Stress subscale was transformed using square root transformations. The severely skewed FAIS family relations and employment and finances subscales were transformed using inverse transformations. The FAIS Meal preparation, maximum food allergy severity rating, and maximum worry subscales were transformed using log 10 transformations, owing to their substantial negative skew.

Preliminary Analyses

Table III presents overall and gender-specific summaries of descriptive statistics for all variables, including perceived impact of the child's food allergy (FAIS scores), and perceived severity and worry ratings. To ensure that child age did not significantly relate to outcome variables, child age was correlated with all outcome variables. There was a trend toward significance for FAIS ratings of social autonomous activities, p = .070. For all other outcome variables, there were no significant correlations with child age, all ps ≥ .18. Consequently, age was not controlled in primary analyses.

Table III.

Descriptive Statistics and Paired Sample t-Tests Between Mother's and Father's Food Allergy Severity and FAIS Subscale Scores

Variable	Parent	Mean	SD	t	df	p
Mean severity	Mother	4.81	1.52	−1.19	40	.243
	Father	4.96	1.62
Maximum severity	Mother	5.91	1.15	0.48	40	.636
	Father	5.70	1.70
Mean worry	Mother	5.08	1.43	0.88	41	.382
	Father	4.74	1.84
Maximum worry	Mother	6.11	1.08	−1.89+	40	.067
	Father	5.41	1.88
FAIS Meal preparation	Mother	5.91	1.57	−2.55*	49	.014
	Father	5.06	2.09
FAIS Family social activities	Mother	4.64	1.84	3.28**	49	.002
	Father	3.86	1.90
FAIS Caregiver-supervised activities	Mother	3.61	1.72	1.85	48	.071
	Father	3.16	1.76
FAIS Family relations	Mother	2.03	1.30	−1.00	49	.321
	Father	1.87	1.37
FAIS Stress and free time	Mother	3.09	1.57	3.23**	49	.002
	Father	2.37	1.49
FAIS School or structured activities	Mother	3.24	1.97	1.75+	49	.087
	Father	2.81	1.95
FAIS Autonomous social activities	Mother	3.74	2.21	1.89+	49	.064
	Father	3.22	1.90
FAIS Employment and finances	Mother	2.31	1.54	−1.96+	49	.056
	Father	1.75	1.19

To rule out the presence of cohort effects, data from the pre-collected sample and the new sample were compared for all outcome measures. There was a trend toward significance for FAIS ratings of family relations, p =  .071, with the new sample scoring marginally higher than the original sample. There were no other significant differences between samples, all ps ≥ .29.

Primary Analyses

Pearson correlations between mother and father ratings were calculated (see Table IV). As predicted, most of the mother and father ratings of several FAIS and severity variables were significantly positively correlated. Paired sample t tests also were conducted to determine whether parent ratings were significantly different from one another. As can be seen in Table III, in general, mothers' ratings of the impact of food allergy during childhood were significantly higher than fathers' for meal preparation, family social activities, and stress and free time, ps ≤ .014 and approached significance (ps ≤ .087) for impact on caregiver supervised activities, school or structured activities, and autonomous social activities. In contrast, fathers' ratings of the impact of food allergy on parent employment and finances were marginally higher than mothers' ratings. Parent ratings for the other FAIS subscales did not significantly differ. Mother's maximum food allergy worry ratings were marginally higher than father's maximum worry ratings, p = .067, but mother and father ratings of food allergy severity and mean worry ratings did not significantly differ, ps ≥ .12.

Table IV.

Pearson Correlations Between Mothers' and Fathers' Ratings of the Child's Food Allergy Severity and FAIS Subscale Scores.

Scale	r	N	p
Mean severity	.51**	41	.001
Maximum severity	.54**	41	<.001
Mean worry	.52**	42	<.001
Maximum worry	.53**	41	<.001
FAIS Meal preparation	.29*	50	.044
FAIS Family social activities	.55**	44	<.001
FAIS Caregiver-supervised activities	.42**	44	.004
FAIS Family relations	.43**	44	.003
FAIS Stress and free time	.38**	44	.009
FAIS School or structured activities	.59**	44	<.001
FAIS Autonomous social activities	.50**	44	<.001
FAIS Employment and finances	.26+	44	.079

Parent Involvement in Food Allergy-Related Child Care

Table V summarizes the frequency of mothers' and fathers' responses to questions regarding how frequently they took their child to food allergy-related medical appointments, prepared meals for their child with food allergy, and purchased food for their child with food allergy. With respect to meal preparation, for 11 of the families, both the mothers and fathers reported that they prepared meals most of the time.

Table V.

