#98 Babies, Bites, and Buddies with Dr. Michael Pistiner

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This transcript was generated using AI software from the original podcast audio and may contain errors, omissions, or minor inaccuracies. It has been lightly edited for readability. Please refer to the full podcast episode for the most accurate representation of the conversation.

Speaker 0:00

Welcome to the Don't Feed the Fear podcast, where we dive into the complex world of food allergy anxiety. I'm your host, Dr. Amanda Whitehouse, food allergy anxiety psychologist and food allergy mom. Whether you're dealing with allergies yourself or supporting someone who is, join us for an empathetic and informative journey toward food allergy calm and confidence.

0:21

On today's episode, I'm so happy to welcome back a guest that many of you already know and love from his previous episodes on the show, number 50 and 51, where we heard Dr. Michael Pistiner walk us through the updated criteria for recognizing anaphylaxis in infants and toddlers and teaching us how to safely and effectively use epinephrine. Those episodes are some of the most popular we've done, and Dr. Pistiner is back because he has so much more to share with us. Dr. Pistiner is a pediatric allergist and the director of Food Allergy Advocacy, Education, and Prevention at Mass General Brigham for Children, Harvard Medical School. He's also a food allergy dad, and as he told us last time, he's learned a lot from that side of his experience. He's the driving force behind an exciting new resource called FAMP-IT. FAMP-IT is created for two different audiences. There's FAMP-IT Family for parents and caregivers and FAMP-IT.org for professionals, and Dr. Pistiner will explain to us the different resources on each one and what the goal of each is. And finally, Dr. Pistiner will talk about his Food Allergy Buddies mentorship program, which is going to be coming nationwide soon, thanks to the support from AAFA, the Allergy Asthma Foundation of America. Dr. Pistiner is amazing at squeezing so much information and so many great ideas and enthusiasm into every conversation, and you won't be disappointed today with all of the exciting things that he's here to tell us about.

Amanda Whitehouse, PhD 1:41

Dr. Pistiner, thank you for being back on the show. You're a crowd favorite on Don't Feed the Fear, and I'm excited to have you back.

Mike Pistiner, MD 1:47

Thanks for having me

Amanda Whitehouse, PhD 1:48

Of course. For those who might have missed your earlier episodes, which were last year, I will tell them all now to go back. We talked about anaphylaxis and epinephrine in infants and toddlers. I've got some great videos of you demonstrating and explaining. Above and beyond that, tell people about you and your work, and your background in the world of allergies.

Mike Pistiner, MD 2:08

All right. So, I am Mike Pistiner. I am a pediatric allergist, and I am also the dad of a 23-year-old with food allergy. And back when I was training to be a pediatric allergist, that was when Scott had his first allergic reaction. And at that time, I had no idea what went into managing a kid with a food allergy from the perspective of dad. I thought I was doing a decent job as an allergy fellow supporting the families that I was taking care of. But then when I was in the shoes of a parent of a kiddo with food allergy, I really saw the gaps and the advocacy needs and the educational needs. And since then, I have been knee-deep in it and part of the food allergy community and trying to support our community and each other

Amanda Whitehouse, PhD 3:02

Well, thank you for sharing that. Obviously it's unfortunate that that was the case with your kiddo. I think that that shows in your work, and I have so much respect for you being able to change lenses and switch back and forth from those perspectives. It really shows in everything that you do, so thank you.

Mike Pistiner, MD 3:17

Thank you

Amanda Whitehouse, PhD 3:18

Yeah. So, that is probably part of the reason that you were led to create both of the things that we're here to talk about today both the new FAMP-IT website that I know you've been working hard on and your Food Allergy Buddies program, which I just love. I'll let you choose where you want to start. What should we talk about first?

