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Allergic Reactions and Anaphylaxis in Babies and Toddlers

When introducing your baby to new foods, one of the things you have to watch out for is signs of an allergic reaction. Most allergic reactions at this age are mild. However, anaphylaxis occasionally happens. Anaphylaxis is a serious allergic reaction that requires quick attention. Fortunately, it’s rare in babies. Also fortunately, there is a great treatment available that little ones respond very well to: epinephrine.  Since your child can’t tell you how they feel yet, this guide will teach you exactly what to look for so you can act fast, stay calm, and keep them safe. Here you will learn how to:

  • Define what infant anaphylaxis is and why it matters
  • Create a customized Anaphylaxis Action Plan with your doctor
  • Recognize the signs of an allergic reaction, including mild symptoms and more severe ones
  • Give epinephrine and follow your Anaphylaxis Action Plan if you think your baby or toddler is experiencing anaphylaxis
A doctor smiles while examining a baby resting on their mother's shoulder. The baby has no clothes on, and the mother looks concerned. They are indoors with a bright background.
  • alert iconThis guide is here to support you with easy-to-understand, medically reviewed food allergy and anaphylaxis information you can trust. Use this as a resource as you prepare to talk with your child’s healthcare team.

What is infant anaphylaxis and why does it matter?

Anaphylaxis is a serious allergic reaction that can be life-threatening. This is scary, no matter how you think about it. It occurs when the body reacts too strongly to a trigger (such as a food allergen, insect sting, or certain medications) that it mistakenly sees as harmful.

During a reaction, the immune system releases chemicals. Symptoms may vary and can involve many different parts of the body, including the lungs, skin, heart, and stomach.

Anaphylaxis is a medical emergency, but one with a proven treatment to help keep babies safe. Epinephrine (the medication form of adrenaline) is the first line of treatment for serious allergic reactions. It should be given first and fast. Epinephrine is the only medication proven to stop anaphylaxis. It can be given easily, and when given early, can keep a reaction from getting worse.

Create an Anaphylaxis Action Plan with your doctor

Okay, your baby has been diagnosed with a food allergy. Now what? The best next step is to work with your allergist or pediatrician (or other members of your healthcare team) to create an Anaphylaxis Action Plan. Think of the anaphylaxis action plan as a great cheat sheet. This cheat sheet makes it easy for you, your family, and other caregivers to be on the same page and know exactly what to do during an allergic reaction.

The plan includes:

  • Patient details including: child’s name, date of birth, weight, and a photo
  • A list of known food or drug allergies
  • Which symptoms to look for
  • When and how to give epinephrine
  • When to call 911
  • The correct adrenaline device prescription and dose
  • Primary caregivers’ contact numbers and any additional emergency contacts
  • Your child’s doctor’s information

Your healthcare team will work together with you to fill out the anaphylaxis action plan. They will explain how to give epinephrine and where to store it. Be sure to include a photo of your child on the plan when sharing it with other caregivers, such as those at a daycare. If you have any questions, don’t hesitate to bring them up with your healthcare team. Remember: everyone has the same goal of keeping your child safe!

Keep a copy of the Anaphylaxis Action Plan:

  1. At home
  2. In your diaper bag or travel kit
  3. Anywhere your child spends time, like daycare or with relatives

It may be helpful to take a photo of the completed plan and store it in a folder on your phone. You can include pictures of your child’s medications. This makes it easy to share the information with others if needed.

Download a copy of the AAP’s Anaphylaxis Action Emergency Plan

If you’re big on prep, planning on travel, or think someone who’s not on your usual list may watch your child, consider making a small allergy safety kit. It could including thins like:

  • A copy of the Anaphylaxis Action Plan
  • Epinephrine products (at least two)
  • A list of your child’s known allergies. (Even though this is on the action plan, it is convenient to have as a chef card or in larger format.)
  • Emergency contact numbers
  • Any additional medical documents
  • A few safe snacks

This safety kit can also be very useful during travel. Keep the kit in a diaper bag or personal bag, and make sure all caregivers know where it is and how to use it. In co-parenting situations, both homes should have the same plan. Caregivers should know how to give epinephrine.

