Pediatric allergist in Waco: care for kids and families

Allergy and asthma care for children is different from adult care. The conditions evolve as kids grow, the testing and treatment options have to fit small bodies and short attention spans, and parents are part of every decision. Our practice has been treating Central Texas children for over 45 years, with staff tenure of 12 to 20 plus years that means many of our pediatric patients are seen by the same nurses their parents knew.

Key takeaways

• Pediatric care from infancy through adolescence
• The atopic march (eczema, food allergy, hay fever, asthma) is treatable when caught early
• Allergy shots and sublingual drops are both options for kids old enough to commit to the schedule
• Same staff over many years means continuity that pediatric care benefits from
• Most major insurance plans accepted including pediatric Medicaid managed care

The atopic march in plain language

Allergic conditions in kids tend to follow a predictable pattern called the atopic march. Eczema usually appears first, in infancy. Food allergies show up next, often in the toddler years. Allergic rhinitis (hay fever) appears in early school years. Asthma can develop at any point, though most often in elementary or early teen years. Not every child follows the full pattern. Catching and treating earlier conditions can reduce the chance of later ones developing.

Eczema in infancy

Severe pediatric eczema is one of the strongest predictors of later allergic disease. Treating eczema well, including identifying allergic triggers when present, can change the trajectory. Modern options include moisturizers, topical anti-inflammatories, calcineurin inhibitors, and biologics like Dupixent for moderate to severe cases. Read more about eczema flare-ups and allergies.

Food allergies in toddlers

Common pediatric food allergens are milk, egg, peanut, tree nuts, soy, wheat, fish, shellfish, and sesame. We test for food allergies when there is a reaction history, when eczema is hard to control, or when a sibling has documented food allergy and parents want to assess risk. Testing approaches include skin testing, specific IgE blood testing, and supervised oral food challenges in our office for situations where testing alone leaves the diagnosis uncertain. Read more at food allergy management.

Hay fever in school years

Allergic rhinitis often begins in the early elementary years and can drive sleep disruption, school performance issues, and recurring sinus or ear infections. Read our coverage of school focus and allergies, recurring ear infections, and mouth breathing in kids.

Asthma at any point

Childhood asthma is one of the most common chronic conditions we manage. Treatment includes identifying triggers (allergic and otherwise), prescribing controller and rescue medications, and stepping up to biologic therapy when symptoms persist. Pediatric biologics include Dupixent (approved for kids 6 months and up), Xolair (6 and up), and others depending on severity.

Pediatric allergy testing

We test children of all ages when symptoms warrant it, including infants. Pediatric panels focus on smaller targeted lists rather than full adult panels. Read more about our allergy testing process.

What testing feels like for kids

Skin testing is mostly itchy rather than painful, and our nurses are practiced at making the visit easy for kids. Distraction works well: a tablet, a parent's phone, or a favorite toy keeps most kids comfortable through the 15 to 20 minute wait while reactions develop. Blood testing is an option when needed.

Age-appropriate panels

For infants and toddlers, we focus on the most likely culprits given symptom history: a few specific foods, dust mites, pet dander, and mold. As kids get older, panels expand to include the full Central Texas environmental panel. The principle is testing what could change management, not testing comprehensively for its own sake.

When food challenges are appropriate

Supervised oral food challenges in our office determine whether a child still reacts to a previously identified food allergen. This is most relevant for children possibly outgrowing an allergy. The procedure runs over several hours under medical supervision.

Treatments for kids

Most pediatric allergic disease starts with environmental control and daily medications appropriate to age. Pediatric formulations of nasal steroid sprays are FDA approved for kids as young as 2. Non-sedating antihistamines (cetirizine, loratadine, fexofenadine) are well-studied in pediatric populations. Avoid Benadryl and other sedating antihistamines for daily use.

Pediatric immunotherapy

For kids with significant allergic loads who do not respond well to medication alone, immunotherapy treats the underlying cause. Sublingual drops are typically a better fit for children than weekly shots. Daily at-home dosing fits family routines without disrupting school. Success rates are 75 to 85 percent for drops vs 85 to 90 percent for shots in our practice.

Biologics for severe pediatric disease

Dupixent is approved for severe eczema and severe asthma in kids 6 months and up. Xolair is approved for asthma in kids 6 and up and for chronic urticaria in kids 12 and up. Other biologics have different age ranges. We administer pediatric biologics in office and have prescribing experience across all approved options. Read more at our medication and infusions page.

School coordination

For students with documented allergies or asthma, school coordination matters as much as medical management.

504 plans and action plans

For kids whose allergic disease meets the threshold for educational accommodation, 504 plans formalize the needed adjustments. We provide documentation of diagnosis and recommended accommodations. Most McLennan-area school districts have established processes.