Mike Pistiner, MD 3:34

All right. Let's talk about FAMP-IT. Food Allergy Management and Prevention, and this is a platform for the infant and toddler. And so in realizing that there were gaps in time and access to allergy specialists, and by the time a kid would make it to an allergist, prevention is too late. So that ship has already sailed. And so a lot of the conversations and a lot of the family support that are going to potentially prevent a food allergy or keep a kid who had one food allergy from developing new food allergies, that time right there upfront is really critical and falls into the realm of the primary care team, pediatricians, family medicine doctors, nurse practitioners, PAs. Two months, four months, six-month visit, this is the time where tons of information is going to need to be exchanged, that parents are going to need to share their questions, concerns about early introduction. The primary care team is going to need to help support and help answer those questions. But the visits these days are really, really short and packed with really important things. And so a 20-minute, 25-minute well-child visit really isn't time enough to be able to then share all the food allergy prevention and management things that a primary care team is going to need.

And again, by the time a family gets to allergy specialists, now we're managing a food allergy, at least one, if not many, and now preventing food allergies, you're losing that opportunity as the kid gets older. And so the initial target population of the FAMP-IT platform was the primary care provider. But now what we've also been realizing is that with the busy clinics and sessions that primary care teams have, they're talking about vaccines, firearms, trampolines, dealing with so many things. Do they have time to focus as much time and effort and energy and support that they need for some of these conversations about early introduction? Keeping in mind the particular kid, the particular family, cultural competency, language barriers, time, health literacy, these are things that are so challenging.

And so WIC, Women, Infants, Children's, the WIC staff are really positioned really well to be able to have multiple contact points with family and be able to support nutrition starting pregnancy, first month of life. The main focus of the WIC teams are supporting the maternal and infant diet, and so it's perfect. So we started then creating support material for WIC teams and then to be shared with family. And ultimately, we've collaborated with many along the way, including National WIC Association, Massachusetts WIC, other state WICs, and then Allergy Asthma Network has recently collaborated with us to help us create the FAMP-IT family platform, which is meant to be directly family-facing. So they helped us create the bones and taught us how to fish.

And so now we have this family-facing website that we continue to add content to and that we are sharing with National WIC Association, the state and local WIC offices, and primary care. Now we have tried to put it at a relatively easy reading level between fifth and eighth grade. It's available in English and Spanish, and we try to make it look pretty and be user-friendly. We've also created videos that could be shared with families that help support early introduction and also skin management in babies. We have handouts that now are available in Spanish, Brazilian, Portuguese, Russian, and we are adding multiple languages. And so we're trying to make this as easy and digestible and fun as possible. We also have support material for the management of food allergy when it happens, so IgE-mediated food allergy. We also have material for non-IgE-mediated food allergy, like FPIES, proctocolitis, and then we also have section for the management of eczema

Amanda Whitehouse, PhD 8:38

That's a lot of things. It's one resource, two resources, family facing and professional facing, and my mind is spinning when I'm thinking about the task of organizing it in the first place, and then keeping it updated. Pediatricians and general care providers, it must be so hard to keep up with the way that the world of allergy is just changing so rapidly

Mike Pistiner, MD 9:00

Yeah. This is kind of part of where I think we fill a need. So when we have updates and guidelines, first off, we kind of help translate the guidelines. So if the guidelines are kind of geared towards allergists or dermatologists, then part of what we did was we then try to communicate the primary care relevant aspects of the guidelines to primary care. And then we try to communicate the WIC staff aspects of the feeding guidelines in a way that is practical and that they can use in the short time that they have with a family. And then we do the same with family. And so this way, if there is a primary care clinician who wants to read an article, we have summarized the articles for them. We have the links to the primary article itself, and sometimes in order to read a particular article, you need a subscription to a journal. And so we are trying to make this information readily available, even when there's people not in a specialty. So we're trying to kind of level the playing field as far as what everybody knows and then give very similar information. So a pediatric dermatologist, a pediatric allergist, the clinician team, WIC in one neighborhood and locale, they'll all be having the same resources that they'll be able to share with the families.

