Anaphylaxis Action Plan for Infants and Toddlers

Although rare in infants and toddlers, anaphylaxis is a serious, possibly life-threatening allergic reaction that needs fast treatment. Yes, this is very scary to think about. The good news is that young children often do very well when given epinephrine at the start of symptoms.

That’s where your anaphylaxis action plan comes in. This is a written document developed by parents and doctors that explains the symptoms of anaphylaxis and what steps to take in an emergency. An action plan created specifically for your child and their allergies is very helpful to have! The American Academy of Pediatrics (AAP) has a trusted action plan – the Allergy & Anaphylaxis Emergency Plan – used by many healthcare providers. In this section, you will:

Understand how anaphylaxis happens and why it can be different for infants and toddlers
How to spot the signs and symptoms
What to do in an emergency
How to create an Anaphylaxis Action Plan with your healthcare team

A smiling baby holding and biting into a green apple slice, with a blurred kitchen background.

This 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.

Understanding infant anaphylaxis risks

Anaphylaxis can happen very quickly after a baby is exposed to an allergen. It is considered life-threatening because symptoms can cause swelling in the mouth or throat, cause breathing problems, and may affect heart and blood pressure. It is important to treat quickly.

Anaphylaxis is scary, but it’s important to remember the condition is rare in infants. Fast treatment with epinephrine makes it a lot less likely that symptoms will get worse. Understanding what happens in a severe allergic reaction is a great step to keeping your child safe.

Why anaphylaxis can be harder to recognize in babies and toddlers

When babies and toddlers have allergic reactions, they can look different and be more difficult to spot. Here’s why:

Babies do not have the talking skills to explain their symptoms or what they are feeling.
Infants are unable to tell the difference between what’s safe and what’s harmful.
Signs like hives, sudden vomiting, or a hoarse cry may be missed or confused with normal fussiness. This can lead to a delay in treatment.
Many babies first try common food allergens like milk, eggs, or peanuts during infancy.

baby being held by dad and thinking that something is wrong, but they can't speak yet

How to spot the signs and symptoms of an allergic reaction in your baby

Any of these serious symptoms can be the start of an anaphylactic emergency. Even if the reaction is mild at first, it can quickly become life-threatening. Always follow your child’s anaphylaxis action plan, and never wait to see if symptoms go away on their own.

Severe Signs and Symptoms

Body System	AAP 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

Mild Signs and Symptoms

Body System	AAP 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

Again, even if a reaction is mild at first, it can quickly become serious. Always follow your child’s anaphylaxis action plan, and never wait to see if symptoms go away on their own.

A young toddler with blonde hair and a blue bib sits in a high chair, looking at a spoonful of food being offered by an adult hand. The child appears hesitant or unsure about eating.

Step-by-step emergency response plan

If you think your baby is experiencing anaphylaxis, it’s important to stay calm and act quickly. The first line treatment is epinephrine. It should be given right away.

Follow these steps:

Epinephrine is a medication that can help stop a severe allergic reaction. It works fast to reduce or stop swelling, open airways, and raise low blood pressure. Administer prescribed epinephrine as soon as you recognize symptoms are severe or affecting two or more body systems.

Multiple types of epinephrine products are available. Epinephrine auto-injectors are approved for infants and toddlers based on weight. Products are available for children weighing between 16.5 to 33 pounds, 33 to 66 pounds, and 66 pounds or more.

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.

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.

Sometimes anaphylaxis symptoms do not get better after a first dose of epinephrine. Other times the symptoms can come back – this is called a biphasic reaction. This occurs when symptom return hours after the first reaction, even without being exposed to the allergen again.

When to give the second dose?

Symptoms do not improve in 5-10 minutes after the first dose, give a second dose of epinephrine.
Symptoms come back or worsen after the first dose, give a second dose of epinephrine.
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 after a severe 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. Anytime you give a second dose of epinephrine, call 911 or seek emergency medical services.

It’s recommended that parents keep two doses of epinephrine readily available at all times, in case a second dose is needed. If you used all your epinephrine, make sure to fill the prescription as soon as possible.

If you don’t have epinephrine readily available to treat your child’s allergic reaction, call 911, seek emergency medical services, or go to the hospital.

If after giving epinephrine, your child appears to be feeling better and symptoms are improving, you do not have to seek emergency medical care. However, you may choose to do so as an added level of caution. You should always follow your child’s anaphylaxis action plan and what you discussed with your child’s doctor.

When should you call 911 or go to the hospital or emergency department? Guidelines recommend the following:

Severe symptoms do not go away within 5-10 minutes or completely after a first dose of epinephrine.
Severe symptoms return or worsen after a first dose of epinephrine.
Anytime anaphylaxis is severe.
A second dose of epinephrine is needed.
The child has other health risks (like asthma or past severe reactions).

