When Zax was a baby, the prevailing infant feeding advice was to delay introduction of highly allergenic foods. However, by the time Kal joined our family in June 2011, I’d seen a lot more advice suggesting that allergenic foods should be introduced earlier to lower the baby’s chances of developing allergies. I asked our allergist whether she recommended that, but she thought that with both a brother and a mother with allergies, we should still delay allergenic foods for Kal. This is advice I regret taking, but more on that later.
Our infant Kal seemed to be in better shape than his brother had been as a baby. Kal never had any eczema, and we successfully introduced eggs to him at 10 months without any problems. He had a couple potential issues with other foods, but nothing we could nail down as a reaction. The skin around one eye got red a few times, but in each case it seemed just as likely that he’d rubbed food in his eye than that he was having an allergic reaction. We were a bit wary at times, but in each case we were able to successfully re-introduce the troubling food without incident a few weeks later.
We successfully introduced Kal to all of the “big 8” foods except peanut and tree nut by his early toddler years. In fact, we even got him introduced to a few tree nuts too--as we slowly tried some of those on Zax, we tried Kal as well. And he tolerated them just fine. (You can read “we” as “hubby.” I watched from a safe distance with Zax’s EpiPen clutched firmly in my pocket, not wanting to get too close to messy eaters eating my personal poison.)
During the summer after Kal turned one, he started coughing and I assumed he was getting a cold. However, the cough lasted for a long time and Kal never showed any other signs of sickness. I wasn’t sure what was going on with him. Then one day, I caught myself reaching for my inhaler because the wildfire smoke in the air was giving me trouble breathing. I stopped cold, realizing that if the smoke was bothering me (with asthma,) and Kal was coughing with no known cause, but hubby and Zax were fine, then that probably meant that Kal had asthma too.
Off we went again to Colorado Allergy and Asthma Center to see what they thought of Kal’s lungs. They were unable to officially give him an “asthma” diagnosis because he was too young to perform lung function tests (the way to diagnose someone with asthma has apparently changed since I was a kid.) They did listen to him, and examined him, and gave him a nebulizer treatment of albuterol in the office. They decided that, at the very least, Kal had Reactive Airway Disease, and sent us home with a prescription for albuterol.
Such was it that a nebulizer came into our household. At the beginning, Kal HATED the nebulizer. He would cry and squirm his way through the entire treatment, and we would have to hold the mask firmly over his face to make sure he inhaled everything. We tried talking to him and reading to him and having his big brother dance around in front of him. Finally, we gave in and let him watch TV, and that was what finally distracted him enough to stop crying through the treatments.
The TV felt like a minor defeat, because we had been trying (pretty successfully) to follow the AAP suggestion that children not get any screen time until the age of 2. We had managed this with Zax, with the exception of home videos and the occasional big event (like a Superbowl Party.) We’d been doing the same with Kal, limiting Zax’s screen time to Kal’s naps, until the nebulizer. But what else can you do when sitting still with a one-year-old for 20 minutes every day?
After a few weeks, I was sure that the nebs were helping Kal. Not only would it improve his symptoms, but there was one day when I was getting settled to hold Kal on my lap for the neb. He reached for the mask and pulled it to his face. Quite quickly. I knew then that Kal must be getting relief from the nebulizer.
A few months later, as we entered into cold season, our doctor suggested that we use a daily inhaled steroid in addition to the as-needed albuterol. We’ve occasionally tried to back off from this during non-cold seasons, but for the most part, this is when we established our current bedtime routine: pajamas, teeth, nebulizer while watching a 20 minute TV show, stories, bed.
The nebulizer has been a blessing, except when it’s not. I love that Kal’s meds go straight to his lungs just like an inhaler, rather than being metabolized all over his body like the oral meds I had as a baby (which used to make me incredibly hyperactive in addition to the struggle it was for me to take them,) but I dislike how long it takes to get him treated. During a cold, when they want us to give him the steroid twice a day in addition to as-needed albuterol treatments, we can be looking at a couple hours on the couch every day. That can be very hard to do, especially when we have to schedule things around his older brother’s school/activities. On more than one occasion we’ve come home late from an evening activity and had to make a tough choice: deprive Kal of a half-hour of sleep in order to do a neb, or send him to bed on time but deprive him of the nebulizer. This is particularly hard if we suspect he’s getting sick--extra sleep is what the body needs in order to fight off the infection, but if his lungs aren’t functioning properly he won’t fight it off anyway. It’s a decision I hate to make, but one that continually comes up because life gets in the way.
I also hate it when Kal wakes up and clearly needs treatment right away. We are not morning people, and our mornings typically have exactly enough time to get ready and out the door to wherever we need to be. I often had to make Kal wait until his brother got to preschool before giving him a neb--but I’ve woken up having difficulty breathing, I know how it feels, and it always tore at my heart to make him wait for treatment.
When Kal turned 2, we went back to CAAC for a post-cold-season assessment. They recommended that we scratch-test him for some allergies to see if his asthma had any underlying triggers, and I agreed. I didn’t get what I expected, however. I thought they’d been referring to environmental allergens, but in that regard, they only tested him for three molds and for cat and dog. The rest of the test was devoted to peanuts and tree nuts. I’m not sure why anyone in the office thought those could be underlying triggers, because he never ate them. In fact, the few tree nuts he occasionally ate (Nutella) they didn’t test him for, because he ate it successfully at home. I was irritated at how that was handled, but the fact remains that the test was done.
The results said that Kal was allergic to cat, dog and peanut. Cat was the only significant reaction, however. Dog and peanut were both small. In fact, they said that peanut was below the threshold at which people can usually eat it safely. They recommended we do peanut as an in-office food challenge for his first taste, however, because of our family history of allergies. Just in case.
Hubby and I hemmed and hawed over this suggestion. Should we do the food challenge just to get it over with? Should we wait until he was a little older and better able to communicate how he feels (like we’d done for Zax)? Should we just challenge peanut ourselves at home? We couldn’t agree, and eventually our indecision turned into inaction as other concerns pushed this to the back of our minds.
Months passed, and then one day during the winter, the allergist’s office called and asked if we wanted to schedule a peanut challenge since we’d already signed the release forms. I decided to make a decision at that point, and said yes. Yes, let’s schedule a peanut challenge for Kal. The food challenge schedule was full for the next few months, though, so we set a date in February and sat back to wait.
February, of course, is smack in the middle of cold season, and much to our chagrin, Kal started coming down with a cold two days before his scheduled challenge. They’d told us they wanted him healthy for the week prior to his test, which seemed like a tall order for a toddler in cold season, but this particular cold was too strong to even consider fudging the rule. It was just starting up, he was miserable, and there was no way we were going to be able to perform the test. The food challenge office was about to go through some staffing changes, which meant we couldn’t reschedule until April. Grumble grumble. More waiting.
Check back Friday for the rest of Kal's story!