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Anaphylaxis in babies and children

young child with swollen eyelids due to allergic reaction
Photo credit: Thinkstock

What is anaphylaxis?

Anaphylaxis is a rapid and severe allergic reaction, and one of the scariest health emergencies a parent can face. It requires immediate medical attention.

Anaphylaxis starts when the immune system mistakenly responds to a relatively harmless substance as if it were a serious threat, triggering the release of histamine and other chemicals that cause a number of symptoms – some of them life-threatening.

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Sadly, anaphylaxis appears to be on the rise among children in the United States. Knowing how to recognize a severe allergic reaction and what to do if it happens can save your child's life.

People sometimes refer to anaphylaxis as anaphylactic shock. Both are the result of a severe allergic reaction, but they're not quite the same. When a child goes into anaphylactic shock, his blood pressure becomes unstable and he may feel dizzy or faint. Anaphylaxis can lead to anaphylactic shock, but it doesn't always.

Can babies get anaphylaxis?

Yes, but it's uncommon in babies under 6 months. That's in part because they haven't been exposed to many allergens, especially food allergens. In general, it takes more than one exposure to an allergen for a reaction to occur, and it can take years for some allergies to develop.

Still, anaphylaxis has been reported in babies as young as 1 month old and in children with no known previous exposure to the allergen.

Signs and symptoms of anaphylaxis in babies and children

Symptoms of anaphylaxis in babies and children can include:

  • Swelling of the skin, lips, throat, tongue, or face
  • Wheezing or severe breathing problems
  • Rapid or weak pulse, or irregular heartbeat
  • Hives
  • Flushing of the skin
  • Dizziness, fainting, loss of consciousness
  • Nausea, vomiting, abdominal cramps, diarrhea
  • Extremely pale skin, sweating, or blue skin color
  • Confusion, slurred speech

Babies may also experience:

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  • Fussiness or inconsolable crying
  • Sudden drooling
  • Unusual sleepiness

How quickly does anaphylaxis happen in babies and children?

Symptoms of anaphylaxis can appear anywhere from between a few seconds to a few hours after your child is exposed to an allergen. Food-induced anaphylaxis usually happens within 30 minutes, for example, while a severe allergic reaction to an insect sting typically occurs within seconds or minutes.

What causes anaphylaxis in babies and children?

There are many possible allergens, but these are the most common:

  • Food. This is the most common cause of anaphylaxis in children. The top trigger foods are:
    • Peanuts and tree nuts (such as walnuts and cashews)
    • Shellfish (like shrimp and lobster) and fish
    • Cow’s milk
    • Eggs
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  • Drugs in the penicillin family, including the popular antibiotic amoxicillin.
  • Insect bites and stings, especially from bumblebees, honeybees, yellow jackets, hornets, wasps, fire ants, and harvester ants.
  • Latex. This was once commonly used in healthcare facilities.
  • Food preservatives and colorings, like FDC yellow No. 5.

What do I do if my baby or child experiences anaphylaxis?

If your infant or child shows signs of a severe allergic reaction, particularly if he is having trouble breathing or altered consciousness:

  1. Call 911 immediately (If you have an epinephrine auto-injector, administer this first).
  2. Lay him down with his feet elevated to reduce the risk of shock.
  3. Try to keep him calm by talking to him and by remaining calm yourself.

Don't give your child any medication by mouth if he's having any trouble breathing or swallowing, as this poses a risk for choking.

How is anaphylaxis in babies and children treated?

When the paramedics arrive, they'll probably treat your child on the spot with an injection of epinephrine that will stop the reaction within minutes. Epinephrine makes the heart beat more strongly, relaxes the muscles throughout the airway, reduces swelling, and improves tone in the blood vessels to increase blood flow to vital areas like the heart and brain.

The paramedics will take your child to the hospital, where he'll be examined, treated, and monitored for delayed reactions. Some children will require IV fluids, oxygen, or repeat doses of epinephrine. The doctors at the hospital can help you determine what caused the problem, although sometimes a specific trigger cannot be identified.  