\And it's in a sense one-stop shopping because many children with eczema go on to develop a food allergy, and we're talking about prevention. And when you even attempt prevention, sometimes you're going to pick up a food allergy. So this way, when there's a team that's using these resources, they may be able to build it into their electronic medical record, have it built within their discharge instructions. And then that's also something that we've added to the platform, is templates that people could dump into their electronic medical record to facilitate that communication with their families

Amanda Whitehouse, PhD 11:19

That's amazing. It sounds like you've really thought of it from all angles, and like you said, facilitating everything, making it as easy as possible for it to be a one-stop shop because there, there are so many resources out there, but sometimes it's overwhelming for people and they don't necessarily know who to trust, and like you said, looking for one piece here and another there. Is that the main idea, to make this so comprehensive that looking around and searching isn't quite such a daunting process?

Mike Pistiner, MD 11:44

Yes. What we, what we try to do is have the needed information up front collated and kind of like coordinated right there. But then we have additional information if people want to get deeper, and then right down into the primary references and right into the guidelines.

Amanda Whitehouse, PhD 12:06

As you emphasize, this is less for the food allergy community as it is for the parents of infants community, right, and people who may not be part of the allergy world yet. So a lot of my regular listeners probably already know, but in case they know a new parent that they want to share this episode and this resource with, what would some of those basic first kind of pieces of information that you would want them to understand be going into first foods and early introduction and some of those things that they wouldn't know yet if they're not already allergy parents?

Mike Pistiner, MD 12:38

Well, part of what we're trying to support and spread the word to everyone who interacts with the parents of infants even before it's time to add complementary solids, even in the very, very early time, even during pregnancy, and including the newborn nursery, is we're trying to normalize feeding. We're trying to take away the scariness of it. Um, we are trying to not feed the fear. So we are trying to... Sorry, I had to do the plug. Um, and, uh, um, so we're trying to normalize it and make it, um, a little bit less confusing. And so what we're trying to get across is like having multiple modalities to pass this along. So to have video, short video clips that will be able to support the currently available guidelines, handouts that also support the videos, language on the website that supports the handouts and the videos. Because if somebody doesn't have time to watch the video, but they have time to have the printout, but they don't have time and on their phone, they just scroll and they look at the website itself, whatever, as long as they have access to this information.

And so in this whole normalization, what we're trying to do is communicate the dietary guidelines for Americans that When a kid is around six months of life and they are developmentally ready, and it might even be before or around six months of life, like four months of life, that is when thinking about adding solids and thinking about adding complementary foods like even allergens is the right thing to do. The guidelines and the studies are showing that delaying the introduction of the highly allergenic foods and the most common foods that we're talking about here are the kinds that cause IgE mediated allergies. Those are the ones that can be more than one system and they can come on quickly, and the ones that we think about treating with epinephrine, those are the IgE mediated allergies. The nine most common allergies that are typically the IgE mediated type allergies are peanut, eggs, cow milk, tree nuts, sesame, fish, shellfish, wheat, and soy. And those account for the majority of foods that kids are allergic to. And the current guidelines and the current science show that delaying these highly allergenic foods may actually increase the risk of developing a food allergy. This is especially seen in peanut and also egg. And vice versa, early introduction of these in high-risk kids, and high-risk kids are kids who have severe eczema or already have a food allergy like egg. In high-risk kids, trying to get These allergens, specifically peanut and egg, between four and six months of life is a great target. Now, we're not doing it before a kid is developmentally ready for solids, and we're not doing it before four months. But then at the same time, we don't want to wait until after six months to introduce the allergens because it can potentially increase risk. So that kind of leaves us like a kind of tight target there.

Amanda Whitehouse, PhD 16:40

As a parent of kids who are all 10 and up now, remembering back to how quickly those newborn months fly by and how overwhelming everything is, that is really easy to fly by without realizing or catching that window of time.

Mike Pistiner, MD 16:53

And so that's a conversation I'm hoping that WIC teams, that primary care clinicians are having even early before a kid is ready for solids is, "Hey, know that this is coming." So it's not gonna be a shock when it comes, and thinking about and preparing and knowing what to look for early on is gonna be really good.

