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Symptoms and Management of Food Allergies in Babies & Toddlers

Introducing your baby to new foods is an exciting stage of your child’s life. Some parents may wonder what happens when you offer foods like peanut butter, eggs, or yogurt for the first time. If you are concerned about food allergies, or there’s a history of food allergies in your family, take the time to learn the symptoms of an allergic reaction in babies.

Infants have still-developing immune systems, which means their bodies are learning what is harmful and what is not. Sometimes, their immune system overreacts to certain foods. It treats them like dangerous invaders. This is a food allergy, and in some severe cases, can lead to a life-threatening allergic reaction called anaphylaxis.

A young child reaches for a piece of orange held by an adult at a table, with pieces of avocado and cauliflower on a plate in front of the child.

While anaphylaxis may sound frightening, it is uncommon in infants and toddlers. If it does occur, early recognition and prompt treatment with epinephrine are important. Young children usually respond very well when treated quickly.

Signs and symptoms of anaphylaxis can look different in babies compared to older children or adults. Since babies can’t explain what they’re feeling, caregivers must be alert to subtle signs and symptoms. Reactions can be hard to spot and may vary from child to child, which makes learning the early warning signs an essential step in keeping your baby safe.

  • 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.

Identifying food allergy symptoms

Babies can’t tell us what’s wrong, so it’s important for parents and caregivers to know what to look for. Allergic reactions in babies can sometimes be mistaken for fussiness or a common cold.

Determining if it is a food allergy

Immediate IgE-mediated reactions

A food allergy happens because of an overactive immune system. It is caused by proteins in the body called IgE (short for Immunoglobulin E). IgE helps fight off allergens that your body thinks are harmful. In food allergies, IgE overreacts to certain foods and releases a chemical called histamine. Histamine is what causes symptoms like hives, swelling and trouble breathing.

An allergic reaction can happen within within minutes up to a few hours after eating a food. Symptoms can lead to a severe allergic reaction if not treated right away.

Delayed non-IgE reactions

Delayed non-IgE reactions are caused by the immune system, but they do not involve IgE antibodies. These reactions are usually not life-threatening.

Delayed non-IgE reactions are sometimes called non-IgE food allergies. They differ from true IgE-mediated food allergies because IgE is not involved. Symptoms can include skin reactions such as eczema (a dry, itchy rash) or stomach troubles like belly pain, diarrhea or vomiting These symptoms may appear more slowly – sometimes hours or even days after eating the food.

There is no specific test to diagnose delayed non-IgE reactions. Doctors rely on a detailed health history and may suggest an elimination diet if it’s safe for your baby. An elimination diet involves removing certain foods from the diet, and then reintroducing them to see if symptoms return. An elimination diet should only be done under the supervision of a doctor.

What are the symptoms of anaphylaxis in infants and toddlers?

Navigating food allergies in infants and toddlers can feel extra challenging because they are unable to use words to tell you what they are feeling. If your child consumes a food allergen, it is going to be up to you to recognize the signs and symptoms of the reaction. Knowing the signs and symptoms can help with the initial diagnosis and identifying accidental exposures.

Generally, food allergy reactions in infants and toddlers tend to be mild. But in some cases, an allergic reaction can be severe. This is anaphylaxis. It’s different from mild allergy symptoms like a skin rash (hives) or a runny nose. Anaphylaxis affects two or more body systems, including the skin, lungs, stomach, and heart. It is also diagnosed if symptoms get worse very quickly in one body system.

Fortunately, severe reactions in infants and toddlers are rare.

The first line of treatment for anaphylaxis is epinephrine. Symptoms of anaphylaxis in babies and young children tend to respond well to epinephrine, especially if they are caught early. If anaphylaxis happens and symptoms do not improve, worsen, or they come back after the first dose of epinephrine, it’s important to contact emergency services, followed by your child’s healthcare team.

The best thing you can do is recognize anaphylaxis symptoms quickly so you can give epinephrine fast. The symptom recognition guide below – based in part on the American Academy of Pediatrics (AAP) Allergy & Anaphylaxis Emergency Plan – lists the specific signs of anaphylaxis to watch for in infants and toddlers.

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

These symptoms can happen right after eating or a few hours later. Always write down what your baby ate and when symptoms appeared. This helps your doctor diagnose a food allergy.

Anaphylaxis in infants is not always obvious. Knowing how your baby is when healthy will help you improve anaphylaxis recognition because you will be able to spot when something is not normal. You might see sudden behavioral changes like clinginess, crankiness, or limpness. If you notice any of these signs and symptoms, act fast.

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.

Managing allergic reactions: REAct

If your baby or toddler is at risk for a severe allergic reaction, be prepared. Work together with your child’s pediatrician or pediatric allergist to develop an anaphylaxis action plan. This plan explains…

  1. How to recognize life-threatening symptoms
  2. How to treat anaphylaxis and when to give epinephrine
  3. When to call for emergency medical help

Everyone who cares for your infant or toddler (parents, babysitters and daycare staff) should know how to respond to anaphylaxis. The longer an anaphylactic reaction goes without treatment, the more dangerous it becomes. The only way to treat it is to use life-saving epinephrine. Use epinephrine first, epinephrine fast. One easy way to remember is called REAct.

