FAQs & Resources

Terminology about food reactions can be confusing, since reactions with very different causes are often referred to using the same words. The main types are:

• Immediate allergic reactions occur within minutes to hours after eating a food and involve an immune molecule called IgE. These are considered "true allergies." Symptoms vary and can include hives, vomiting, or lip swelling. Anaphylaxis is the most severe type.
• Delayed reactions begin hours to days after ingesting a food, and are caused by the immune system but not by IgE. Examples include coeliac disease and cow's milk protein intolerance/allergy. These are often called "non-IgE allergies" but do not cause anaphylaxis.
• Intolerances occur when there is a problem digesting a food, and do not involve the immune system. An example is lactose intolerance. Allergy testing is not useful for intolerances.

For more detail, refer to this ASCIA page on food intolerance.

Small amounts of mucus in the stool of a well infant is normal and may play a role in helping stool pass smoothly.

Large amounts of mucus and/or any blood in the nappies would make us think about other causes, such as infection. Mucusy stool with fresh blood in a healthy, thriving baby is commonly due to a delayed immune reaction to a food protein (often cow's milk). Although sometimes called cow's milk protein allergy, this condition does not cause immediate symptoms like hives or anaphylaxis. Other less common causes should also be considered, and a thorough assessment by a GP or paediatrician is always warranted.

Lactose is a sugar found in milk (including breastmilk and cow's milk), and its digestion requires an enzyme called lactase. Lactose intolerance occurs when there is not enough lactase in the gut, leading to tummy pain, bloating and diarrhoea.

In infants and young children, lactose intolerance is usually a temporary problem after a viral illness like gastroenteritis, and resolves within weeks. It is extremely rare for babies to be born with lactose intolerance — this is much more commonly a condition that develops in older children and adults.

The most important part of allergy diagnosis is the history — the description of symptoms linked to exposure to an allergen. If an immediate-type allergy is suspected, a skin prick test, blood test, or oral food challenge can help to confirm the diagnosis.

• A skin prick test involves pricking the skin with food extracts and looking for a wheal (swelling).
• A blood test measures IgE antibodies targeting specific foods.
• An oral food challenge involves eating small amounts of a food under close medical supervision.

The decision to carry out allergy testing requires careful consideration, as interpreting these tests is not straightforward. For delayed reactions or food intolerances, skin prick testing is not useful.

Common food allergens include cow's milk, egg, soy, tree nuts, peanut, sesame, wheat, fish and shellfish. Food allergens should be introduced from around 6–12 months of age along with other solids. Each allergen should be introduced by itself first, and during the day, so that any reaction can be detected.

Peanut and tree nuts should always be given as crushed or paste form (e.g. nut butters) to infants and young children. Once introduced, try to keep giving allergenic foods regularly (e.g. twice a week) to maintain tolerance.

For further information, see preventallergies.org.au.

Bedwetting is developmentally normal in young children. Young children often don't produce enough ADH (a hormone that helps retain fluids overnight), and deep sleepers may not be woken by the urge to urinate. In an otherwise healthy child, bedwetting often doesn't need treatment until at least 6–7 years of age. Medical review should be considered at this age, particularly if bedwetting is causing distress.

Rarely, bedwetting can be associated with another medical condition. A medical review should be sought if there are unusual daytime symptoms, or if a child who was previously dry at night for at least six months has started bedwetting again.

For more information, see this factsheet from the Sydney Children's Hospital Network.

If bedwetting is associated with another medical condition such as constipation, this should be treated first. Behavioural strategies like a bedwetting alarm are highly successful when used consistently for several weeks. It is rare to require medication for uncomplicated bedwetting.

The most common cause of constipation in young children is 'functional' constipation — toddlers and young children may ignore the urge to defecate, then develop anxiety after a painful bowel movement. Continued avoidance leads to stool building up in the rectum and large bowel.

Investigations are not needed to diagnose functional constipation, but may be required if other less common medical causes are suspected. A careful medical assessment is always recommended.

Functional constipation is usually treated with a combination of diet and behaviour modification and medications such as stool softeners and laxatives. A common reason for treatment failure is stopping laxatives too early — the bowel can take many months to fully heal, so treatment often needs to be prolonged and tapered gradually.

For further information, see this factsheet from the Sydney Children's Hospital Network.

