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Should Your Child See a Doctor?

Bee or Yellow Jacket Sting

Definition

  • The child was stung by a honeybee, bumblebee, hornet, paper wasp, or yellow jacket
  • Over 95% of stings are from honey bees or yellow jackets

First Aid Advice for Anaphylaxis - Epinephrine (pending EMS arrival)

  • If you have epinephrine (Epi-pen or Twinject), give it now.
  • Do this while calling 911 (Reason: life-saving advice).
  • Over 50 pounds: 0.3 mg. Auto-inject Epi-Pen or give 0.3 ml Twinject.
  • 20-50 pound child: 0.15 mg. Auto-inject Epi-Pen Jr. or give 0.15 ml Twinject.
  • Less than 20 pound child: Give dosage recommended by your doctor (or 0.1 ml if you have an epinephrine ampoule).
  • Inject it  into the muscle (IM) upper outer thigh.
  • Can be given through clothing if necessary.
  • Benadryl: After giving epinephrine, give oral Benadryl or other antihistamine if the child is able to swallow.

First Aid Advice for Anaphylactic Shock

  • Lie down with feet elevated.

Local Reactions

  • The sting involves injecting venom into the human from the bee's stinger.
  • The main symptoms are pain, itching, swelling and redness at the sting site.
  • Severe pain or burning at the site lasts 1 to 2 hours. Itching often follows the pain.
  • Swelling: Normal swelling from venom can increase for 24 hours following the sting. Stings of the upper face can cause severe swelling around the eye, but this is harmless.
  • Redness: Bee stings can normally become red. That doesn't mean they are infected. Infections rarely occur in stings.
  • The redness can last 3 days and the swelling 3-5 days.

Anaphylactic Reaction

  • A severe life-threatening allergic reaction is called anaphylaxis
  • The main symptoms are difficulty breathing and swallowing starting within 2 hours of the sting
  • Anaphylactic reactions to bee stings occur in 0.4% of children
  • The onset of generalized hives or facial swelling following a bee sting is usually an isolated symptom, not the forerunner of anaphylaxis

When to Call Your Doctor for Bee or Yellow Jacket Sting

Call 911 If…

  • Your child is not moving or too weak to stand
  • For any of the following symptoms of anaphylaxis, see FIRST AID. Anaphylaxis usually starts within 20 minutes, and always by 2 hours following a sting.
  • Wheezing or difficulty breathing
  • Hoarseness, cough or tightness in the throat or chest
  • Difficulty swallowing or drooling
  • Speech is confused or slurred
  • Passed out or very weak
  • Previous severe allergic reaction to bees, yellow jackets, etc. (not just hives)

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Hives or swelling occur elsewhere on the body
  • Sting inside the mouth
  • Sting to the eye
  • Abdominal pain or vomiting
  • More than 5 stings/10 pounds of weight (teens over 50 stings)

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • Sting looks infected (red streaking from the sting area, yellow drainage) (Note: infection and cellulitis don't start until at least 24-48 hours after the sting. Any redness starting in the first 24 hours is due to venom)
  • Swelling is huge (e.g., spreads beyond wrist or ankle)

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns

Parent Care at Home If

  • Normal local reaction to yellow jacket or bee sting and you don't think your child needs to be seen

Home Care Advice for Bee or Yellow Jacket Sting

  1. Try to Remove the Stinger (if present):
    • Only honey bees leave a stinger.
    • Use a fingernail or credit card edge to scrape it off.
    • If the stinger is below the skin surface, leave it alone. It will be shed with normal skin healing.
  2. Meat Tenderizer:
    • Apply a meat tenderizer-water solution on a cotton ball for 20 minutes (EXCEPTION: near the eye). This may neutralize the venom and decrease pain and swelling.
    • If not available, apply aluminum-based deodorant or a baking soda solution for 20 minutes.
    • For persistent pain, massage with an ice cube for 10 minutes.
  3. Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen immediately for relief of pain and burning.
  4. Antihistamine: If the sting becomes itchy, give a dose of Benadryl.
  5. Hydrocortisone Cream: For itching or swelling, apply 1% hydrocortisone cream over-the-counter to the sting area 3 times per day.
  6. Expected Course: Severe pain or burning at the site lasts 1 to 2 hours. Normal swelling from venom can increase for 24 hours following the sting. The redness can last 3 days and the swelling 3-5 days.
  7. Call Your Doctor If:
    • Develops difficulty breathing or swallowing (mainly during the 2 hours after the sting) (call 911)
    • Redness lasts over 3 days
    • Swelling becomes huge or spreads beyond the wrist or ankle
    • Sting begins to look infected
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.

References

  1. Betten D, Richardson W, Tong, T, Clark R. Massive honey bee envenomation-induced rhabdomyolysis in an adolescent. Pediatrics. 2006; 117(1): 231-235.
  2. Booker, G. Insect stings. Pediatr Rev. 2005;26(10):382-383.
  3. Golden DB, Kagey-Sobotka A, Norman PS, et al. Outcomes of allergy to insect stings in children with and without venom immunotherapy. N Engl J Med. 2004;351:668-674.
  4. Krakowski A., Golden D. Hymenoptera stings: A practical guide to prevention and management. Contemp Pediatr. 2005;23(8):30-37.
  5. Moffitt JE, et.al. Joint Task Force on Practice Parameters. Stinging insect hypersensitivity: A practice parameter update. J Allergy Clin Immunol 2004; 114:869-886.
  6. Schuberth KC. How dangerous are insect stings? Contemp Pediatr. 1989 May;6:69-88.
  7. Schumacher MJ, et al. Rate and quantity of delivery of venom from honeybee stings. J Allergy Clin Immunol. 1994;93:831-835.
  8. Sellinger CR. Immunotherapy for insect stings. Pediatr Rev. 1993;14:246.
  9. Sherman RA. What physicians should know about Africanized honeybees. West J Med. 1995;163:541-546.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 1/4/2010

Last Revised: 6/16/2009 12:43:14 PM

Copyright 1994-2010 Barton D. Schmitt, M.D.

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