Many allergists will prescribe multiple devices. Never hesitate to ask for at least two sets of epinephrine products for a multi-caregiving setup.

If your baby or toddler goes to daycare or is watched by someone else, here are some tips to make sure your baby gets the care they need.

  • Give the caregiver a copy of the Anaphylaxis Action Plan and explain it step by step.
  • Provide at least one clearly labeled epinephrine product and any other emergency medications.
  • Make sure caregivers know where the epinephrine is stored and how to use it.

You may also want to include:

  • Your child’s feeding instructions.
  • A list of approved safe snacks.
  • A selection of safe snacks for backup situations.

Recognize allergic reactions and anaphylaxis in babies and toddlers

It may be comforting to know that anaphylaxis is rare in infants. More often than not, if your baby has an allergic reaction, it’s a mild one. The downside is that babies and toddlers can’t tell us what they are feeling. This makes it extra important to know the signs so you can recognize anaphylaxis when it happens. Sometimes it can be easy to mistake an allergic reaction for normal behavior. Knowing what to look out for means earlier treatment and keeping kids safe.

Severe Signs and Symptoms

Body SystemAAP Allergy and Anaphylaxis Emergency Plan (all ages)In young children, also look for...
1: Respiratory / Airways

  • Shortness of breath, wheezing, or coughing

  • Tight or hoarse throat

  • Trouble breathing or swallowing

  • Swelling of lips or tongue that makes breathing more difficult

  • Belly breathing (in which the baby’s belly goes up and down in an obvious way), fast breathing, nasal flaring, chest or neck tugging (the skin around the chest or neck appears to suck in with breathing)

  • Hoarse voice, hoarse cry, barky or croup-like cough, unexplained drooling
2: Cardiovascular (Heart)

  • Skin color is pale or has a bluish color

  • Weak pulse

  • Fainting or dizziness

  • Mottling of the skin (discolored patches or blotches on the skin), pale appearance in lighter skin or dusky appearance in darker skin, particularly on the lips, tongue or gums

  • Fast heartbeat not related to crying or other causes, usually with other signs of an allergic reaction

  • Wobbly appearance, limp, floppy or poor head control
3: Skin
  • Many hives or redness over the body
  • Hives that appear red on lighter skin or look darker, purplish or blend with skin tone in children with skin of color, obvious swelling on the face
4: Gastrointestinal (Gut)
  • Vomiting or diarrhea (if severe or combined with other symptoms)
  • Throwing up more than once or throwing up that occurs with other symptoms, large amounts of diarrhea or diarrhea that occurs with other symptoms
5: Neurologic (Behavior)
  • Feeling of "doom," confusion, agitation
  • Lethargic or very tired, difficult to wake up, withdrawn, unexpected crankiness, inconsolable or nonstop crying
some symtoms of an allergic reaction in a baby, including coughing, vomiting, diarrhea, and hives

Mild Signs and Symptoms

Body SystemAAP Allergy and Anaphylaxis Emergency Plan (all ages)In young children, also look for...
1: Upper Respiratory / Mucus Membranes
  • Itchy nose, sneezing, itchy mouth

  • Pushing out the tongue (called thrusting), pulling on the tongue, repetitive lip licking or licking of hands or objects, throat itching, ear pulling, scratching, putting fingers in the ears, eye rubbing, eye itching
2: Skin

  • A few hives

  • Skin scratching or rubbing skin
3: Gastrointestinal (Gut)
  • Mild stomach nausea or discomfort

  • Hiccups, spit-up that is not routine and more intense than normal, arching of the back, putting knees to chest

Give epinephrine and follow your Anaphylaxis Action Plan if you think your baby or toddler is experiencing anaphylaxis

If you think your baby or toddler is experiencing anaphylaxis, you must act fast – quick treatment is the best way to stop a serious allergic reaction and keep it from getting worse.

If you don’t have epinephrine handy, call 911, seek emergency medical services, or go to the hospital.

If you have epinephrine and have made an Anaphylaxis Action Plan for your child, follow the steps listed there.