Like looking for the signs of developmental readiness. Looking for signs of potential eczema in a kid. Because if a kid has eczema, then looping in with a clinician team, letting them know that eczema is starting to be an issue, taking care of the eczema, and then being very careful about not having food directly exposed to the angry skin and washing hands before applying creams or lotions, especially after eating allergens is gonna be something important to do.

And then also having eczema means that having a plan for getting those foods in on the earlier side is gonna be really great. And again, the science shows that if a kid has severe eczema, targeting between four and six months of life with peanut and likely egg is the way to go. And that's gonna take having a good relationship with the primary care team and having access to them and reaching out early and coming up with a plan

Amanda Whitehouse, PhD 18:26

I'm thinking of all the ways that you have through this to try to balance that giving enough information, but empowering families, not overwhelming them. And the point that you just got to is where I know a lot of people get stuck is, but what if they do have a reaction, right? What if I do it and the child does have a reaction?

Mike Pistiner, MD 18:43

One of the reassuring things is that when the reactions occur in a younger infant, they tend to be less severe than in an older child, than in a toddler, than in a preschool-aged child that the majority of allergic reactions will be mild and some will be considered anaphylaxis, which is a serious allergic reaction that can be more than one system. And so this does happen in infants, but it's rare and usually these reactions are less severe than when they occur in an older kid.

So that's something reassuring and that In that window of that between four and six months in the kids who are high risk with those early introductions, in one of the studies in particular, the LEAP study, when they had reactions in the younger kids, they didn't have many reactions that required epinephrine. But then when they had their food challenges in the older ages around age five, those were the kids who then were requiring epinephrine and having reactions that fulfilled criteria for anaphylaxis.

Amanda Whitehouse, PhD 20:44

Wonderful. Thank you for the reminder. I'll encourage listeners if you know people in the healthcare field that you want to share the website with as well, obviously there are those resources you described for them.

Amanda Whitehouse, PhD 20:55

But let's highlight some of the things on the family side that would be important.

Mike Pistiner, MD 20:59

So the Food Allergy Management and Prevention Platform, in this case for families, It's meant for any parent of an infant. So kids who don't have any high risks, kids who don't yet have eczema, kids who don't have a brother or a sister with a food allergy, just anyone who's interested in feeding their kid, this is for them. And so in this we have tips and tricks with knowing when is the appropriate time to add solids, complementary foods including allergens, how to mix some of the foods, how frequently, how much, and what to look for.

And we also then are gonna be giving extra tips and tricks for the parents of kids who then have reasons to be thinking about other factors like eczema. One nice thing to know is that having a mom, a dad, a brother, a sister with a food allergy does not mean, or this is really important to know, you don't wanna delay introducing allergens. There's no reason to, and if that is the only risk, that isn't a reason to screen, and in the past it hasn't been a reason to get any testing, to go to an allergist. And so feeding a brother, a sister, a kid of someone who has a food allergy, there's nothing extra that needs to be done, and we don't wanna slow things down and add extra steps. So that's something that I'd like to take the opportunity to pass along.

Amanda Whitehouse, PhD 22:56

Yeah, that's one of those things I think that lingers back to when you and I were having kids that we were saying then that has changed, but sometimes that information doesn't catch up, right? Because that's definitely how I handled it when my older kids were little, and that's important to correct, so thank you for clarifying.

Mike Pistiner, MD 23:10

And one thing that we also kinda help talk about in this that isn't out there yet, in readily available information is this idea of the dual exposure hypothesis. What that is, is that the skin is the route of sensitization and the gut is the route of tolerance. And so I mentioned earlier that the majority of the, those common nine IgE mediated allergies... IgE is immunoglobulin E. It's a protein that is, in most cases, it's gonna be around when somebody has a multi-system allergic reaction, the kind that we use epinephrine for. So we do a blood test or a skin test to look for the presence of IgE. If a kid makes IgE, we say that they're as sensitized just because...

