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Anaphylaxis

For anyone experiencing anaphylaxis, epinephrine should be given right away followed by a call to 911 for further treatment and transfer to a hospital. The main medicine to treat anaphylaxis is epinephrine. This is a medicine given by an injection. The best place to inject it is in the muscles of the outer part of the thigh. If the symptoms do not improve very quickly, the injection should be given again in 5 to 30 minutes.

Anaphylaxis is a serious allergic reaction. It comes on quickly and can be fatal. It often affects many body systems. This type of reaction is a medical emergency and immediate medical attention is important. Children with asthma and allergies to certain foods, stinging insects, or medicines are at highest risk, though anaphylaxis may occur in anyone. Your pediatrician may refer you to an allergist. An allergist has specialized training in diagnosing the cause of anaphylaxis and providing additional treatment. Parents should know the symptoms of anaphylaxis and what to do in case it happens to their child.

What are the symptoms of anaphylaxis?

Anaphylaxis includes a wide range of symptoms that often happen quickly. The most severe symptoms restrict breathing and blood circulation. Combinations of symptoms may occur. The most common symptoms may affect the following:

  • SKIN: itching, hives, redness, swelling

  • NOSE: sneezing, stuffy nose, runny nose

  • MOUTH: itching, swelling of lips or tongue

  • THROAT: itching, tightness, difficulty swallowing, hoarseness

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

  • HEART: weak pulse, passing out, shock

  • GUT: vomiting, diarrhea, cramps

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

What causes anaphylaxis?

Anaphylaxis occurs when the immune system overreacts to normally harmless substances called allergens. The following are the most common allergens that can trigger anaphylaxis:

  • Food such as

    • Peanuts

    • Nuts from trees (such as walnuts, pistachios, pecans, cashews)

    • Shellfish (such as shrimp, lobster)

    • Fish (such as tuna, salmon, cod)

    • Milk

    • Eggs

  • In rare cases, anaphylaxis may be related to a certain food followed by exercise.

  • Insect stings such as from

    • Bees

    • Wasps

    • Hornets

    • Yellow jackets

    • Fire ants

  • Medicines. Antibiotics and antiseizure medicines are some of the more common medicines that cause anaphylaxis. However, any medicine, even aspirin and other non­steroidal anti-inflammatory drugs, have the potential to cause severe reactions.

What should I do if my child has an anaphylactic reaction?

For anyone experiencing anaphylaxis, epinephrine should be given right away followed by a call to 911 for further treatment and transfer to a hospital. The main medicine to treat anaphylaxis is epinephrine. This is a medicine given by an injection. The best place to inject it is in the muscles of the outer part of the thigh. If the symptoms do not improve very quickly, the injection should be given again in 5 to 30 minutes.

Children who are old enough can be taught how to give themselves epinephrine if needed. The medicine comes in auto-injector syringes (EpiPen or Twinject) to make this easier. Epinephrine should be prescribed for anyone who has ever had an anaphylactic attack and for children at high risk for anaphylaxis. They are available in 2 different doses based on the weight of the child. You should always have at least 2 doses with you at all times. School-aged children also need one at school with instructions from their doctor about how and when to use it.

During a reaction, an oral antihistamine may also be given, but not as a substitute for 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. Your doctor should also give you a written action plan outlining the steps to take in the event of an emergency. It is important to share this action plan with anyone who cares for your child.

How can I prevent another anaphylactic attack?

After an anaphylactic attack, your child needs to be seen by a doctor. Even if the cause seems obvious, it may be more complicated than you think. An evaluation by an allergist is often needed to identify the cause(s). A customized care plan for prevention and treatment can be created once the causes are known.

In most cases, the only way to prevent it from happening again is to avoid the cause. However, your child's care plan can help provide safe alternatives without unnecessary restriction of safe foods, medicines, or activities. An emergency action plan describing the allergies, symptoms, and treatments can help prepare you if your child has another attack.

Can anaphylaxis be outgrown or cured?

Although children's allergies are often outgrown, anaphylaxis frequently lasts for many years or even for life. Periodic reevaluation may be needed 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 shots) can help prevent anaphylaxis from future stings, but is currently not available for other types of anaphylactic allergies.

To find out more

  • American Academy of Pediatrics— Section on Allergy and Immunology: www.aap.org/sections/allergy

  • American Academy of Allergy Asthma & Immunology: www.aaaai.org/patients/gallery

  • American College of Allergy, Asthma & Immunology: www.acaai.org/public

  • Food Allergy & Anaphylaxis Network (FAAN): www.foodallergy.org

Please note: Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this publication. Phone numbers and Web site addresses are as current as possible, but may change at any time.

Products are mentioned for informational purposes only. Inclusion in this publication does not imply endorsement by the American Academy of Pediatrics.

