Babies can experience anaphylactic shock. Anaphylaxis is a severe, rapidly progressing, life-threatening allergic reaction affecting multiple body systems. This immune response is triggered when the body encounters a substance it mistakenly identifies as a threat. Understanding the signs and knowing how to respond is paramount, as this reaction can quickly compromise a child’s breathing and circulation.
How Anaphylaxis Presents in Infants
Recognizing anaphylaxis in a nonverbal infant presents a challenge, as signs are often subtle and can mimic other childhood ailments. Infants cannot communicate sensations like an itchy throat. Parents must observe distinct physical and behavioral changes that signal a severe, systemic reaction. Symptoms typically involve two or more of the body’s organ systems and progress rapidly.
Skin reactions are the most common initial sign, appearing as generalized hives, widespread flushing, or swelling around the eyes, lips, and tongue. These symptoms can sometimes be the only observable sign. Observing a sudden pale or bluish discoloration of the skin, particularly around the mouth or on the extremities, indicates a drop in blood pressure.
Respiratory distress is a serious manifestation requiring immediate attention. Parents may notice a persistent cough, wheezing, or stridor, a high-pitched, noisy sound that occurs when the upper airway is obstructed. Other signs of breathing difficulty include rapid breathing, nasal flaring, or a hoarse or weak cry. Any sign of breathing trouble following allergen exposure should be treated as an emergency.
Gastrointestinal symptoms can also be a primary sign, often manifesting as sudden, severe vomiting or persistent diarrhea. These digestive signs, especially when combined with a skin or respiratory symptom, indicate a severe allergic reaction. A sudden and unexplained change in behavior is also a significant indicator of systemic distress, including lethargy, inconsolable crying, unusual sleepiness, or sudden limpness with poor head control.
Identifying Common Allergic Triggers
Food allergens are the most frequent cause of anaphylaxis in infants, often encountered during the introduction of new foods. The most common culprits are cow’s milk and hen’s egg, which account for a large percentage of allergic reactions in the first year of life. Peanut and tree nuts, such as cashew and walnut, also pose a risk.
Other common food triggers include soy and wheat, found in various infant formulas and early solid foods. The timing of an infant’s first exposure to a new food is a high-risk period. Reactions to non-food items, while less common in infants, can also cause anaphylaxis.
Certain medications, most notably penicillin-based antibiotics like amoxicillin, can trigger severe allergic reactions. In rare cases, stings from insects, like bees or wasps, can cause anaphylaxis. Parents should discuss the risk of all potential allergens with their pediatrician before introducing new foods or medications.
Emergency Protocol and Treatment
The immediate administration of epinephrine is the most important action during an acute anaphylactic episode. It is the only medication that can halt the progression of a severe reaction. Epinephrine reverses life-threatening symptoms by relaxing airway muscles and stabilizing mast cells. The medication is delivered via an auto-injector, such as the EpiPen Jr., which contains a pre-measured 0.15 mg dose.
Caregivers should administer the auto-injector dose into the muscle of the anterolateral thigh. This intramuscular injection provides the quickest absorption and best effect, and it can be given directly through clothing. The benefit of rapidly administering epinephrine outweighs the risk of the medication itself.
After the first dose of epinephrine, emergency medical services (EMS) must be called immediately by dialing 911 or the local emergency number. The infant should be kept lying flat on their back with their legs elevated to help with circulation. If they are vomiting or experiencing severe breathing difficulty, they should be placed on their side. If symptoms do not improve or worsen within five to fifteen minutes, a second dose of epinephrine should be administered, provided a second auto-injector is available.
The infant must be transported to an emergency department for observation, even if the injection appears to have resolved the symptoms. This follow-up care is necessary because anaphylaxis can involve a biphasic reaction, where symptoms return hours after the initial reaction has cleared. Antihistamines and inhaled bronchodilators may be given at the hospital, but they should never be used as a substitute for the initial epinephrine injection.
Long-Term Diagnosis and Management
Following an anaphylactic event, a referral to an allergist is necessary to confirm the specific trigger and develop a long-term management plan. The allergist will conduct diagnostic testing, which may include skin prick tests or blood tests to measure Immunoglobulin E (IgE) antibodies. These tests help identify the allergen responsible for the reaction.
The allergist will create an individualized Anaphylaxis Action Plan, a document outlining how to recognize and treat future reactions. This plan specifies the child’s known allergens, lists the symptoms to watch for, and provides clear instructions for using the epinephrine auto-injector. This document should be shared with all caregivers and childcare providers.
Management centers on allergen avoidance, requiring careful reading of food labels and preparation of meals. Since the risk of recurrence is present, parents must consistently carry two prescribed epinephrine auto-injectors at all times. Periodic follow-up appointments are needed to re-evaluate the child’s allergies and adjust the epinephrine dosage as the infant grows and gains weight.