If you do not have an Anaphylaxis Action Plan, you can remember what to do by using REAct:

R – Recognize anaphylaxis

Watch for serious symptoms like trouble breathing, vomiting, sudden sleepiness, swelling, or symptoms affecting two or more body systems. 

E – Epinephrine first

Give epinephrine (the first-line medicine to stop the reaction) right away. It works fast to reduce or stop swelling, open airways, and raise low blood pressure.

If your baby or toddler is experiencing some symptoms and you’re not sure it’s anaphylaxis, the best approach is to still give epinephrine right away. The medication is unlikely to cause harm if it is not really needed. But if it is needed, delaying treatment could be dangerous. Early treatment can keep a reaction from getting worse and make the child feel better quickly. 

Position your baby after epinephrine

After giving epinephrine, choose the safest position based on your baby’s symptoms:

If there’s trouble breathing or coughing:

  • Hold your baby upright against your chest to make breathing easier.
  • Keep the head supported.

If there’s dizziness, sleepiness, or the baby’s head and body are limp and floppy:

  • Lay your baby flat on the back with legs slightly raised to help blood flow.
  • Do not pick your baby up suddenly or let your baby move around.
When to give a second dose of epinephrine

Sometimes, anaphylaxis symptoms do not get better after a first dose of epinephrine. Other times, the symptoms can come back, even if you’ve stopped feeding – this is called a biphasic reaction. 

Give a second dose of epinephrine if:

  • Symptoms do not improve in 5-10 minutes after the first dose, or
  • Symptoms come back or worsen after the first dose, or
  • Anaphylaxis symptoms are severe.

Most second reactions happen within the first 4 to 6 hours, but doctors recommend watching closely for up to 72 hours (3 days) after a serious allergic reaction.

If your child needs a second dose of epinephrine, inject it into the outer thigh, just like the first dose. You can use a different spot on the same leg or the other leg. If you give a second dose of epinephrine, call 911 or seek emergency medical services.

Safety Tip: Keep two doses of epinephrine nearby at all times, in case a second dose is needed. If you used all your epinephrine, make sure to refill the prescription as soon as possible. 

Act – Activate emergency plan

Not all allergic reactions require emergency medical care, but all cases of anaphylaxis need epinephrine fast. If your baby’s symptoms get better after a first dose of epinephrine, you may not need to go to the hospital or emergency department. But you should keep a close eye on your baby’s symptoms during and after the reaction, even after giving epinephrine.

Call for emergency medical help or go to the hospital or clinic after treating with epinephrine if…

  • you don’t have a second dose of epinephrine;
  • symptoms return or worsen after the first dose of epinephrine;
  • your baby has severe symptoms;
  • symptoms do not go away quickly or completely after the first dose of epinephrine;
  • a second dose of epinephrine is needed;
  • you are more than 30 minutes from the nearest hospital.

After the case of anaphylaxis is resolved, schedule a follow-up appointment with your child’s healthcare team. Discuss what happened and make a change to your child’s Anaphylaxis Action Plan, if needed.

FAMPIT Prevention and Emergency PreparednessDownload

Important questions to think about and discuss with your healthcare team

Here are the most frequent causes of anaphylaxis in infants and toddlers:

  • Food allergens: The top foods that can cause infant anaphylaxis are cow’s milk, eggs, and peanuts. Even a small amount can cause a severe allergic reaction in babies who have a food allergy. Tree nuts, sesame,fish, shellfish, wheat, and soy can also be common triggers in this age group.
  • Medications: Some babies can react to medications, most commonly antibiotics like penicillin.
  • Insect stings: While less common in this age group, stings and bites from bees, wasps or red ants can lead to serious symptoms, including anaphylaxis.

If your baby has a known allergy, avoid known triggers (when possible). This is the best way to prevent an allergic reaction. Always talk to your child’s primary care clinician or a pediatric allergist if you suspect a food allergy.

Anaphylaxis in babies can appear different to older children and adults. Because babies are unable to tell you what they are feeling, their symptoms may be harder to notice.

