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Should Your Child See a Doctor?

Hives

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Definition

  • An itchy rash made up of raised pink spots with pale centers

Symptoms 

  • Raised pink bumps with pale centers (welts)
  • Hives look like mosquito bites
  • Sizes of hives vary from ½ inch (12 mm) to several inches (centimeters) across
  • Shapes of hives are variable and change repeatedly
  • Itchy rash

Causes 

  • Widespread hives usually are caused by a viral infection. Can also be an allergic reaction to a food, drug, infection, insect bite, or other substances. Often, the cause is not found. Hives from foods usually resolve in 6 hours.
  • Localized hives are usually due to skin contact with plants, pollen, food or pet saliva. Localized hives are not caused by drugs, infections or swallowed foods.

When to Call Your Doctor for Hives

Call 911 If…

 
  • Your child has difficulty breathing or is wheezing
  • Your child has hoarseness or cough with rapid onset
  • Your child has difficulty swallowing, drooling or slurred speech with rapid onset
  • Your child has had a severe life-threatening allergic reaction in the past to similar substance
 

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Hives began after a bee sting, medicine or high-risk food (e.g., peanuts or fish) and no previous reactions
  • Age under 1 year with widespread hives.
 

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

  • You think your child needs to be seen
  • Severe hives (eyes swollen shut, very itchy, etc.) not improved after 2nd dose of Benadryl
  • Fever or joint swelling is present
  • Abdominal pain or vomiting present
 

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • Hives interfere with school or normal activities after taking Benadryl every 6 hours for more than 24 hours
  • Food suspected as cause
  • Hives have occurred 3 or more times and cause is unknown
  • Hives last over 1 week
 

Parent Care at Home If

  • Hives with no complications and you don't think your child needs to be seen
 

Home Care Advice for Hives

  1. Localized Hives:
    • For localized hives, wash the allergic substance off the skin with soap and water.
    • If itchy, massage the area with a cold pack or ice for 20 minutes.
    • Localized hives usually disappear in a few hours and don't need Benadryl.
     
  2. Benadryl for Widespread Hives:
    • Give Benadryl 4 times per day for widespread hives that itch. (no prescription needed). See Dosage chart.
    • If you only have another antihistamine at home (but not Benadryl), use that.
    • Continue the Benadryl 4 times per day until the hives are gone for 12 hours.
    • Contraindication: Age is under 1 year (Reason: Benadryl is a sedative). Give your doctor a call for advice.
     
  3. Food-Related Hives:
    • Foods can cause widespread hives
    • Sometimes the hives are isolated to just around the mouth
    • Hives from foods usually are transient and gone in under 6 hours
     
  4. Cool Bath: Give a cool bath for 10 minutes to relieve itching. (Caution: avoid causing a chill) Rub very itchy areas with an ice cube for 10 minutes.
  5. Remove Allergens: Give a bath or shower if triggered by pollens or animal contact. Change clothes.
  6. Avoid Allergens: If you identify a substance that causes hives (e.g., a food), help your child avoid that substance in the future.
  7. Contagiousness: Hives are not contagious. Your child can return to child care or school if the hives do not interfere with normal activities. If the hives are associated with an infection, your child can return to school after the fever is gone and your child feels well enough to participate in normal activities.
  8. Expected Course: Hives from a viral illness normally come and go for 3 or 4 days, then disappear. Most children get hives once.
  9. Call Your Doctor If:
    • Severe hives persist after 2nd dose of Benadryl
    • Most of the itch is not relieved within 24 hours on continuous Benadryl
    • Hives last over 1 week
    • Your child becomes worse
     

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


References

  1. Eitches RW. Urticaria: A wheal of misfortune. Contemp Pediatr.1993 Jun;10:90-100.
  2. Hogan PA and Weston WL. Persistent symptoms: An itch that won't go away. Contemp Pediatr. 1992;9(7):100.
  3. Kwong KY and Jones CA. Urticaria and angioedema: Pathophysiology, diagnosis and treatment. Pediatr Ann. 1998;27:719-724.
  4. Mortureux P, Leaute-Labreze C, Legrain-Lifemann V, Lamireau T, et al. Acute urticaria in infancy and early childhood: A prospective study. Arch Dermatol. 1998;134:319-323.
  5. Plumb J, Norlin C, Young PC. Exposure and outcomes of children with urticaria seen in a pediatric practice-based research network. Arch Pediatr Adolesc Med. 2001;155:1017-1021.
  6. Sackesen C, Sekerel BE, Orhan R, et al. The etiology of different forms of urticaria in childhood. Pediatr Dermatol. 2004;21:102.
  7. Shah KN, Honig PJ, Yan AC. Urticaria multiforme. Pediatrics 2007;199: e1177.
  8. Weston WL and Badgett JT. Urticaria. Pediatr Rev. 1998;19:240-244.

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: 8/1/2010

Last Revised: 10/20/2010

Copyright 1994-2011 Barton D. Schmitt, M.D.

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