Ask An Expert / Selective Mutism

My 5-year-old has selective mutism and a life-threatening nut allergy. How can we keep her safe in school?

Behavioral treatment is urgently needed to help her find her voice

Melissa L. Ortega, PsyD

My 5-year-old daughter with selective mutism also has a life-threatening nut allergy. She will be entering the public school system in the fall. Any suggestions for helping my daughter stay safe? How can she communicate any symptoms she is having? How can we help her ask if food contains nuts at class parties? The school is far from nut-free!

Severe allergies can, indeed, be life threatening. For parents of a child diagnosed with selective mutism, they are especially concerning and scary, since these children often cannot advocate for themselves. Most parents of children with allergies have taught them at an early age to avoid nuts. Hopefully, your daughter is already on the lookout for peanut butter and jelly sandwiches or brownies with nuts. My advice is to start behavioral treatment for your daughter’s selective mutism as soon as possible. Her SM can literally impact her health, safety, and well-being, and treatment should be your first priority. You should know that intensive treatment for SM is very successful, and children with SM often learn to overcome their anxiety and find their voices in a matter of weeks.

However, until your child has received treatment and can speak in school there are a few things you can do.

  1. Make sure the school is aware of her allergy and provide the staff with a list of symptoms that could indicate that she has been exposed to or ingested nuts. I would make sure everyone from the principal to the secretary to teachers all know and understand the severity of a nut allergy.
  2. Provide the school with the outline of a plan to follow in case of an emergency (e.g., contact numbers, location of Epipen, where should she be taken).
  3. Get your daughter a medical bracelet or necklace that has information about the allergy, her name, age, and your telephone number.
  4. Create picture icons that you can have velcroed to her desk and put in her lunch box. These icons can be used to communicate until your daughter can verbalize in school. For example, the icons can be a picture of a person smiling (“I feel fine”) and on the opposite side can have a picture of a person feeling ill (“I feel sick”). You will have to explain to your daughter what feeling sick means (trouble breathing, itchy, throat closing up, tongue feels too big for her mouth).
  5. Another option would be to make a necklace or pin for her to wear in the cafeteria that has “No Peanuts” on it. This ensures you that anyone who comes in contact with your daughter is aware that she cannot have nuts. None of these options are ideal, but these extra precautions are the best strategy until your daughter gets medical attention and is in the care of parents or adults she’s comfortable talking to. The most important thing is to keep your daughter safe.