R = Recognize anaphylaxis

Know the signs and symptoms of a serious allergic reaction. These may include:

  • Widespread hives on the skin
  • Itchiness
  • Swelling of the lips, tongue, or throat
  • Trouble breathing, belly breathing or noisy breathing
  • Severe vomiting, diarrhea or stomach upset
  • Changes in blood pressure
  • Limpness
  • Pale or blue skin (especially lips and fingers)
  • Change in behavior: crankiness, clinginess, or unusual tiredness

If you see these anaphylaxis symptoms in your baby and they affect more than one body system, give epinephrine right away.

E = Epinephrine first

Epinephrine is the first-line treatment and the only medicine that can stop anaphylaxis. It works quickly to reverse the symptoms of an allergic reaction, whether from food allergies, insect stings, medication allergy or latex allergy.

You should:

  • Always have two doses of epinephrine with you and your child at all times. (The second dose is for if symptoms return or worsen after the first dose.)
  • Practice using a trainer epinephrine product so you can act fast if your baby shows signs of anaphylaxis.
  • Train those who care for your infant to be confident in giving epinephrine.

If you’re unsure whether your child is experiencing an allergic reaction, give epinephrine anyway. It’s better to be safe. Epinephrine is safe and giving it quickly can prevent anaphylaxis.

If you do not have epinephrine on hand to treat anaphylaxis, you should call 911 for emergency medical help or go to the hospital or emergency department for treatment. Do not delay!

Act = Activate emergency response

Whenever your baby has an anaphylactic reaction, it’s important to activate your emergency plan based on shared decision making with your allergist.

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 continually monitor your baby’s symptoms during and after the reaction. 

You should call for emergency medical help or go to the hospital or clinic if…

  • symptoms return or worsen after the first dose of epinephrine.
  • your baby has severe anaphylaxis;
  • symptoms do not go away promptly or completely after the first dose of epinephrine;
  • a second dose of epinephrine is needed.

Work together with your child’s healthcare team to develop an anaphylaxis action plan. This plan will tell you exactly what to do in case of 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.

After the case of anaphylaxis is resolved, don’t forget to schedule a follow-up appointment with a pediatrician or a food allergy specialist. You may need to discuss what happened and make a change to your child’s anaphylaxis action plan.

Questions & answers (Q&A) on food allergy symptoms and management

The first step toward preventing an anaphylactic reaction is being able to recognize food allergy symptoms. Here are answers to some common questions we’re asked about food allergies and anaphylaxis in infants and toddlers.

If your baby shows sudden changes in appearance or how they act soon after eating, it might be a food-allergic reaction. Sudden symptoms may include hives on the skin, swelling, breathing problems, stomach issues and/or high or low blood pressure.

Reactions can happen within minutes to two hours of eating the food.

If the symptoms seem mild, call your doctor. But if your baby’s reaction seems to be getting worse quickly, or if more than one body organ is affected (skin, stomach, breathing, heart), give epinephrine right away. If you do not have access to epinephrine, call 911.

Some babies can have an allergic reaction after touching a food allergen. These reactions are usually mild and affect the skin. Symptoms may include:

  • A rash (hives) where the food touched
  • Itchy skin or swelling

Touching a food is unlikely to lead to anaphylaxis. It’s still important to watch your baby closely. If your baby touches a food allergen and then rubs the eyes or mouth, the reaction could get worse.

Some babies outgrow food allergies as they get older, especially those with allergies to milk, egg or soy. Others may keep their allergies into childhood or adulthood. Every baby or toddler is different, though.

It’s important to have regular checkups with a pediatrician or pediatric allergist who can monitor your baby’s symptoms, do allergy tests if needed, and guide you on safe foods. In the meantime, always avoid the allergen and follow your child’s care plan.

Most allergic reactions happen soon after eating – usually within a few minutes to two hours. However, in some babies, symptoms can take longer to appear, especially if the reaction affects the digestive system. Even when symptoms show up hours later, they are still signs of a food allergy.

Keep an eye out for:

  • New widespread hives
  • Vomiting (more than once)
  • Diarrhea
  • Strong stomach pain or discomfort
  • Refusing to eat or spitting up more than usual

If these symptoms happen along with other signs of an allergic reaction – such as hives, swelling, or breathing problems – give epinephrine right away (if prescribed) or call 911 for emergency help.

Trust your instincts. If something doesn’t seem right, it’s always safest to reach out to your child’s doctor or seek medical care immediately.

Some babies are more likely to develop food allergies than others. Knowing if your baby is high risk can help you make safe choices about when and how to start new foods.

Babies may be at higher risk if they:

  • Have moderate to severe eczema. Babies with eczema that starts early or is hard to control have a higher chance of developing food allergies, especially to peanuts and eggs.
  • Already have a food allergy. If your baby reacts to one food, they may be more likely to react to others.
  • Have a parent or sibling with allergies. A family history of allergies, asthma, or eczema can raise your baby’s risk.

If your baby is high risk, talk with your baby’s healthcare team before introducing foods like peanuts, eggs, or milk. Doctors now suggest introducing these foods early to help lower the chance of developing allergies later.

Knowing your baby’s risk helps you plan ahead. With your doctor’s help, you can introduce foods safely and support your baby’s healthy growth and development.

Babies are considered at high risk for food allergies if they have…

  • Moderate to severe eczema (an itchy, bumpy skin condition)
  • A parent or sibling with food allergies, asthma, or eczema

Talk to your doctor about the best way to introduce common allergens, like peanuts, tree nuts or eggs, into your baby’s diet.