Frequencies of Mother's and Father's Responses to Parent Involvement Questions

	Mother		Father
Questions	Frequency	%	Frequency	%
Food allergy visit attendance frequency
Most of the time	23	88.5	2	7.7
Some of the time	3	11.5	7	26.9
None of the time/very rarely	0	0.0	17	65.4
Meal preparation frequency
Most of the time	23	88.5	12	48.0
Some of the time	2	7.7	10	40.0
None of the time/very rarely	1	3.8	3	11.5
Food purchasing frequency
Most of the time	23	88.5	9	37.5
Some of the time	2	7.7	8	33.3
None of the time/very rarely	1	3.8	7	29.2

Parents' responses on these variables were compared using Wilcoxon signed-rank tests to determine whether there were significant differences in involvement for these measures. Mothers reported that they took their child to food allergy appointments significantly more than fathers did, p < .001. Mothers also indicated that they prepared meals for their child with food allergy significantly more often than fathers did, p = .005, and that they planned food purchases significantly more than fathers did, p = .001. There were no significant differences in support group attendance, p = .102.

To further explore these results, parents' endorsements of food allergy medical appointment attendance frequency, meal planning frequency, and food purchase frequency were correlated with FAIS and severity ratings, using Spearman correlations and split by gender. Fathers' food allergy medical visit attendance was significantly correlated with fathers' self-reported likelihood to plan food purchases (r(22) = .41, p = .050). Fathers attendance at child's food allergy visits was also correlated with FAIS ratings of impact for meal preparation (r(24) =−.40, p = .043), such that fathers who endorsed that they attended more food allergy medical appointments rated the impact of the child's food allergy on meal preparation as significantly higher than fathers who did not attend visits as frequently. However, fathers' food allergy medical visit attendance was not significantly correlated with fathers' self-reported likelihood to prepare meals for their child (r(23) = .33, p = .113). Because 23 of 26 mothers reported that they take their child to food allergy visits most of the time, prepare meals most of the time, and plan food purchases most of the time, there was not enough variability in the sample to calculate correlations for mothers.

Discussion

The primary aim of the current study was to obtain a better understanding of how fathers perceive the impact and severity of their child's food allergy in comparison with mothers. In general, mothers tended to rate their child's food allergy as more burdensome in several (but not all) domains of daily living. Mothers rated their child's food allergy as having a significantly greater impact on meal preparation, family social activities, and parents' stress and free time than fathers, and although only marginally significant, their ratings of impact on school or structured activities, caregiver-supervised activities, and autonomous social activities were also greater than those of the fathers.

These findings are consistent with studies of mothers and fathers of children with other health conditions, and may reflect the tendency for many of the mothers and fathers in this sample to have differing levels of involvement in their child's illness-related care. For example, mothers in this sample reported engaging in more meal preparation and planning of food purchases—activities highly affected by food allergy—than did fathers. Mothers also were more likely to attend food allergy-related medical appointments than fathers. Mothers also may be organizing more family outings and family free time activities than fathers (hence the greater perceived impact associated with such events).

The findings also suggest that gender differences in perceived impact of food allergy may be reduced in families where fathers are more involved in food-allergy-related care. Fathers who attended food allergy visits more frequently rated their child's food allergy as having a greater impact on meal preparation than fathers who did not attend visits as frequently. These findings support the notion that fathers who engage in fewer activities directly related to childcare (such as attending food allergy visits and meal preparation) could be buffered from experiencing the impact of their child's food allergy on these activities.

Mother's ratings of their maximum amount of worry owing to food allergy were also higher than those of fathers, although this difference was only marginally significant. Despite differences in involvement and perceptions of the impact of food allergy, parents did not significantly differ in their evaluations of their child's food allergy severity. This finding is in contrast with previous studies documenting that parents' perception of severity and worry relates to the impact of the illness (Bonner et al., 2007; Wysocki & Gavin, 2004). However, previous studies have focused on chronic conditions other than pediatric food allergy. It is possible that the burden of caring for a child with food allergy is similar, regardless of the severity of the child's allergy, as one must still read every food label and monitor food intake.

Limitations

The current study contains several limitations that could temper the generalizability and interpretation of its findings. The current study's relatively small sample size constrained power to detect small affects. Although previous literature (Holm et al., 2008; King et al., 2009) suggested it was reasonable to expect moderate to large effect sizes, actual effect sizes were in the small to moderate range for many analyses. It is possible that increased sample size would improve the ability to detect subtler effects.

However, study enrollment was hampered by difficulties in recruiting both fathers and mothers. The rate of recruitment for the new sample was slow (albeit comparable with rates from other studies of mother–father pairs, such as King et al. (2009), who collected data from 46 mother–father pairs over the course of 2 years). Of the 125 families who were eligible to participate from both samples, only 50 (40.0%) completed all questionnaires and procedures. Our 40.0% overall participation rate is lower than previous studies, which recruited mother and father pairs (i.e., for King et al., 2009, 82.1% of eligible couples who were approached completed all study procedures). Our low overall completion rate could reflect the difficulty of engaging both parents in online research when one parent is not present during the initial recruitment contact.

