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What is anaphylaxis?

Anaphylaxis is a serious allergic reaction that often affects many body systems. It comes on quickly and can be fatal.

Parents and caregivers should know the signs and symptoms of anaphylaxis and what to do in case it happens to their child. Immediate medical attention is important!

Causes

Anaphylaxis occurs when the immune system overreacts to normally harmless substances called allergens . Children with asthma and allergies to certain foods, stinging insects, or medicines are at highest risk, though anaphylaxis may occur in anyone.

Common allergens that can trigger anaphylaxis include

  • Foods such as peanuts; nuts from trees, like walnuts, pistachios, pecans, and cashews; shellfish like shrimp and lobster; fish like tuna, salmon, and cod; milk; eggs. In rare cases, anaphylaxis may be related to a certain food followed by exercise.

  • Insect stings from bees, wasps, hornets, yellow jackets, and fire ants.

  • Medicines like antibiotics and antiseizure medicines. However, any medicine, even aspirin and other nonsteroidal anti-inflammatory drugs, have the potential to cause severe reactions.

Signs and Symptoms

Anaphylaxis includes a range of signs and symptoms that often happen quickly and occur at the same time. The most severe symptoms restrict breathing and blood circulation. Signs and symptoms are different for each child and may include

  • Skin: itching, hives, redness, swelling

  • Nose: sneezing, stuffy nose, runny nose

  • Mouth: itching, swelling of lips or tongue

  • Throat: itching, tightness, difficulty swallowing, hoarseness

  • Gut: vomiting, diarrhea, cramps

  • Chest: shortness of breath, cough, wheeze, chest pain, tightness

  • Heart: weak pulse, passing out, shock

  • Nervous system: dizziness, fainting, feeling that you are about to die

Treatment

For anyone experiencing anaphylaxis, epinephrine should be given right away followed by a call to 911 for further treatment and transfer to a hospital.

Epinephrine is the main medicine to treat anaphylaxis. The medicine comes in auto-injector syringes. It's important to know how to use the medicine. Your child's doctor can go through the medicine directions with you. Ask your child's doctor what to do if the symptoms do not improve very quickly after a single dose.

Epinephrine should be prescribed for anyone who has ever had an anaphylactic attack and for children at high risk for anaphylaxis. Epinephrine is available in 2 different doses based on the weight of the child. Parents and caregivers should always have at least 2 doses with them when with their child. The best place to inject it is in the muscles of the outer part of the thigh.

Children who are old enough can be taught how to give themselves epinephrine if needed. School-aged children also need one at school with instructions from their doctor about how and when to use it. It is important to share this action plan with anyone who cares for your child.

During a reaction, an oral antihistamine may also be given, but not in place of epinephrine. Also helpful in case of an emergency is medical identification jewelry that includes information about your child's allergy. This should be worn at all times.

Prevention

After an anaphylactic attack, your child needs to be seen by a doctor. Even if the cause seems obvious, there may be other causes. An evaluation by an allergist is often needed. An allergist has specialized training in diagnosing the cause of anaphylaxis and providing additional treatment. They will recommend a prevention and treatment plan based on the causes.

In most cases, the only way to prevent an attack from happening again is to avoid the cause. An emergency action plan describing the allergies, symptoms, and treatments is important so that the child and any caregivers knows what do if another attack occurs.

Note: Although children's allergies are often outgrown, anaphylaxis often lasts for many years or even for life. Your child's doctor may recommend regular checkups to see if your child is still allergic and to review how to avoid triggers and treat reactions. In the case of anaphylaxis caused by stinging insects, immunotherapy (also called allergy injections or allergy shots ) can help prevent anaphylaxis from future stings, but is currently not available for other types of anaphylactic allergies.

For More Information

American Academy of Pediatrics

www.aap.org and www.HealthyChildren.org

  • Download and fill out an Allergy and Anaphylaxis Emergency Plan at www.HealthyChildren.org/AnaphylaxisPlan .

American Academy of Allergy, Asthma & Immunology

www.aaaai.org/tools-for-the-public

American College of Allergy, Asthma & Immunology

www.acaai.org

Food Allergy & Anaphylaxis Network

www.foodallergy.org

Disclaimer

The AAP is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.

In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion.

Any websites, brand names, products, or manufacturers are mentioned for informational and identification purposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication. The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

AAP Feed run on: 4/3/2025 Article information last modified on: 9/23/2024

Croup: When Your Child Needs Hospital Care

Croup is a common illness that affects the airways, making it hard for a child to breathe. It's most common in toddlers but can affect children between 6 months and 12 years of age.

Another symptom is a loud barking cough that is worse at night. Trouble breathing and the barking cough can be scary for parent and child. Most children with viral croup also have a fever.

When to Call 911

Most cases of croup can be treated at home. However, children with severe cases of croup may need to be treated in the hospital. Call 911, your local emergency number, or an ambulance right away if your child

  • Makes a whistling sound (called stridor) that gets louder with each breath.

  • Cannot speak because of a lack of breath.

  • Seems to struggle to get a breath.

  • Has pale, bluish or grayish colored lips, mouth, or fingernails.

  • Drools or has trouble swallowing.

Care At the Hospital

At the hospital, your child's doctor will decide the best way to treat your child. Treatments may include the following:

  • Epinephrine. This medicine can help reduce swelling in the upper airways so that your child can breathe better. Epinephrine is given through a nebulizer . A nebulizer is a machine that turns liquid medicine into a fine mist. The mist is breathed in through a mouthpiece or face mask. Often, when this medicine is used, doctors prefer to continue to watch a child for several hours after it is given. This sometimes requires a stay in the hospital.

  • Corticosteroids. These medicines can be useful in reducing inflammation in the body. They work in 2 ways. Systemic corticosteroids must go through the body to treat the inflammation in the upper airway. Inhaled or intranasal corticosteroids go directly to where the inflammation is. (Corticosteroids are not the same as anabolic steroids that are used illegally by some athletes to build muscle.)

  • Oxygen. Sometimes when breathing is very difficult for a child, the body may not get enough oxygen. Oxygen given through a mask or a small tube near the nose will make it easier to breathe.

As soon as your child's breathing improves, usually within a few hours, they will be allowed to go home. Sometimes a child with croup will stay in the hospital overnight for observation.

Care At Home

If your child has a mild case of croup, breathing in moist air may help.

  • Bring your child into a bathroom where a hot shower is running. Let your child breathe in the moist air to help open their airway. However, do not leave a young child alone with the shower running.

  • Use a cool-mist humidifier in your child's room.

  • Take your child outdoors for a few minutes. Inhaling moist, cool night air may help open the air passages so that they can breathe more freely. Remember to dress your child for the cold weather.

If breathing in moist air doesn't help and you notice any of the symptoms to watch for (see When to Call 911), your child needs to be taken to the hospital right away. Call 911 or an ambulance for help.

Help Keep Your Child Healthy

Here are ways to keep your child healthy:

  • Stop germs from spreading. Most cases of croup are caused by cold and flu viruses. Frequent hand washing with soap is the best way to prevent germs from spreading. You can also use a waterless hand cleaner.

  • Avoid germs. Try to keep your child away from other children with croup or other upper respiratory infections (such as colds and flu).

  • Avoid smokers. Do not let anyone smoke around your child, as it can make croup worse.

Visit HealthyChildren.org for more information.

Disclaimer

The AAP is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.

In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Copyright © American Academy of Pediatrics Date Updated: Nov 17 2024 20:38 Version 0.1

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