Hay Fever in Children
The signs children show rather than describe, what they can safely take at which age, the exam-season problem, and a straight answer on nasal sprays and growth.
Part of the Complete Hay Fever Guide.
Key fact: Hay fever in children is routinely mistaken for a summer cold that will not go away. The tell is how long it lasts: a cold runs its course in a week or two, hay fever runs for the season — and it itches, which colds do not.
Spotting it in a child
Hay fever usually appears between the ages of five and fifteen, and the first season is the one that gets missed, because a child with a runny nose in June looks like a child with a cold. Three things separate them.
| Hay fever | A cold | |
|---|---|---|
| How long | Weeks to months, following the season | Seven to ten days |
| Itching | Nose, eyes, roof of the mouth, sometimes the ears — the hallmark | Not a feature |
| Discharge | Clear and watery throughout | Often thickens and changes colour after a few days |
| Temperature | None | Common, especially early |
| Pattern | Worse outdoors, worse on warm dry days, better in rain | No relationship to weather |
The signs parents miss
Children rarely describe hay fever accurately. They show it instead, and these signs are worth knowing because they are easy to read once you have seen them.
- The allergic salute — rubbing the nose upwards with the palm, repeatedly. Done often enough it leaves a horizontal crease across the bridge of the nose, which is close to diagnostic.
- Allergic shiners — dark shadows under the eyes from congested veins, frequently mistaken for tiredness.
- Mouth breathing and snoring, and a child who is not sleeping well without being able to say why.
- Constant throat clearing or a dry night cough, from mucus running down the back of the throat.
- Eye rubbing, sometimes hard enough to look sore.
- Poor concentration and irritability in the summer term specifically.
Hay fever and exams
This deserves its own section because the timing is unusually cruel: the UK exam season falls precisely across the grass pollen peak. Research on GCSE cohorts has found that pupils with hay fever symptoms on the day of an exam are measurably more likely to drop a grade compared with their own mock performance, and that the effect is larger in those taking sedating antihistamines.
The practical point: if a teenager is sitting exams in May and June, do not give them a sedating antihistamine such as chlorphenamine. Use a non-drowsy one, start it in early May before the season, and add a steroid nasal spray so they are not sitting a two-hour paper unable to breathe through their nose.
Schools and exam boards can take medical circumstances into account, but that is a poor substitute for controlling the symptoms in the first place, and it needs arranging well in advance.
What children can take
Licensed ages differ between products and between formulations of the same drug, so the pack is the authority and a pharmacist can confirm. As a general map:
| Treatment | Typically from | Notes |
|---|---|---|
| Cetirizine oral solution | 2 years | Non-drowsy in most children, once or twice daily by age. A liquid is far easier than asking a young child to swallow a tablet. |
| Loratadine syrup | 2 years | Non-drowsy, once daily. |
| Fexofenadine | 6 years for the lower strength; 120mg from 12 | The least sedating option, which matters for school and exams. |
| Chlorphenamine syrup (Piriton) | 1 year | Sedating. Reasonable for night-time itching in a younger child, poor for daytime use and wrong during exams. |
| Steroid nasal sprays | Sold over the counter to adults only; available to children on prescription | Do not give an adult over-the-counter spray to a child on your own initiative — a clinician should choose the agent and dose. |
| Sodium cromoglicate eye drops | 6 years | Preventive rather than fast-acting, so used regularly through the season. |
Under two years old, hay fever is uncommon and symptoms that look like it should be assessed rather than self-treated.
Nasal sprays and the growth question
This is the concern parents raise most, and it deserves a straight answer rather than reassurance.
Steroid nasal sprays deliver a very small dose directly to the nasal lining, and the modern agents are designed so that almost none of what is swallowed reaches the bloodstream. Studies of the older compounds, principally beclometasone, did detect small effects on growth velocity in children using them long term. Studies of the newer agents, fluticasone furoate and mometasone, have not shown the same effect at licensed doses. Those are the ones generally chosen for children for exactly this reason.