A good rule of thumb for children with eczema is to keep the skin cool, clean and moisturised:

• Cool: Avoid hot baths, showers or hot itchy clothing.
• Clean: Wash daily to remove bacteria from the skin; bleach baths can be considered if needed.
• Moisturised: Apply moisturiser twice daily, even when skin appears healthy. Avoid products containing fragrances or food substances (e.g. almond oil, coconut oil, milk), as these can increase the risk of developing an allergy to those foods — especially in infants with eczema.

Eczema can flare in response to many triggers, including food allergens, dustmites, chemicals like chlorine or soap, and after viral illness. Although rare, some people have reported a flare after a vaccine.

It can be impractical (or inadvisable) to avoid certain triggers. For example, strict dietary restriction may cause nutritional imbalances, while avoiding vaccination increases the risk of serious infection. Maintaining excellent baseline skin care helps minimise flares while allowing more flexibility in diet and lifestyle.

Topical steroids (creams or ointments) are safe to use in children with eczema and should be applied in ample amounts to the affected areas — not sparingly. They can be stopped when the skin has healed, and regular moisturisers should be continued. Side effects are rare and more likely only with long-term use of very strong steroids over large skin areas.

There are increasing concerns about 'topical steroid withdrawal', which is not yet well understood. A British dermatology expert group has released a statement acknowledging that more needs to be learnt, but emphasising that topical steroids should continue to be used as needed.

Hayfever (allergic rhinitis) is an allergic reaction to environmental substances such as house dust mite, pollens, grasses and moulds, causing sneezing, runny nose and itchy eyes. It is uncommon under 2 years of age and gradually becomes more common, affecting about 1 in 3 adolescents.

The impacts of hayfever are often underrecognised. It can cause troublesome daytime symptoms, significantly impact sleep quality, and in turn affect daytime function including attention and behaviour.

Hayfever can be diagnosed based on symptoms and examination findings. Testing is not needed to confirm the diagnosis but can help identify specific triggers, for example by skin prick testing.

Useful resources:

• House dust mite allergy factsheet from the Sydney Children's Hospital Network
• ASCIA advice on reducing allergen exposure

• Sharing Knowledge About Immunisation (SKAI) — an Australian website with simple, reliable information about vaccines and common safety concerns.
• AusVaxSafety — monitors vaccine safety and includes accessible, up-to-date Australian data on common side effects.
• Let's Talk Shots — a video library from Johns Hopkins Institute for Vaccine Safety explaining how vaccines work and addressing common misconceptions.

The national schedule covers at least 15 diseases, but there are some additional vaccines worth considering:

• Meningococcal B vaccine (Bexsero) is strongly recommended for all infants (and is funded for Aboriginal and Torres Strait Islander infants). Meningococcal infection is rare but serious. It can be given on the same day as other routine vaccines.
• A second chickenpox dose is recommended for all children but must be purchased privately — it is often given at 4 years of age.
• Annual influenza vaccine is free for children aged 6 months to 4 years, and recommended for all children.
• Additional vaccines may be recommended based on your child's medical risk factors or your family's travel plans. Discuss these with your GP.

• Infant and baby nutrition from the Sydney Children's Hospital Network — guidance on breastfeeding, formula feeding and introducing solids.
• Infant formula factsheet — explains the different categories of infant formula.
• Monitoring weight and growth from Tresillian — advice on monitoring your baby's growth and when to seek support.

Reflux (gastroesophageal reflux) is when the contents of the stomach come back up the oesophagus — sometimes into the mouth. All young babies have some degree of reflux ('posseting' or 'spilling'), because the ring of muscle separating the oesophagus from the stomach is weak in young babies, and because they are fed lying down. Reflux naturally improves from about 4 months of age.

Most babies do not need treatment for reflux, as it naturally improves over time. Treatment may be considered if there are concerning features such as signs of pain during feeding, feed refusal, poor weight gain, or vomiting blood — this is called 'gastroesophageal reflux disease' (GORD). Treatment options include positioning, feed thickeners and medication.

For more information, see the Sydney Children's Hospital Network reflux factsheet.

Tongue tie is when the lingual frenulum — the tissue connecting the tongue to the bottom of the mouth — is too short or tight, limiting tongue mobility. Most babies with tongue tie can successfully breastfeed without any intervention.

Severe tongue tie can affect a baby's latch when breastfeeding, causing nipple pain — though many other factors can also cause nipple pain, most commonly incorrect positioning. In rare cases, tongue tie can affect speech later in childhood.

Severe cases can be managed by cutting the restrictive tissue (frenotomy). This procedure should only be considered after careful assessment by an experienced health professional.