The parents who did participate may not be representative of the general population of parents of children with food allergy. Parents were highly educated; over 90% of the sample had completed at least some college, and 74.0% had completed 4 years of college. Consequently, participants may have been more knowledgeable about their child's food allergy and more in tune to the potential severity of the condition. A more heterogeneous sample with fewer socioeconomic supports and/or poorer illness understanding might have reported the impact of food allergy differently as well. Participants were also mostly Caucasian, and mostly presented traditional family structures (i.e., parents were cohabiting, intact couples). This limits the generalizability of these findings for families who are not Caucasian and who represent more diverse family structures. Additionally, children whose parents were recruited as part of the first sample were generally younger as compared with Sample 2, with a restricted age range of 3–6 years of age. This restricted age range could limit generalizability for conclusions drawn with this sample. However, participants from Sample 2 were deliberately recruited with a wider child age range to obtain a sample that was more representative of a population that typically presents to food allergist clinics.

Finally, the sample may reflect parents who are atypically worried about their child's food allergy. Parents who perceive their child's health condition to be more serious may be more motivated to participate in a study with relatively low financial incentives, as they may consider themselves to be likely to benefit in some way from the research.

One possible solution to this selection problem for future studies is to recruit parents from settings where both parents are likely to be present, such as schools, malls/stores, restaurants, and sporting events. However, such recruitment efforts would require significantly more resources, and would need to be conducted on a much larger scale.

Conclusions and Future Directions

Despite these limitations, the current study contributes to the literature and expands knowledge on the experience of fathers of children with food allergy. Results from this study replicate findings from the parenting literature and studies of other pediatric health conditions. Mothers were more involved in children's care than fathers (both in terms of medical visits and management of the condition at home), and mothers reported greater impact from their child's food allergy as compared with fathers. These findings are consistent with the parenting literature that mothers are still more involved in direct childcare than fathers, and might experience more burden from childcare owing to this greater involvement (Goldbeck, 2001; Mitchell et al., 2007; Clarke et al., 2009; Berge et al., 2006). As a group, fathers may be buffered from impact related to their child's illness, possibly owing to gendered division of activities. However, the study also provides evidence that fathers who are more involved in child's food-allergy-related care are more likely to experience their child's health condition as more burdensome.

Future studies should explore paternal involvement in greater depth by developing better measures of paternal involvement, such as Wysocki and Gavin's (2004) DADS measure of paternal involvement for children with diabetes mellitus. Although increased paternal involvement in disease management may be associated with a greater risk of experiencing psychological distress or burden in fathers, recent research suggests potential benefits to the family as well. For example, greater paternal involvement in disease management has been associated with less maternal psychological distress, and lower ratings of the impact of the chronic condition on family functioning, better treatment adherence, and higher quality of life ratings in adolescents with diabetes (Gavin & Wysocki, 2006; Wysocki & Gavin, 2006). Future studies could examine whether increased paternal involvement also has benefits for children with food allergies.

Additionally, future studies could explore why fathers differ in their levels of involvement across families. Qualitative studies may be particularly beneficial for exploring why some fathers are more involved than others in food allergy-related care. Qualitative studies could also be used to further explore why mothers and fathers differ in their perceptions of the burden and severity of their child's illness.

Future studies could also compare father involvement in pediatric food allergy with involvement in other pediatric chronic conditions. It could be that fathers of children with food allergy may be less involved with illness-related care than fathers of children with other chronic illnesses, owing to the unique tasks related to food allergy care.

Finally, future studies should also focus on how parents' differences in perceived impact, severity, psychological distress, and dyadic adjustment relate to child psychosocial outcomes. General parenting research has shown that greater paternal involvement is associated with several positive child outcomes (Lamb & Lewis, 2010); future research could focus specifically on how fathers' involvement in food allergy affects outcomes for their child.

Acknowledgments

The authors thank Linda Herbert, Emily Law, Caitlin Thompson, Julia Zeroth, Wendy Pinder, Emily Foxen-Craft, Sydney Baker, Natasha Barlow, Jacqueline Douglas, Shashanna Eaton, Nour Al Ghriwati, Laura Goodwin, Valerie Koury, Nicole Magin, and Abigail Matthews for their support and help with data collection.

Funding

This work was supported in part by the National Institute of Child Health and Human Development at the National Institutes of Health (grant number R03HD057313).

Conflicts of interest: None declared.

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