Against that has to be set what untreated allergic rhinitis does to a child: broken sleep, mouth breathing, impaired concentration, worse asthma control and a summer term spent unwell. The considered position in UK practice is that a nasal steroid at the lowest effective dose, prescribed and reviewed, is the right trade, and that a child's height should be checked periodically if they are on one long term. That is a conversation to have with a clinician rather than a reason to avoid treatment.
Itchy eyes
Eye symptoms are often what bothers a child most, and rubbing makes them considerably worse by releasing more histamine. Cool compresses help immediately. Sodium cromoglicate drops are the usual choice in children, used regularly rather than only when the eyes are bad, because they work by preventing mast cells releasing histamine rather than by blocking it afterwards.
A red eye with pain, light sensitivity or blurred vision is not hay fever. Allergic eye symptoms itch and water; they do not hurt and they do not affect how well a child can see. Anything that does needs same-day assessment.
What to avoid
- Sedating antihistamines before school or exams. They impair concentration and reaction time at exactly the wrong moment.
- Adult-strength products given at a guessed dose. Use the paediatric formulation.
- Decongestant nasal sprays. Not appropriate for regular use in children, and rebound congestion applies to them too.
- Waiting until symptoms start. The same two-week head start applies — early May for grass pollen, as set out in the UK pollen calendar.
- Drying school uniform and bedding outdoors in June.
When to see someone
Book an appointment if symptoms persist despite a non-drowsy antihistamine taken daily, if sleep or school is being affected, if there is cough or wheeze alongside the nasal symptoms, if blockage is confined to one side, or if the child is under two. Wheeze in a child with hay fever should always prompt a question about asthma rather than more antihistamine.
Frequently Asked Questions
How do I know if my child has hay fever or a cold?
Duration and itching. A cold clears in seven to ten days; hay fever continues for weeks or months in line with the pollen season. Hay fever itches — the nose, the eyes, often the roof of the mouth — and colds do not. Hay fever discharge stays clear and watery, there is no temperature, and symptoms are worse outdoors on warm dry days and better in the rain.
At what age can children take hay fever medicine?
It depends on the product. Cetirizine and loratadine liquids are typically licensed from two years, chlorphenamine syrup from one year, and fexofenadine from six years at the lower strength. Steroid nasal sprays are sold over the counter to adults only and need a prescription for a child. Always check the pack and ask a pharmacist, and have a child under two assessed rather than self-treated.
Are steroid nasal sprays safe for children?
At licensed doses, the modern agents such as fluticasone furoate and mometasone have not been shown to affect growth, and they are the ones usually chosen for children for that reason. Older compounds showed small effects on growth velocity with long-term use. Untreated allergic rhinitis carries real costs of its own, including broken sleep, poor concentration and worse asthma control. A nasal steroid for a child should be prescribed and reviewed, with height checked periodically if used long term.
Can hay fever affect my child's exams?
Yes. The UK exam season coincides with the grass pollen peak, and research on GCSE cohorts has found pupils with symptoms on the day of an exam are more likely to underperform relative to their mocks, with a larger effect in those taking sedating antihistamines. Use a non-drowsy antihistamine, start it in early May before the season, and treat nasal blockage rather than relying on extra time.
Why does my child keep rubbing their nose upwards?
That is the allergic salute, one of the more reliable signs of hay fever in children. Repeated upward rubbing to relieve itching and open a blocked nose leaves a horizontal crease across the bridge of the nose over time. Alongside dark shadows under the eyes, mouth breathing and constant throat clearing, it is worth acting on even if the child has not complained of anything.
References
- NHS. Hay fever. nhs.uk
- National Institute for Health and Care Excellence. Clinical Knowledge Summary: Allergic rhinitis. cks.nice.org.uk
- British Society for Allergy & Clinical Immunology. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis. bsaci.org
- Joint Formulary Committee. British National Formulary: antihistamines, allergen immunotherapy and allergic emergencies. bnf.nice.org.uk
- electronic Medicines Compendium. Summaries of Product Characteristics. medicines.org.uk
- Met Office. Pollen forecast and the UK pollen calendar. metoffice.gov.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Allergy medicines differ in how much drowsiness they cause and in who can take them, and decongestant nasal sprays are not for long-term use. If you have asthma, breathing symptoms that worsen alongside hay fever need review rather than more antihistamine. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.