Last Reviewed:9/20/2019 2:20:08 AM
Last Revised:9/19/2019 10:07:50 PM
Copyright © 2007 American Academy of Pediatrics

Choking Prevention and First Aid for Infants and Children

When children begin crawling, or eating table foods, parents must be aware of the dangers and risks of choking. Children younger than 5 years can easily choke on food and small objects.

When children begin crawling, or eating table foods, parents must be aware of the dangers and risks of choking. Children younger than 5 years can easily choke on food and small objects.

Choking occurs when food or small objects get caught in the throat and block the airway.This can prevent oxygen from getting to the lungs and the brain. When the brain goes without oxygen for more than 4 minutes, brain damage or even death may occur. Many children die from choking each year. Most children who choke to death are younger than 5 years. Two-thirds of choking victims are infants younger than 1 year.

Balloons, balls, marbles, pieces of toys, and foods cause the most choking deaths.

Read more about choking prevention and first aid.

Dangerous foods

Do not feed children younger than 4 years round, firm food unless it is chopped completely. Round, firm foods are common choking dangers. When infants and young children do not grind or chew their food well, they may try to swallow it whole. The following foods can be choking hazards:

  • Hot dogs

  • Nuts and seeds

  • Chunks of meat or cheese

  • Whole grapes

  • Hard, gooey, or sticky candy

  • Popcorn

  • Chunks of peanut butter

  • Raw vegetables

  • Fruit chunks, such as apple chunks

  • Chewing gum

Dangerous household items

Keep the following household items away from infants and children:

  • Balloons

  • Coins

  • Marbles

  • Toys with small parts

  • Toys that can be squeezed to fit entirely into a child's mouth

  • Small balls

  • Pen or marker caps

  • Small button-type batteries

  • Medicine syringes

What you can do to prevent choking

  • Learn CPR (cardiopulmonary resuscitation) (basic life support).

  • Be aware that balloons pose a choking risk to children up to 8 years of age.

  • Keep dangerous foods from children until 4 years of age.

  • Insist that children eat at the table, or at least while sitting down. They should never run, walk, play, or lie down with food in their mouths.

  • Cut food for infants and young children into pieces no larger than one-half inch, and teach them to chew their food well.

  • Supervise mealtime for infants and young children.

  • Be aware of older children's actions. Many choking incidents occur when older brothers or sisters give dangerous foods, toys, or small objects to a younger child.

  • Avoid toys with small parts, and keep other small household items out of the reach of infants and young children.

  • Follow the age recommendations on toy packages. Age guidelines reflect the safety of a toy based on any possible choking hazard as well as the child's physical and mental abilities at various ages.

  • Check under furniture and between cushions for small items that children could find and put in their mouths.

  • Do not let infants and young children play with coins.

First aid for the child who is choking

Make a point to learn the instructions on the following pages of this publication. Post the chart in your home. However, these instructions should not take the place of an approved class in basic first aid, CPR, or emergency prevention. Contact your local American Red Cross office or the American Heart Association to find out about classes offered in your area. Most of the classes teach basic first aid, CPR, and emergency prevention along with what to do for a choking infant or child. Your pediatrician also can help you understand these steps and talk to you about the importance of supervising mealtime and identifying dangerous foods and objects.

Last Reviewed:9/20/2019 2:20:11 AM
Last Revised:9/19/2019 10:07:56 PM
Copyright ©2006

CPR

In the past, we used the "ABC's of CPR " because it reminded us that there was a very specific order in which a person should be resuscitated. However, the American Heart Association updated its recommendations for CPR in October, 2010 and now recommends that an untrained rescuer begin chest compressions immediately. The ABC acronym has been changed to CAB.


Compressions
Airway
Breathing

Untrained rescuers should focus on continuous compressions and not perform mouth-to-mouth resuscitation if they are not familiar with it.

CPR FOR INFANTS (under 1 year)

EVALUATE your child's condition. Shout or gently shake your child to see if he will awaken. Put your ear next to his nose and listen for breathing. Look at the chest to see if it rises with each breath.

CALL FOR HELP. Have someone dial 911. If no one is available, do CPR for 2 minutes before calling 911.

IF YOUR CHILD IS NOT BREATHING OR WILL NOT AWAKEN:

POSITION your child. Put him on his back on a firm surface. If you think he could have injured his neck, support his head in order to keep the neck from twisting as you roll him over.

TILT THE HEAD BACK so that his nose is "in the air". Check the mouth to make sure your child has not choked on anything.

diagram of woman doing CPR on an infant under 1

BEGIN CHEST COMPRESSIONS. With an infant, place two fingers on the breastbone, with your index finger at the height of the nipples. Compress at a depth of 1 1/2 inches (about 1/3 of the chest height) at a rate of two compressions per second. Do 30 compressions.