Amanda Whitehouse, PhD 24:11

Not necessarily allergic, but

Mike Pistiner, MD 24:12

Exactly right. So just because somebody makes IgE and they have a positive blood test or a skin test, it doesn't mean they're clinically allergic, but we're using the word sensitized. So now back to the dual exposure hypothesis, skin seems to be the one of the routes of sensitization. So if a kid has eczema, then they may have barrier dysfunction and inflammation, and the immune system under their skin, especially the angry skin, when it comes in contact with the allergens, if the kid has not yet had the opportunity to eat those foods and is not yet tolerating those foods, if a kid who hasn't been eating them routinely comes in contact on, especially their red angry skin where there's barrier dysfunction and inflammation, then the immune cells under there get fired up, and then they can present it to the body and it starts creating a food allergy. So after enough time and sensitization, then it may become clinically relevant. So that is where Again, the gut is the tolerizing route. So if a baby isn't yet allergic to a food and they have early introduction, and they have that food in a meaningful quantity and a meaningful frequency, then that allows their immune system to establish tolerance. The immune system of the gut can tolerize. So that way, once a kid starts eating some of these common allergens and sees it through their gut first in a meaningful way, then that may then decrease the chance that they'll be sensitized through their skin. So again, that's the dual exposure hypothesis. So this is where if a family then thinks about what foods they really enjoy eating and what foods are around them, what's the big brother, what's the big sister, what's the dog eating? What's grandma eating? What's mom and dad eating? Baby wakes up from a nap after grandma eats a handful of cashews. Grandma wipes her hands off on her shirt, just like we all do after we eat power food, right? Picks up the baby, puts the moisturizer on the baby's skin, takes off the diaper, changes the diaper, mashes Desitin in the diaper rash, closes the diaper, and then she washes her hands. But put that on repeat. That's where a kid might get sensitized.

So then if a family thinks about the foods that they really enjoy eating and the allergens, that's gonna be something to think about prioritizing. Now, some foods we don't give to babies. So we don't give babies honey until after age one. We don't give babies milk as a beverage until after age one. No loose nuts or seeds until about five. I'm a choke-a-phobe, so I use that older, and some clinicians may go a little younger, and that's gonna be up to the families, up to the primary teams. And then obviously, if you got like a four-year-old having some nuts, they're sitting down and everybody's being really careful. So that's where no loose nuts or seeds, and I'm gonna say until around five. No added salt and sugar to reason. No high mercury fish, like swordfish and many forms of tuna can have a lot of mercury, so something like salmon is good. No raw fish or shellfish or things that can have foodborne illness. And other than that, then that's where a family can think of the foods they really like eating and then adding those in developmentally appropriate non-choke forms to baby. So baby can see it and eat it in reasonable quantities and in reasonable frequency.

Amanda Whitehouse, PhD 28:29

I will say for everybody listening, the way you just described that is exactly how I feel like your website turned out, because every conversation with you is packed full of information, but in a digestible and understandable and sometimes even fun way. I want people to know that that's how the website feels. It's really a lot of really good information, but in an accessible way. Before we move on to our next topic, any last pieces that you wanna drop in there, including how people can find it? The web address for them and tell them the last bits about utilizing that.

Mike Pistiner, MD 29:00

Sure. The platform in general is FAMP-IT.org. Check it out. And if there's a new baby in your life or a new grandkid or a niece or a nephew or a kid you take care of, check it out and pass it along to the parents.

Amanda Whitehouse, PhD 29:23

Thank you so much for creating this. I'm excited listening to you, and then there's always that part of me, those moms like me listening and dads like me listening that didn't have this information. We did the best we could. I can see everything you're describing playing out with my own kiddo and his eczema and the food allergies. So I say that to relieve a little bit of the guilt, to validate that, and to assure people who might have caught this who aren't in that of life yet and hopefully can prevent it, this is the information that you need.