Before your child leaves the hospital, you should receive a prescription for an epinephrine auto-injector (commonly EpiPen). Make sure you understand how to use your auto-injector prior to leaving the hospital. You'll want to follow up with your child's doctor, who will likely refer you to a pediatric allergist for additional testing and follow-up care.

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Which babies and children are at risk for anaphylaxis?

Any child could suffer anaphylaxis, but some kids are more at risk. Your child is more likely to have a severe allergic reaction if she has:

  • Asthma
  • Allergies
  • A family history of anaphylaxis
  • Has had anaphylaxis in the past

What can I do to prevent anaphylaxis in my baby or child?

Avoid known allergens. If you know your child is allergic to something, avoiding it is the best prevention.

Get your child’s asthma under control. Work with your doctor to keep your child’s asthma as controlled as possible to lessen the severity of breathing difficulties during an allergic reaction.

Read food labels. If your child is allergic to certain foods, it may take only a trace amount to trigger a reaction, so it's important to read labels carefully and ask at restaurants or friends' houses whether or not a meal contains any of the off-limit items. You'll need to be vigilant about this for your child until he can do it for himself. For more tips, check out the Food Allergy NetworkOpens a new window.

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Find bug-free play spots. If insect bites or stings cause trouble, help your child find places to play that are free of bugs. Don't rely on bug sprays – they don't repel bees and fire ants, which commonly sting children. In addition, don't let your child run around outside barefoot. Many children are stung when they unintentionally step on a stinging or biting insect.

Carry epinephrine auto-injectors. If your child has had a severe allergic reaction, his doctor will likely recommend that you carry a penlike injection device loaded with epinephrine, such as EpiPen Jr. It's available by prescription. You should keep two epinephrine auto-injectors with your child at all times because he may need two doses. Develop an emergency plan with your doctor ahead of time so you know exactly what to do when you need to use the auto-injector. Rest assured that epinephrine is very safe and should be used any time an allergic reaction is suspected.

Communicate with caregivers. Also make sure that anyone who cares for your child – caregivers, daycare workers, relatives – knows about  his allergies, how to recognize an allergic reaction, and exactly what to do if he has one. You may need to obtain detailed instructions from your child's doctor to share with your child's daycare or preschool provider. The American Academy of Pediatrics has an Allergy and Anaphylaxis Emergency Plan templateOpens a new window you can fill out with your child's doctor.

Wear a medical-alert bracelet. Once your child has had a severe reaction such as anaphylaxis, it's wise for him to wear a medical-alert ID bracelet (available online or in most pharmacies), as this can alert healthcare providers to his condition in case of an emergency.

Introduce babies to allergenic foods early. Doctors used to suggest delaying the introduction of allergenic foods in children with a higher risk of allergies. However, research now shows that delaying the introduction of allergenic foods may actually raise the risk of food allergies. Today, experts suggest introducing commonly allergenic foods as soon as your baby is developmentally ready for solids and has tolerated a few other typical first foods such as meats, fruits, and vegetables. However, if you have a family history of food allergies, talk with your child's doctor or nurse first.

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BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies.

AAP. 2019. Anaphylaxis in infants and children. HealthyChildren.orgOpens a new window https://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/Anaphylaxis.aspxOpens a new window [Accessed April 2020]

CDC. 2019. When, What and How to Introduce Solid Foods. Centers for Disease Control and Prevention. https://www.cdc.gov/nutrition/infantandtoddlernutrition/foods-and-drinks/when-to-introduce-solid-foods.htmlOpens a new window [Accessed April 2020]

MedlinePlus. 2018. Anaphylaxis. http://www.nlm.nih.gov/medlineplus/ency/article/000844.htmOpens a new window [Accessed April 2020]

Dana Dubinsky
Dana Dubinsky is a health and science editor. 
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