What to do after the reaction

Anaphylaxis emergency care doesn’t stop once symptoms go away. It’s important to watch 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 coming into contact with 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.

Creating a customized anaphylaxis action plan

After your infant is diagnosed with a food allergy, the next step is to work with your allergist 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 doctor will work together with you to fill out the anaphylaxis action plan. The doctor will explain how to administer (give) your child’s 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 facility. If you have any questions, don’t hesitate to bring them up with your healthcare team. Everyone has the same goal of keeping your child safe.

Keep a copy of the anaphylaxis action plan:

At home
In your diaper bag or travel kit
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.

When to update your child’s anaphylaxis action plan?

Keeping a current anaphylaxis action plan helps everyone caring for your child respond quickly and confidently during an emergency. You and your child’s doctor should update it…

after a severe allergic reaction;
if new allergies are diagnosed; and
as your child grows and their epinephrine dose changes.

Daily management strategies

Managing a child’s food allergy should be part of an everyday routine. Once you have an anaphylaxis action plan, the next step is making sure everyone around your child understands how to use it and keep your child safe.

Safety kits for multi-caregiver environments

When more than one person is caring for your child, such as babysitters, family members, co-parents, or during travel, it’s important to have a shared plan. Pack a small allergy safety kit that includes:

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

Keep the kit in a diaper bag or travel 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.

Daycare and school plan distribution

If your baby or toddler attends daycare or is watched by someone else, here are recommendations for working with the staff to ensure your baby or toddler is properly cared for.

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.

Questions & answers (Q&A) on anaphylaxis action plans for babies

An anaphylaxis action plan helps parents and caregivers know what steps to take to care for infants and babies at risk for a serious allergic reaction. Here are answers to some common questions we’re asked about anaphylaxis action plans for young children.

If you think your infant is experiencing anaphylaxis (a serious allergic reaction), act quickly:

Give epinephrine right away.
Watch your baby closely. If symptoms don’t improve after 5-10 minutes, administer a second dose if available. If you do not have a second dose or epinephrine to give, call 911 immediately.
Call your doctor or emergency services based on your action plan, or if you’re unsure what to do.

Do not wait to see if symptoms go away on their own. Epinephrine is the most important treatment. It is safe and works best when given early.

If your baby is showing signs of anaphylaxis and you do not have epinephrine readily available, call 911 or emergency medical services right away. Tell them your child is having a severe allergic reaction and needs help fast.

While you wait:

Lay your baby flat and raise the legs slightly if your baby is sleepy, floppy or pale.
Hold your baby upright with the head supported if there’s difficulty breathing.
Do not give antihistamines. These will not treat anaphylaxis. They are not indicated for children under 2 years of age due to risk of side effects.

After the emergency is over, your child’s allergist can work together with you on developing an anaphylaxis action plan. Talk with your child’s doctor about seeing an allergist to get an epinephrine prescription. Epinephrine should always be available if your child has a known food allergy.

This is a step-by-step guide for treating severe allergic reactions in babies and children. It includes these key steps:

Give epinephrine immediately at the first signs of anaphylaxis. This is the most important step.

Position your child safely:

Lay your baby flat and raise the legs slightly if your baby is sleepy, floppy or pale.
Hold your baby upright with the head supported if there’s difficulty breathing.

Watch closely after giving epinephrine. If symptoms do not improve within 5-10 minutes, or if they return, give a second dose of epinephrine if available.
Call 911 or emergency medical services if:

You need to give a second dose.
Your child has severe or ongoing symptoms.
You do not have epinephrine or need a second dose of epinephrine.
You are unsure or concerned about your child’s condition.

If your baby has had an anaphylactic reaction, activate the anaphylaxis action plan you developed with your child’s healthcare team. This plan should be based on shared decision-making with your doctor and tell you exactly what to do in an emergency. It should explain when to give a first and second dose of epinephrine, call for an ambulance, or go to the hospital or ER.

Many anaphylaxis action plans for children follow the same basic steps:

Recognize the signs and symptoms of anaphylaxis, such as hives, swelling, vomiting, trouble breathing, or sudden tiredness.
Give epinephrine immediately as prescribed.
Position your child safely depending on symptoms: flat with legs up if weak, or upright if coughing.
Call 911 or emergency medical services if symptoms don’t improve, they return, or if you don’t have epinephrine.
Watch your child closely and be prepared to give a second dose if symptoms continue after 5-10 minutes.

These steps may vary slightly depending on your child’s needs. Your anaphylaxis action plan will include exact instructions for what to do during a serious allergic reaction.