Baby

Help! My Baby Has a Rash!
Know what to do when an allergic reaction strikes

Q. I think my child is having an allergic reaction. Do I need to go to the ER?

Clarify the reaction. Do you see a rash or is he having difficulty breathing?

Priority 1:
Needs immediate evaluation and treatment—NOW:

RED FLAGS
Anaphylactic Reaction
Call 911 for a child who is drooling, ious, having obvious labored breathing (stridor), lip swelling, sweating. Another serious allergic reaction is called Stevens Johnson Syndrome. This is an extensive rash accompanied by mouth ulcers. This requires immediate medical attention.

If your child is having an anaphylactic reaction, do not attempt to drive to the hospital. Unless you can see the hospital from your front door, call 911 and get immediate help. Most ambulances are equipped with medicine to handle these reactions immediately.
Diagnoses: Anaphylactic reaction, Stevena-Johnaon Syndrome

Priority 2:
Needs appointment the next day.
Most rashes are less of an emergency. Allergic reaction rashes can have various configurations. They are all itchy. Rashes (except Stevens Johnson Syndrome, see above) can be evaluated by a doctor when their office is open. These include:

• Hives: raised mosquito bites with flat red circles around them or large flat red areas with raised edges (for example, a drug allergy).

• Erythema multiforme: extensive, small, flat, red patches with raised edges (for example, a drug allergy).

• Eczema: red plaques with a scaly rough appearance overlying it (for example, a food allergy).

• Contact dermatitis: red pimples or blisters in a patch or streak (for example, poison ivy).

See our Web site at Baby411.com for a visual library of common rashes.

Reality Check
Have your child in front of you when you speak to the doctor on the phone. You will be asked to describe what you see over the phone.

What the doctor will ask you about:
ALLERGIC REACTIONS:

1. Is your baby having any trouble breathing?
2. What does the rash look like? Where is it on the body?
3. When did you first see the rash?
4. Is the rash itchy?
5. Is your baby currently taking any medication?
6. Has your baby been exposed to any new oods, laundry detergents, clothing, or soaps?

Helpful Hints
• Unless your child is having an anaphylactic reaction (see above), give diphenhydramine (Benadryl) and schedule an appointment.
• Stop any other medication until a doctor sees your child.
• Don’t give diphenhydramine (Benadryl) in the morning before your appointment—otherwise, the rash will be gone.
• Try to think of any new medication or food your child may have had recently.

Reality Check
FYI: An allergic reaction is caused by a release of a chemical called histamine. Diphenhydramine (Benadryl), an anti-histamine, effectively clears the results of histamine (the rash) until the medicine wears off (about six hours). Histamine levels stay elevated for several DAYS. So, don’t be surprised to see the rash come back after the medicine wears off. You will need to use the antihistamine medicine for a few days.

Causes of allergic reactions: Food allergy, medication allergy, bug bites, poison ivy (rhus dermatitis).

Dr. Ari Brown is an official spokesperson for the American Academy of Pediatrics and has been frequently quoted or interviewed by the national media. Dr. Brown earned her medical degree from Baylor College of Medicine and then went on to complete her pediatric residency at Harvard University/Boston Children’s Hospital with acclaimed pediatrician, Dr. T. Berry Brazelton. She is the co-author of Baby 411, a guide for new parents.