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HIVES
An hour after dinner you are giving your one-year-old a bath. You notice a
red and white, raised welt on her tummy. You find more on her legs. Fifteen
minutes later she is practically covered in welts. What could this be? Should
you rush her to the ER? Should you page your doctor?Relax and don't worry.
This is probably hives.
WHAT ARE HIVES?
Hives are caused by an allergic reaction within the body. Histamine is
released under the skin and causes areas of swelling.
WHAT DO HIVES LOOK LIKE?
They appear as red or white, raised welts on the skin. They can appear
suddenly out of nowhere, and can spread rapidly. They are most common on the
chest, tummy, and back, but can also be on the extremities, and rarely on the
face. A very distinct characteristic of hives is that each welt will often come
and go over a period of 10 to 15 minutes or as long as a few hours. You will
see some welts on the tummy, and then look again an hour later and find them
gone, only to see new ones on the back. The welts can be small or very large,
round or irregularly shaped, single or clustered together and over-lapping.
They usually itch, but not always.
WHAT CAUSES HIVES?
There are many possible causes of hives:
Illness – illnesses are the most common cause of hives in children.
The body can have an allergic reaction to the illness. These illnesses are
usually viruses, but can be any cause. So, if your child is sick, and breaks
out in hives, it is probably due to the illness. A note – don't worry about
what illness might be causing the hives. If there is no fever or symptoms of
any illness, then the hives probably are not due to illness. If there is a
fever, but no other symptoms, then it is probably a harmless virus. Click on Fever for help on what to do.
Foods – foods that most commonly cause hives include shellfish, nuts,
berries, and fish. Think about any new foods your child might have eaten in the
past 24 hours.
Medications – any medicine can potentially cause hives. Think back
through the past 24 hours. Have you given your child any medication (it doesn't
have to be a new medicine)? If your child is sick, have you been using any cold
medicine or new kind of pain or fever medication? If so, it may be hard to tell
if the hives are from the illness or the medicine.
External irritant – there are a variety of substances that children
come into contact with each day that they can be allergic too. The list
includes new soap or shampoo, new laundry detergent or fabric softener, new
suntan or other lotion, new clothes, blankets, or bed sheets, and playing
outside among grass and bushes. Try to think of anything new that could have
come into contact with your child's skin.
Despite all these possible causes, most of the time a parent or doctor is
unable to pinpoint the definite cause of the hives. It is not necessary to
determine the cause of the hives unless your child continues to have a problem
with recurrent hives.
HOW DO I TREAT HIVES?
Benadryl(diphenhydramine) is an antihistamine, available over-the-
counter, and is the standard treatment for hives. At the first sign of hives,
give your child a dose. Click on Benadryl for a dosing chart. It is best not
to wait to give Benadryl to see if the hives go away on their own because some
allergic reactions can proceed rapidly. The sooner the Benadryl is given, the
less severe the reaction will be. You can continue giving Benadryl every 6
hours as needed.
HOW LONG WILL HIVES LAST?
Hives usually only last for 1 or 2 days. However, they can come and go for
several weeks, even though your child is no longer exposed to the original
cause.
SHOULD I KEEP GIVING MY CHILD BENADRYL AS LONG AS I SEE THE HIVES?
No. Benadryl is important for the first dose. You should continue it every
6 hours for the first day or two only if the hives flare up dramatically, for
example, if you see more than 5 or 10 spots. If there are only a few spots, and
do not seem to bother your child, then you don't need to give Benadryl. You can
use Benadryl safely on and off for several weeks if needed.
DO I NEED TO SEE THE DOCTOR FOR HIVES?
No. Hives are not serious. Most cases do not need to be evaluated by a
doctor. The typical parent comment is, "his rash looks terrible but he seems
fine. "If, however, your child is having trouble breathing or acting
progressively sicker, seek medical attention.
WHAT IF THE HIVES ARE SPREADING UP TOWARDS THE NECK? DOES THIS MEAN MY
CHILD'S THROAT MIGHT START TO CLOSE?
No. Hives on the skin have no relation to how severe or mild the reaction
might be internally. The vast majority of cases of hives have no serious
internal allergic reaction.
WHEN TO WORRY
When to go to the ER: Because this is an allergic reaction, you need to
observe your child for other signs of a severe allergic reaction such as throat
tightness, wheezing, breathing difficulty, extreme weakness or lightheadedness,
significantly pale, or persistent vomiting. Go to the ER if these happen. When
to call your doctor's office for an immediate appointment: If none of the above
signs of a severe allergic reaction occur, but your child has swelling of the
hands, feet, or face, or the hives are all over the body, and they don't improve
within 2 hours after Benadryl, see your doctor right away. If it's the weekend
or after hours, go to the ER.
The vast majority of cases of hives are not serious, and go away with little
or no treatment. THERE IS NO NEED TO PAGE YOUR DOCTOR AFTER HOURS,
unless you need help deciding whether or not you should go to the ER.
AskDrSears.com is intended to help parents become better informed consumers
of health care. The information presented in this site gives general advice
on parenting and health care. Always consult your doctor for your individual
needs.