Mike Pistiner, MD 29:49

I'd like to validate that also. So my son Scott, he's 23, and back when he was a baby, we were following the old recommendations, and we delayed the introduction of the highly allergenic foods to him. And it turns out that the foods that he's allergic to are the foods that we ate the most around him, and we really loved cashews, and we really loved walnuts. And it turned out that we, at that time, didn't really like peanuts or almonds, and so he happens to be allergic to the foods that we were pounding down and eating on top of his head. You're all in good company.

Amanda Whitehouse, PhD 30:26

Yeah. Even more powerful then to hear it from you as an allergist. So thank you for sharing that. And we know better, do better, right? So we're paying it forward and learning more and teaching.

Mike Pistiner, MD 30:35

This is the way science evolves. And so now that we know it, what's so cool is, it really can work as long as we get this information to families early enough. And again, the allergists, we're all preaching to the choir, but by the time you get to us, that ship has sailed. So now we're trying to get this information to the primary care, but even then that's a little late and that's why WIC and then that's why folks like you getting it out to the world.

Amanda Whitehouse, PhD 31:05

Yes, brilliant. And yeah, so everybody listening, share this with your friends who don't have a kiddo with allergies yet and hopefully won't.

Mike Pistiner, MD 31:11

One of the things that I really did not want the opportunity to not talk about is the amazing team that has gone into the creation of the FAMP-IT platform. So many volunteers, so many people have been part of this, and so many experts reviewing and adding content, and so many people and volunteers doing translation for us. And you're gonna be on it soon. So it's been an amazing and fun community in itself, being able to create some sort of tool like this. And so I thank everyone who's had an involvement and it's been wonderful to work with everyone.

Amanda Whitehouse, PhD 31:49

Well, thank you for giving them credit, and thank you to all those people for contributing to something that's just becoming so valuable. Let's talk a little bit, before we run out of time about the Food Allergy Buddies. I just love the model of this program, and I'm so excited that it'll be reaching more people now.

Mike Pistiner, MD 32:04

So, Food Allergy Buddies is a community mentorship program, and for now we have it in the Boston area. It's open to anybody who wants to come and keep coming. And, this is about our seventh year now, and high school kids with food allergies are the bigs, they're the mentors. And elementary age kids between kindergarten and fifth grade, they are the littles, and the middle schoolers are the mentors in training, and they are the middles. And so the sixth, seventh, and eighth graders are helping the high school kids run activities, run the events for the little kids with food allergy.

This has become one of my favorite parts of my job. I am a glorified camp director. It is so cool, it is so fun, and we've built a really great community. We've been having a really great time. We are thinking about different ways to expand our program. And so while we've had our local program where we've had four events a year, and we try to have some continued interactions over the year, but for the most part, it's four in-person events, we are thinking about how to expand and make this program something that's gonna be nationally available.

And so we've partnered with Asthma Allergy Foundation of America now for a few years, and we have been and are working on having a digital version. This year, they're gonna be helping us even more with our local, and now we are then hoping to be able to take what we're learning and be able to then provide the digital version for the following school year. So that's something that, that we're excited about. We're also collaborating and partnering with Children's National and Linda Herbert and the team there. And we are gonna be studying the impact of our program on self-efficacy, on quality of life and sense of community, and we're looking forward to working with them. And so that's gonna be something exciting.

We're also thinking about expanding into schools. And so we've piloted with our Reading school nurses. We've piloted, a school version, and the hope is to take what we're doing and help teach school nurses how to fish. Because the school nurses then are gonna have their districts where they have the elementary, the middle, and the high school, and those are gonna be kids who are gonna be together forever. And so to build those communities that way is really cool. And so we are now, like about a year and a half in with the Reading school nurses. They're amazing, and it's been really fun. So this is great, and we're gonna keep trying to keep spreading the word and building buddies. We invite anybody to reach out and ask about it, and if you're in the Boston area, join us.

Amanda Whitehouse, PhD 35:13

So you're talking about this being digital?

