New Tool Helps Parents Manage Dietary Needs of Children with Food Allergies

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Investigators from the Republic of Korea validated a reliable, effective tool for assessing parental self-efficacy in managing children's dietary needs with food allergies.¹

Food allergies among children have increased in the past few decades. According to a 2021 National Health Interview Survey, 5.8% of children have a food allergy—an increase of 50% from 2007.^2,3 Before that, there had been a 50% increase in food allergies among children from 1997 to 2011.³

The team recognized the importance of parents effectively managing children's diets with food allergies.¹ Led by Soo Jin Lee, from the department of food science and nutrition and Kimchi Research Institute, Pusan National University in the Republic of Korea, the team sought to develop and validate a tool with quantifiable measurements to evaluate how well parents follow dietary practices for their children with food allergies.

“A pivotal aspect in the management of children with [food allergies] is striking a balance between eliminating allergenic foods and ensuring the provision of essential nutrients for their growth,” investigators wrote. “Parents are crucial in navigating this complex balance.”

Simply avoiding giving foods to a child who is allergic can lead to risks of poor growth and suboptimal nutrient intake. Thus, children still need to receive the proper nutrients in another area in their diet.

Lee and colleagues developed the Parental Self-Efficacy Scale for Dietary Management of Children with Food Allergies (PSED-FA) through a literature review and semi-structured interviews. Investigators also conducted an exploratory factor analysis, confirmatory factor analysis for model fit, and evaluation of internal consistency using Cronbach’s alpha when developing the tool. A panel of 5 allergists and 5 dietitians refined the tool, and investigators validated it with the responses from caregivers of children with food allergies.

The study included 9 focus interview groups, with 114 participants in the validation group. The focus interview groups had an average age of 2.4 years and mean height and weight percentiles of 50.2 and 42.7, respectively.

The validation group had a mean age of 6.5 years and 63.8% males. The most common food allergy was egg whites (55.2%), followed by tree nuts (35.2%), peanuts (22.8%), cow milk (20%), wheat (20%), and fruits (15.2%).

In the sample, parents scored the highest for their confidence in communicating food allergy management instructions to educational institutions, preparing meals, determining, safe processed foods, and selecting appropriate foods from institutional meal plans. They scored the lowest in their confidence in seeking professional help and preparing snacks.

The exploratory factor analysis identified 3 factors of effective management of dietary needs for allergies: preparing allergen-free meals, knowledge of nutrition management, and management of food restrictions.

The tool included 15 questions, designed to measure how self-assured parents felt about managing their child’s diet when said child has a food allergy. PSED-FA is intended to be used for parents who have a child < 12 years old.

Ultimately, the tool demonstrated a high internal consistency, with an overall Cronbach’s alpha score of 0.902, as well as met the criteria for both convergent and divergent validity, assessed using average variance extracted, maximum shared variance, and average shared variance.

Investigators wrote the findings may not be generalized to other populations since the tool was assessed only in South Korea. However, they did note the study participants had a wide spectrum of health beliefs, psychological variables, education levels, and socioeconomic statuses. Additionally, the tool was not yet validated in the English version, which leaves room for future research.

“…. the role of parents in educating their children on avoiding food allergens and communicating between school and parents about the allergens that students need to avoid is important for properly managing allergic reactions,” investigators wrote. “Our newly developed PSED-FA can evaluate the essential confidence of parents of children with FA with the aim of improving their children's health and quality of life. Future research could benefit from analyzing PSED-FA scores based on the timing of FA diagnosis, the characteristics of restricted food allergens, and parental socioeconomic status.”

References

1. ^{Lee SJ, Yoo S, Kim J, Kim Y, Lee Y, Lim C, Kim H, Jung M. Development and Validation of Parental Self-Efficacy Scale for Dietary Management of Children with Food Allergies. Pediatr Allergy Immunol. 2025 Feb;36(2):e70031. doi: 10.1111/pai.70031. PMID: 39891493.}
2. ^{Zablotsky, B, Black, L, et al. Diagnosed Allergic Conditions in Children Aged 0–17 Years: United States, 2021. January 2023. https://www.cdc.gov/nchs/products/databriefs/db459.htm. Accessed February 7, 2025.}
3. ^{Facts and Statistics. Food Allergy Research & Education. https://www.foodallergy.org/resources/facts-and-statistics. Accessed February 7, 2025.}