Ways infant reactions can be different:

  • More subtle signs: Babies may just look sleepy, pale, or floppy instead of showing clear distress.
  • Less obvious breathing problems: Instead of saying they can’t breathe, babies may grunt, cough, make a high-pitched sound, or have noisy breathing.
  • More skin symptoms: Skin reactions like hives and swelling are often the first clue.
  • Frequent vomiting: Babies with food-induced anaphylaxis may vomit many times with or without other clear symptoms.
  • Sudden behavioral changes: A baby might suddenly cry inconsolably, or become unusually quiet or clingy.

Because of these differences, it is important for parents, caregivers and their healthcare team to learn the signs and symptoms of anaphylaxis in this age group. Quick action can keep a serious reaction from getting any worse and will make the child feel.

Many signs and symptoms of anaphylaxis look like other common problems in babies. For example:

  • Spitting up can look like vomiting from an allergic reaction.
  • Flushed skin can look like a mild rash or overheating.
  • Crying and fussiness can be mistaken for hunger or tiredness.

This makes it harder for parents and doctors to see that it is anaphylaxis right away.

It’s helpful to think of antihistamines as “comfort medicine.” They may help you feel a little better, but they are not going to treat all the things happening during a severe allergic reaction. That’s because they only block histamine and do not affect the other chemicals involved.

We have a lot of histamine receptors on our skin and mucous surfaces, so antihistamines can help with skin symptoms, like itching and hives, during an allergic reaction. However, they can take about 30 to 60 minutes to start working.

Giving an antihistamine should never slow down treatment of a serious allergic reaction with epinephrine. Epinephrine is the medicine form of adrenaline. It is the treatment of choice for anaphylaxis, which is a severe allergic reaction.

One of the reasons epinephrine works so well is that it works where we want it to and it works quickly. It acts on many parts of the body where allergic reactions are happening, including the skin, lungs, heart, and blood vessels.

Epinephrine also works directly on allergy cells, called mast cells and basophils. It helps stabilize these cells, making it less likely that they will keep releasing what’s inside them. These cells contain things like histamine, leukotrienes, and platelet-activating factor, which cause the symptoms we see.

When those chemicals are released, they can cause swelling, itching, trouble breathing, and changes in blood pressure or fast heartbeat. Epinephrine helps shut that process down.

It also helps keep fluid inside the blood vessels, supports blood pressure, relaxes the lungs to make breathing easier, and reduces swelling in the airway.

So overall, epinephrine works in many places in the body and helps stop the reaction at its source, not just the symptoms.

The following instructions are for using an epinephrine auto-injector:

  • When giving epinephrine, lay your baby flat on the back or hold in your lap while keeping the legs stretched out in front.
  • Do not stand or carry your baby upright when administering the medication, as this can cause a sudden drop in blood pressure.
  • Inject the epinephrine into the outer thigh muscle. You can give the shot through clothing if needed.
  • If you’re worried about hitting bone, gently pinch the thigh to create a soft area and inject the medicine into the muscle.
  • Hold the epinephrine auto-injector in place for 3-10 seconds, or follow the instructions on the medication label.

If you’re unsure how to use the device, ask your healthcare provider for a demonstration. Most auto-injectors come with a trainer device so you can practice and feel confident.

It’s also important to teach anyone who cares for your baby about how to use the epinephrine device.For more information, see this step-by-step guide for more detailed guidance on epinephrine auto-injectors.

Anaphylaxis emergency care doesn’t stop once symptoms go away. It’s important to monitor your child, follow up with their doctor, and take time to process the experience as a family.

Watch for a second reaction

Some children have what’s called a biphasic reaction. This means symptoms may return hours after the first reaction, even without being exposed to the allergen again.

  • Most second reactions happen within the first 4 to 6 hours, but doctors recommend watching closely for up to 72 hours after a severe allergic reaction.
  • Keep your child’s epinephrine nearby and call your doctor or nurse practitioner if any new symptoms appear.
  • If you used all your epinephrine, make sure to fill the prescription as soon as possible. 

Follow up with a pediatric allergist

It may be best to see a pediatric allergist for specialized care and treatment. Ask your child’s doctor or nurse practitioner for a referral to a pediatric allergist.