Mike Pistiner, MD 35:16

So what we would do is we would onboard high school kids, middle schoolers, elementary kids from around the country. Then we would build these teams, and they would get back together with each other we're thinking about four times a year. So then they actually can build these communities, but online. So it might be a kid from Boston, a kid from Cincinnati, a kid from San Diego. But the kids get to know each other, and we're modifying some of the activities that we're doing for things that would work in an online version. And unfortunately or fortunately, during COVID, our Buddies Program was forced to go completely digital, and we did some pretty fun stuff with the kids, including a scavenger hunt where the kids would run around their house and come back with their pet or their dad or something and show it to the rest of the kids. And so we're gonna, we're gonna have fun with this.

Amanda Whitehouse, PhD 36:14

I was picturing this as something for communities to roll out on their own locally, and you were giving them the activities, but you're actually still being connected to the staff and prepping them. That's amazing that it's gonna be so involved and connected.

Mike Pistiner, MD 36:29

And it's also like, as you can kind of see, I'm kind of like fixated on this community thing. And so like doing this and planning this with Asthma Allergy Foundation of America has been awesome. And so they have a humongous online community where they reach the parents great. And so this is kind of like such a cool partnership and collaboration because here now we get to bring the kids in. And now by the way, so when we're doing our in-person and then we're planning with the digital community, then we are planning and we already have programming for the parents. So what we do is this is Food Allergy Buddy sanctioned helicopter parenting. So we don't let the parents of our elementary or middle schoolers leave because who would be crazy enough to drop off 120 kids with food allergies and then have all their parents go? So the parents stick around while we're doing these events that are being run and facilitated by the high school kids and the rest of our team.

But then we're teaching, and a lot of times I'm teaching the parents what it is that the kids are doing, what games they're doing, and why they're participating in certain things. Then we let them watch the kids interact with the big kids, and so they could watch from afar, and they're not getting involved in the activities of the children or their relationships, and the kids are doing it on their own. So like we did a scavenger hunt in the Museum of Science, and the parents are like 30 to 40 feet behind while the kids are out exploring with their teams. And so then we're talking about the different conversations and activities that those teams are doing, and then I'm teaching the parents how to reinforce this when they're not in the Museum of Science. So in the car on the way home, a couple of days later, or if it comes up in casual conversation, talking a little bit about the skills that they worked on, this is a way to kind of take the edge off, make it more fun, and gamify some stuff that can sometimes be scary.

Amanda Whitehouse, PhD 38:37

It's such a brilliant model for so many reasons that I probably can't articulate as well as you. But I'm curious if you were inspired by a different program. Like I was involved in a research program in my undergrad that was an ADHD summer camp for kids and same model with the parents and involving the bigger kids. Was there an inspiration for you that was something similar to that?

Mike Pistiner, MD 38:56

I was fortunate enough to do my fellowship with Jennifer Leibovich at Children's Hospital Boston. And so there she was having these things called coping groups. So I would co-lead the parents in the coping groups with her. And then separately, the kids would play with each other and child life specialists. That was something that I've just continued to volunteer and work with. But then with my own son, Scott had no interest in hanging out with other big kids with food allergies. But he really wanted to be a role model and take care of little kids with food allergies. And whenever I would try to engage Scott in his own self-management and try to just make sure that he was taking care of himself the way I would hope, but you know with teens, it's a little hard to get to them.

I realized that maybe if we started having programming that had big kids taking leadership roles with little kids, then that might be the special sauce, and I think that that's a big Jedi mind trick. So what we try to do is we teach the big kids to take good care of little kids. And now I'm hoping, and this is what maybe our study's gonna do, I'm hoping that those big kids are gonna take better care of themselves because we were sneaky. They don't wanna let the little kids down, and they wanna be role models. And so when we onboard the big kids for orientation, I'm teaching them how to take care of a little kid as if you were their babysitter, you were their camp counselor, you were their big mentor for Food Allergy Buddies. And so teaching them label reading skills, teaching them cross-contact, teaching them all the things you would need to do to take care of a little kid, and obviously teaching them to take care of themselves.

