Can Babies Get Hay Fever?

Every April parents arrive with a baby who has been sneezing, rubbing their eyes and snuffling for a fortnight, worried it is hay fever because a parent has it. Sometimes it is, in an older toddler. In a baby it almost never is, and knowing why helps you work out what is actually going on.

Why hay fever is rare in babies

Hay fever is an allergy to pollen. Allergy is learned: the immune system has to meet the pollen, decide it is a threat and make antibodies against it, and that takes repeated exposure across at least one season, usually two. A baby in their first spring has never met tree pollen before, so there is no allergy yet. This is why hay fever is unusual under one, uncommon under two, and then climbs steadily through the preschool years. It peaks in the teens and early adulthood.

Having a parent with hay fever, asthma or eczema roughly doubles a child's chance of developing it, but it still cannot appear before the immune system has had time to learn.

What is more likely in a baby

• Colds. Babies and toddlers get six to ten a year. A cold brings a runny nose and sneezing with a mild fever, lasts seven to ten days, and then goes. Hay fever has no fever and lasts for the whole season.
• Dust mite, pet or mould allergy. These are year round, not seasonal, and are the commonest allergic cause of a blocked nose in the under threes. Symptoms are often worst first thing in the morning or in particular rooms.
• A dry or irritated nose. Central heating, smoke, and the natural narrowness of a baby's nose cause snuffling that sounds dramatic and means little.
• Teething. Produces dribble and a runny nose but not itchy eyes or sneezing fits.
• Viral conjunctivitis. Sticky, red eyes with a cold. Allergic eyes are itchy, watery and clear rather than sticky.

Signs it really is hay fever in a toddler

From around two or three, these together point to hay fever rather than a cold:

• Sneezing fits, a clear runny or blocked nose and itchy, watery, red eyes that come back at the same time each year and last weeks rather than days
• Worse on warm, dry, breezy days and after playing outside; better on wet days and indoors
• No fever, and the child is otherwise well
• Rubbing the nose upwards with the palm (the "allergic salute"), a crease across the nose, dark shadows under the eyes
• Poor sleep, mouth breathing and snoring during the season
• Cough or wheeze that flares in the same months, which can mean the pollen is also affecting the lower airways

Tree pollen (birch, in particular) runs from late March to mid May, grass pollen from mid May to July, and weed pollen into September. A child who is always worse in April has a different trigger from one who suffers in June, and that matters for timing treatment.

What is safe to give, by age

Never give an adult product or an adult dose to a child, and never give sedating antihistamines to help a child sleep. If in doubt, ask a pharmacist or GP; they will check the age, weight and whether a liquid formulation exists.

Reducing pollen exposure

• Check the pollen forecast and keep outdoor play for the afternoon on high days; counts are highest in the early morning and early evening
• A smear of petroleum jelly around the nostrils traps pollen
• Wash face and hands and change clothes after being outside; bath and hair wash before bed
• Dry washing indoors on high pollen days; keep bedroom windows closed in the early evening
• Wraparound sunglasses for toddlers who will tolerate them
• Wipe pets down after walks, as fur carries pollen in

Allergy testing in young children

Testing is not needed to diagnose hay fever in a child with a clear seasonal pattern; the history is enough. It is useful when symptoms are year round and the trigger is unclear, when there is also eczema, food reactions or wheeze, or when a decision about immunotherapy or a pet depends on it. Skin prick testing can be done from infancy, and a blood test for specific IgE to grass, tree and dust mite is an alternative that does not need the child to sit still. Neither is painful in the way parents fear, and both can be done at OneMedicine with a GP interpreting the results.

When to see a doctor

Will they grow out of it?

Some do. Around a third of children see their hay fever ease by adulthood, and symptoms often change character over the years. For the majority it persists, which is why controlling it well matters: untreated hay fever in childhood is linked to poorer sleep, worse concentration and lower exam performance in the summer term, and it makes asthma harder to control. For older children with severe grass pollen allergy, immunotherapy (daily tablets or injections over three years) is the one treatment that changes the course of the condition rather than just the symptoms, and a GP can advise on referral.

Questions people ask

Can a newborn have hay fever?

No. Hay fever requires the immune system to have met pollen across at least one season and built an allergic response, which a newborn has not had time to do. Sneezing and snuffling in a newborn are almost always a cold, a narrow dry nose or a normal reflex, not allergy. See a GP if a newborn is feeding poorly, breathing fast or has a fever.

At what age can a child get hay fever?

It is rare under one and uncommon under two. From about two or three it becomes increasingly common, and by school age it affects roughly one child in five. The peak is the teenage years and early twenties.

How can I tell if my baby has hay fever or a cold?

A cold brings a runny nose and sneezing with a mild fever, lasts about a week and clears. Hay fever has no fever, causes itchy watery eyes as well as sneezing, lasts for weeks, is worse outdoors on dry breezy days, and returns at the same time every year. In a baby under two a cold or a year round allergy such as dust mite is far more likely.

What can I give my 1 year old for hay fever?

Saline nose drops, a damp cloth for the eyes and pollen avoidance. Most antihistamines are not licensed under two; a GP may prescribe cetirizine liquid from one in selected cases. Do not give Piriton (chlorphenamine) to a child under one, and only on medical advice between one and two. Never use an adult product.

Is Piriton safe for babies?

Chlorphenamine (Piriton) is not licensed under one and is used only on medical advice between one and two. It causes drowsiness and occasionally the opposite, agitation, in young children. From two, a non drowsy antihistamine such as cetirizine or loratadine liquid is usually preferred.

Can babies be allergy tested?

Yes. Skin prick testing can be done from infancy and a specific IgE blood test at any age. Testing is only worth doing when the result would change what you do, for example year round symptoms with an unclear trigger, associated eczema or wheeze, or a decision about a pet. A clear seasonal pattern in a toddler does not need a test.

Does hay fever in a toddler mean they will get asthma?

Not necessarily, but the two are linked. Children with hay fever are more likely to develop asthma, and in a child who already has asthma, pollen season often makes it worse. A cough or wheeze that flares each spring or summer alongside nose and eye symptoms should be mentioned to a GP.

Written by Dr Ibrar Ahmed, MBChB MRCP MRCGP PhD PG Dip (Cardiology), GMC 4401399
Specialist interest: Cardiovascular Medicine · OneMedicine, CQC registered clinic