  • An allergist can confirm a food allergy diagnosis, do allergy tests if needed, and help you avoid future reactions.
  • An allergist can update your child’s anaphylaxis action plan and refill the epinephrine prescription if needed.

When preparing for an appointment with a pediatric allergist, make sure you have:

  • notes about your child’s reaction history
  • a list of signs and symptoms
  • a list of suspected foods that caused the reaction
  • any photos of the symptoms (if available)
  • your child’s current medications

Supporting your family emotionally

A severe allergic reaction can be scary for both children and their caregivers. It’s normal to feel anxious afterward. You may worry about safe food, playdates, daycare or future travel.

  • Give yourself time to recover emotionally following a severe allergic reaction.
  • Talk to your pediatrician or pediatric allergist if you need support. Ask for a referral to a mental health professional.
  • Connect with others, whether through family, friends, food allergy support groups or online communities.

Feeling informed and prepared can help build confidence moving forward.

After an allergic reaction, it is important to take steps to prevent another episode. Learn what your baby is allergic to (if you don’t already know) through allergy testing and find out where allergens may show up. Check food product labels, clean surfaces and develop routines to limit the possibility of an accidental exposure.

These steps can help prevent reactions. And you will feel more confident caring for your baby’s severe allergy.

Essential resources for parents

These trusted resources can help you find reliable information about anaphylaxis in infants, connect with other families, and feel more prepared:

Finding support

  • Food Allergy Counseling Directory – Find mental health professionals who understand food allergies and can support you and your family.
  • Food Allergy Parents Facebook Groups – Find local and national support groups for real-time advice and understanding from other parents.

If you have questions or feel unsure, reach out to your child’s doctor or a pediatric allergist for help every step of the way.

A healthcare worker in blue gloves uses a stethoscope to listen to a baby’s chest while an adult holds the baby, providing comfort during the medical examination.

Long-term management and care

Caring for a baby with food allergies means planning ahead and working with trusted professionals. Food allergies are usually a long-term condition, and managing them takes both day-to-day planning and thinking about the future. Some allergies may change over time, but many will continue as your child grows. These steps can help you feel ready and keep your child safe every day.

Working with pediatric allergists

A pediatric allergist is a doctor who specializes in children’s allergies. They can help you confirm your baby’s diagnosis. They also perform specialized tests, like an oral food challenge. Allergists are also able to explain test results and teach you how to prevent and treat allergic reactions. Seeing a board-certified allergist regularly helps you stay up to date on the best care for your child. They can also retest over time to see if your baby’s allergies have changed.

Developing a personalized plan

An Anaphylaxis Action Plan is a written guide that explains what to do if your baby has a reaction. This plan should list your baby’s known allergens, show what symptoms to look for, and give clear steps on when and how to give a dose of epinephrine. Share this plan with anyone who cares for your baby, including family members and daycare staff.

When to carry epinephrine 

If your baby has a serious allergic reaction, epinephrine is the first-line treatment. Your child’s doctor will tell you if you should always carry two doses of epinephrine. Keep epinephrine with you at all times and check the expiration dates often. Your doctor or pharmacist can show you how to practice with a trainer device so you feel comfortable using it in an emergency. Having epinephrine ready can save your baby’s life.

Emotional support for caregivers

Managing a serious allergic reaction can be overwhelming. It is normal to feel shaken, upset, or even guilty after an emergency. Many parents say the experience was very scary, and these feelings can last for days or weeks.

It’s important to take care of yourself, too. Get enough sleep and talk with your child’s healthcare team. Finding support and learning more about allergies can also help you feel more confident and calm. Remember, you and your child are not alone in this journey, and help is available.

Questions & answers (Q&A) on infant anaphylaxis

Caring for a baby or toddler with food allergies can feel overwhelming. The more you know, the more confident you will feel in successfully managing the condition and keeping your baby safe. Here are answers to some common questions we’re asked about infant anaphylaxis.