Amanda Whitehouse, PhD 40:51

Brilliant. It's, you're right, it's a Jedi mind trick for teenagers. Treating them as if they're capable, and then they step up to the plate.

Mike Pistiner, MD 40:59

And then as I kind of thought more about this stuff and as this really seemed like something that would work great for the high school kids, then it really is a little something for everybody. Because a lot of the high school kids also wanted to hang out with other high school kids with food allergy. And some of the little kids never really met a bunch of people with food allergy, and they wanna hang out with little kids. And the little kids wanna meet big kids with food allergies. And now imagine being the parent of a kindergartner who's kinda new to this, and now you meet the 10th grader who's taking care of your kid and has it together and is doing great. It's so cool for the parents of the little kids who could not even see what's middle school gonna be like, what's high school gonna be like. Watching these kids kill it, it's so great. So like that's a little something for everybody

Amanda Whitehouse, PhD 41:59

Yeah, that visualization and representation, so powerful.

Mike Pistiner, MD 42:02

And to add, now again, what I was saying about my feelings towards the community, an unintended thing that came out that was amazing is our team. So many of the Buddy's team are volunteers, and so many of us have our own food allergies and children with food allergies. And being part of this community has been so fun, and to do this with this team has been amazing. And so we've all really enjoyed the kids and their families and each other. So this has been awesome.

Amanda Whitehouse, PhD 42:39

Thank you again for creating this. We will all be following. Maybe Dr. Herbert can join you, depending on how the research pans out. I'll make sure all the links are in the notes, and we'll talk about it more another time. But for now, thank you for being here and making sure to keep us updated on all the busy things in your life. I don't know how you do it all.

Mike Pistiner, MD 42:56

Well, thank you so much for having me, and I look forward to perhaps a next time.

43:00

Thank you again to Dr. Pistiner for being here. I love the energy that you bring and all of the projects that you are working on to create community and make sure that families are not alone. Here are your three action steps from today's episode.

Number one, share FAMP-IT with your pediatrician or primary care provider, and anyone who works with babies or young children. When our providers have current information, families get clearer, more consistent guidance that is up to date and reduces a lot of confusion and fear.

Pass FAMP-IT family along to anyone with a baby or a toddler. It would benefit you just to understand how the guidelines are changing, and then you can share that information with new parents, pregnant friends, grandparents, babysitters, anyone who's caring for a baby in the age where they're just starting solids or already managing an allergy in a young child. While you're there, I hope you'll read my article on the emotional side of early food introduction. Feeling nervous during this stage of food introduction with all of the information and fear that's out there is very common, and parents deserve support for that part of this journey too. Of course I'll put a link in the show notes along with everything else that we talked about in today's episode.

Number two, if you're newer to finding the show and you haven't heard Dr. Pistiner's earlier episodes on the updated criteria for recognizing anaphylaxis in infants and toddlers and using epinephrine safely, then go back to episodes 50 and 51 of the show. They will be linked in the show notes for you.

Number three, please share this episode and the podcast with anyone that you think might benefit from it. We all are working together as a team to get this information out there and make it common knowledge. So sharing this episode or the show in general is a huge help. Leaving ratings and reviews means so much to me, because that spreads the information to a wider audience. Following or subscribing will make sure that you don't miss out on all the great episodes.

Up next week, we'll have Mackenzie Farmer, who's the interim director of FooDiversity, which we mentioned today. She'll be joining me to talk about their work and how they are working with Dr. Pistiner to get FAMPIT to more families too.

The content of this podcast is for informational and educational purposes only, and is not a substitute for professional medical or mental health advice, diagnosis, or treatment. If you have any questions about your own medical experience or mental health needs, please consult a professional. I'm Dr. Amanda Whitehouse. Thanks for joining me. And until we chat again, remember don't feed the fear.