GIVE 2 RESCUE BREATHS. For an infant, place your mouth over his mouth and nose and breathe GENTLY, watching to see if the chest rises and falls. If not, readjust the head (see POSITION above), then give 2 breaths and return to chest compressions. NOTE: If the chest will not rise (or you do not know how to do rescue breaths), skip that step and just do chest compressions. You can try it again after 30 more compressions*.

*Continue chest compressions and breathing until paramedics arrive.

CPR FOR CHILDREN (1 to 8 years)

EVALUATE your child's condition. Shout or gently shake your child's shoulders to see if he will awaken. Put your ear next to his nose and listen for breathing. Look at the chest to see if it rises with each breath.

CALL FOR HELP. Have someone dial 911. If no one is available, do CPR for 2 minutes before calling 911.

IF YOUR CHILD IS NOT BREATHING OR WILL NOT AWAKEN:

POSITION your child. Put him on his back on a firm surface. If you think he could have injured his neck, support his head in order to keep the neck from twisting as you roll him over.

TILT THE HEAD BACK so that his nose is "in the air". Check the mouth to make sure your child has not choked on anything.

BEGIN CHEST COMPRESSIONS. For a child, put one hand on the chest between his nipples. Lock your elbows and press straight down about 2 inches. Continue for 30 compressions at a rate of two compressions per second.

GIVE 2 RESCUE BREATHS. For a child, place your mouth over his mouth and press his nose shut with your fingers. Breathe GENTLY, watching to see if the chest rises and falls. If not, readjust the head (see POSITION above), then give 2 breaths and return to chest compressions. NOTE: If the chest will not rise (or you do not know how to do rescue breaths), skip that step and just do chest compressions. You can try it again after 30 more compressions*.

*Continue chest compressions and breathing until paramedics arrive.

CPR FOR OLDER CHILDREN & ADULTS

EVALUATE THE VICTIM Shout or gently shake her shoulders to see if she will awaken. Put your ear next to her nose and listen for breathing. Look at the chest to see if it rises with each breath.

CALL FOR HELP. Have someone dial 911. If no one is available, do CPR for 2 minutes before calling 911.

IF THE VICTIM IS NOT BREATHING OR WILL NOT AWAKEN:

POSITION the victim. Put her on her back on a firm surface. If you think she could have injured her neck, support her head in order to keep the neck from twisting as you roll her over.

TILT THE HEAD BACK so that her nose is "in the air". Use a "Chin Lift" by pulling up on the back of the jaw to open the airway. If you did not witness the event, check the mouth to see if there is any food/foreign body.

BEGIN CHEST COMPRESSIONS. Put the heel of your hand in the middle of her chest, placing the other hand over the first hand. Lock your elbows and press straight down about 2 inches. Allow the chest to return to its normal position. Continue for 30 compressions at a rate of 100 times a minute. (Some people recommend that you press to the beat of "Stayin' Alive").

If you have NOT been trained in CPR, you may continue to just give chest compressions until help arrives or the victim wakes up. Otherwise, proceed to give rescue breaths.

If you are in a public building that has an automated external defibrillator (AED), turn it on. If you saw the victim collapse, attach the AED immediately and follow the instructions. Otherwise, perfom CPR for 1 minute before using the AED.

GIVE 2 RESCUE BREATHS. Place your mouth over her mouth (or use a CPR mask if available) and press her nose shut with your fingers. Breathe GENTLY, watching to see if the chest rises and falls. If not, readjust the head (see POSITION above), then give 2 breaths and return to chest compressions. NOTE: If the chest will not rise (or you do not know how to do rescue breaths), skip that step and just do chest compressions. You can try it again after 30 more compressions*.

*Continue chest compressions and breathing until paramedics arrive.

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 low fever.

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 low fever.

Symptoms to watch for

Most cases of croup can be treated successfully at home. However, children with severe cases of croup may need to be treated in the hospital. Call 911 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 a bluish color of the lips, mouth, or fingernails.

  • Drools or has trouble swallowing.

Care of your child 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 and the work of breathing increases. Oxygen given through a mask or a small tube near the nose will make it easier to breathe.

When can my child go home?

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

Care of your child 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 her 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 she 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" listed previously, your child needs to be taken to the hospital right away. Call 911 or an ambulance for help.

Keep your child healthy

The following 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.

Last Reviewed:9/20/2019 2:20:12 AM
Last Revised:9/19/2019 10:07:57 PM
Copyright © 2008

Poison Control Hotline

For a poison emergency in the U.S. call 1-800-222-1222

When Your Child Needs Emergency Medical Services

It is rare for children to become seriously ill with no warning. Depending on your child's symptoms, you usually should contact your child's pediatrician for advice. Early recognition and treatment of symptoms can prevent an illness or injury from getting worse or turning into an emergency.