District allergy policies

McLennan-area districts (Waco ISD, Midway, Connally, La Vega, Robinson, China Spring, and others) all have policies for managing food allergies, asthma, and severe reactions in school. Policies vary on epinephrine access, classroom snacks, and field trip protocols. We help families work with district health services as needed.

Athletic department coordination

For students with asthma or severe environmental allergies who participate in outdoor sports, athletic trainers and coaches need access to medications and action plans. We provide written documentation for athletic departments and update annually.

Pediatric subspecialty network

Pediatric allergic disease often involves multiple specialties, and we coordinate routinely.

Pediatric pulmonology

For severe pediatric asthma, pediatric pulmonology adds expertise in pulmonary function testing, complex case management, and coordination with our biologic therapy. We refer when warranted and accept referrals from pulmonology when allergy contributes to asthma management.

Pediatric gastroenterology

For eosinophilic esophagitis, severe food allergy with GI symptoms, and complex food allergy presentations, pediatric GI coordination matters. We work jointly with pediatric GI for shared management.

Pediatric ENT

For chronic ear infections, sleep-disordered breathing, and adenoid hypertrophy contributing to chronic allergic disease, pediatric ENT evaluation often runs in parallel. Coordinated care addresses both structural and allergic components.

Eczema and the connection to allergies

Severe pediatric eczema is one of the strongest predictors of later allergic disease. Treating eczema well, including identifying allergic triggers when present, can change the trajectory. Modern options include moisturizers, topical anti-inflammatories, calcineurin inhibitors, and biologics like Dupixent for moderate to severe cases.

Eczema treatment ladder

Daily moisturizers as the foundation. Topical corticosteroids during flares (different strengths for different body areas and ages). Topical calcineurin inhibitors (tacrolimus, pimecrolimus) for sensitive areas where steroids are problematic. Crisaborole for non-steroidal topical use. Dupixent for moderate to severe disease not controlled with topicals.

Insurance and what to expect

We accept most major insurance plans including most pediatric Medicaid managed care plans. New patient visits are typically scheduled within 1 to 3 weeks. We send pre-visit instructions to parents covering medication washouts and what to bring.

Pediatric Medicaid coverage

Most pediatric Medicaid managed care plans in Texas cover specialty allergy services. Our front desk verifies your specific plan in 5 to 10 minutes when you call. Some plans require pediatrician referrals; we work with the family to obtain whatever authorization is needed.

What to bring to a first visit

Vaccination records. List of current medications including any over-the-counter use. Prior allergy testing if available. Symptom journal for the past few months if you have one. Insurance card. Comfortable clothing for the child (short sleeves, easy to access back).

Continuity for kids

Pediatric allergic disease often spans years to decades. Our staff tenure of 12 to 20 plus years means kids often see the same nurses their parents knew. This continuity matters for kids who develop comfort with familiar faces and for clinical accuracy when subtle changes need to be tracked across years of follow-up.

Common presentations from pediatric patients

Pediatric patient histories cluster around recognizable patterns shaped by age and atopic march progression.

The infant with severe eczema

Severe infant eczema often presents as the first sign of the atopic march. Treatment focused on skin barrier repair plus identification of any food triggers can change the trajectory of allergic disease across the next decade.

The toddler with new food reactions

Sudden food reactions in toddlers commonly involve milk, egg, peanut, or tree nuts. Workup includes specific IgE testing, sometimes oral food challenges, and action plan documentation for daycare and family caregivers.

The school-age child with seasonal symptoms

Children whose grades drop or whose behavior changes during specific months often have undiagnosed seasonal allergies driving sleep disruption. Read about the connection at school focus and allergies.

The teen with severe asthma

Pediatric asthma sometimes worsens during teenage years, particularly in athletes and during peak allergy seasons. Biologic therapy options have changed outcomes for severe pediatric asthma substantially.

Working with families across years

Pediatric care often spans a decade or more. Treatment approaches evolve as the child grows.

Transitioning from pediatric to adult care

Many of our pediatric patients continue with our practice into adulthood. The continuity matters because allergic disease often persists or evolves into adulthood, and the longitudinal record helps with treatment decisions. Patients who transition to other adult practices receive comprehensive records to support continuing care.

Sibling and family-wide care

Allergic disease often runs in families. We commonly see multiple siblings, plus parents, in the same family. The shared family medical history matters for clinical decisions and helps inform pediatric risk assessment for younger children in the family. Parents who know their own allergic history are often more attuned to early signs in their kids and seek evaluation sooner.

When to schedule

If your child has chronic congestion, recurring infections, eczema that is hard to control, suspected food allergy, asthma flares, or any persistent allergic symptom, schedule an evaluation. New patient visits are typically within 1 to 3 weeks. Start at our new patients page.