Anaphylaxis in infants occurs when symptoms affect two or more parts of the body. These may include:

  • Skin: widespread hives or swelling of the face, lips, or eyes
  • Breathing: noisy or difficult breathing, or breathing that seems harder than usual
  • Stomach: vomiting, diarrhea, or stomach pain
  • Heart and circulation: appearing pale, limp, weak, or having blotchy skin

Babies may also seem very sleepy, unusually fussy, crying, or hard to comfort. Because infants can’t describe how they feel, noticing these changes early and getting medical help right away is very important.

If you see these signs, give epinephrine right away.

A mild allergic reaction may cause just a few hives on the skin, mild swelling or a runny nose. In some cases, it can be treated with an antihistamine, but only if the child is 6 months or older and it’s approved by your child’s doctor.

Anaphylaxis is a serious allergic reaction. It is more severe and diagnosed when…

  • more than one part of the body is affected at the same time (for example, skin symptoms plus stomach problems and/or trouble breathing); or
  • only one body part is affected, but gets worse very quickly (like severe swelling that makes it hard to breathe); or
  • your baby has a sudden drop in blood pressure and looks very pale or limp after contact with an allergen.

Anaphylaxis is a medical emergency and must be treated with epinephrine right away.

It’s helpful to think of antihistamines as “comfort medicine.” They may help you feel a little better, but they are not going to treat all the things happening during a severe allergic reaction. That’s because they only block histamine and do not affect the other chemicals involved.

We have a lot of histamine receptors on our skin and mucous surfaces, so antihistamines can help with skin symptoms, like itching and hives, during an allergic reaction. However, they can take about 30 to 60 minutes to start working.

Giving an antihistamine should never slow down treatment of a serious allergic reaction with epinephrine. Be cautious when giving diphenhydramine (Benadryl) because it can cause tiredness and has side effects. Non-sedating antihistamines like cetirizine (Zyrtec) are a better choice for treatment of mild and limited symptoms.

Delayed anaphylaxis is a serious allergic reaction that occurs hours or even days after exposure to an allergen. Symptoms may include:

  • New widespread hives or swelling
  • Difficulty breathing
  • Vomiting or diarrhea

Remember that your infant cannot verbalize the symptoms, so be sure to monitor your baby closely for non-verbal signs of delayed anaphylaxis.

In addition, sometimes anaphylaxis symptoms can come back hours after initial symptoms appear. This is called a biphasic reaction. This can happen up to 72 hours after the first reaction, so watch your baby closely and follow your doctor’s instructions.

Symptoms can start within 5-10 minutes to 2 hours after your baby consumes an allergen. Sometimes symptoms are delayed for more than 2 hours. So keep monitoring your child for symptoms if there has been an exposure.

Anaphylactic shock in infants is a medical emergency and requires immediate action. The first-line treatment is epinephrine.

  1. Give epinephrine right away at the first signs of anaphylaxis (do not “wait and see”). Epinephrine is safe for infants. Even if given unnecessarily, it won’t cause long-term harm.
  2. Call 911 for emergency medical services if symptoms do not improve or worsen after giving epinephrine. Be sure to tell dispatch it’s anaphylaxis in an infant.
  3. Positioning the baby is important to support breathing. Keep the baby lying on the back or in a caregiver’s arms with legs elevated if possible. Do not hold the baby upright, as this can worsen low blood pressure. If there’s vomiting, place the baby on the side to prevent choking.
  4. Repeat epinephrine if needed. If symptoms don’t improve or return before EMS arrives, a second dose can be given after 5–15 minutes.

It depends on the type and severity of the reaction. Mild reactions often go away within a few hours. If your baby has just a few hives or minor stomach upset, these symptoms usually clear up in a couple of hours. Antihistamines can treat mild symptoms, but they are not approved for children under the age of 2 unless recommended by your child’s doctor.

Anaphylaxis is different. This is a severe, life-threatening reaction that must be treated right away with epinephrine. This medication can resolve symptoms, sometimes within minutes.

Even if your baby seems to get better, symptoms can return later. This is called a biphasic reaction. A second wave of symptoms can happen up to 72 hours after the first reaction, even if your baby does not have contact with the allergen again. To treat a biphasic reaction, give a second dose of epinephrine and contact 911.