When Your Child Needs Emergency Medical Services

It is rare for children to become seriously ill with no warning. Depending on your child’s symptoms, you should usually contact your child’s doctor for advice. Early recognition and treatment of symptoms can prevent an illness or injury from getting worse or turning into an emergency.

What is an emergency?

An emergency is when you believe a severe injury or illness is threatening your child’s health or may cause permanent harm. In these cases, a child needs emergency medical treatment right away.

Discuss with your child’s doctor in advance what you should do and where you should go in case of an emergency.

Emergencies can result from medical illnesses. In an emergency, your child may show any of the following signs:

  • Strange or more withdrawn and less alert behavior

  • Unconsciousness or no response when you talk with your child

  • Rhythmic jerking (a seizure)

  • Increasing effort or trouble with breathing

  • Skin or lips that look blue, purple, or gray

  • Neck stiffness with fever

  • Increasing or severe persistent pain

  • A cut that is large, deep, or to the head, chest, or abdomen

  • Bleeding that does not stop after applying pressure for 5 minutes

  • A burn that is large or involves the hands, feet, groin, chest, or face

  • Any loss of consciousness, ongoing or worsening confusion, headache, or vomiting after a head injury

Many emergencies involve sudden injuries. These injuries are often caused by the following events:

  • Bicycle or car crashes

  • Falls

  • Burns or smoke inhalation

  • Choking

  • Drowning

  • Firearms or other weapons

  • Electric shocks

  • Poisoning*

*Call Poison HELP line at 1-800-222-1222 at once if your child has swallowed a suspected poison, another person’s medicine, a button battery, or a magnet—even if your child has no signs or symptoms.

Call 911 (or your local emergency number) for help if your child is not breathing, your child is unconscious or having a seizure, or you are concerned that your child’s life may be in danger or that your child is seriously ill or injured. Call your child’s doctor if you think your child is ill or have a question about an injury or illness.

In addition, every parent should be prepared. Part of preparation includes learning CPR (cardiopulmonary resuscitation) and basic first aid. For classes near you, contact your child’s doctor, the American Red Cross, the American Heart Association, or a national or local organization that offers training.

In case of an emergency

  • Stay calm.

  • Start CPR if your child is not responsive.

  • Give rescue breaths if your child is not breathing.

  • Call 911 if you need immediate help. If you do not have 911 service in your area, call your local emergency ambulance service or county emergency medical service. Most cell phones can reach 911, but you will have to tell the operator where you are.

  • Apply continuous pressure to the site of bleeding with a clean cloth.

  • Place your child on the floor with her head and body turned to the side if she is having a seizure. Do not put anything into her mouth.

  • Do not move your injured child unless he is in immediate danger (eg, from a fire).

  • Stay with your child until help arrives.

Bring any medicine your child is taking with you to the hospital. Also, bring suspected poisons or other medicines your child might have taken.

After you arrive at the emergency department, make sure you tell emergency staff the name of your child’s doctor. Your child’s doctor can work closely with emergency department doctors and nurses and can provide them with more information about your child.

It is important to have an Emergency Information Form or similar form for each of your children. It should include cell phone numbers for parents, an emergency contact other than the parents, and health care needs of the child, including medicines and allergies. This form is available from the American Academy of Pediatrics (www.aap.org>) and the American College of Emergency Physicians (www.acep.org). Attach the Emergency Information Form to a filled in copy of the Emergency Contact Information form (see end of this publication), and give it to the first emergency care person who sees your child.

It is important that babysitters and child caregivers have these numbers and know the following steps to take in an emergency:

  • How to dial 911 or your local emergency number

  • Whether 911 can be reached from a cell phone in your area

  • Your home address, directions to your home or current location, and a phone number (An emergency operator would ask for this.)

  • Location of a spare car safety seat

  • Location of your child’s Emergency Information Form and key rescue medicines (such as an inhaler) in your home

  • The phone number and address where you (the parents) can be located

  • A neighbor who could respond to an emergency

Remember, for nonemergency conditions, first call your child’s doctor. If you believe an injury or illness is threatening your child’s health or may cause permanent harm, call for an ambulance. If your child is seriously ill or injured, it is safer for your child to be transported to the emergency department by ambulance.

Listing of resources does 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.  

Last Reviewed:9/20/2019 2:20:24 AM
Last Revised:9/19/2019 10:08:17 PM
© 2006 American Academy of Pediatrics, Updated 12/2015. All rights reserved.
Copyright © 2019 Anywhere Pediatrics, p.c.. All rights reserved.