Hives In Children

Hives In Children
McKenzie Pediatrics
Hives are a very itchy rash, sometimes also referred to as “welts”, but medically better known as
Urticaria.
Hives are raised pink spots with pale centers, ranging in size from ½ inch to several inches
across. They are usually oval or round in shape, but this is quite variable. They can rapidly change
shape, size, and even location. They can even wax and wane depending on time of day and on the
external temperature.
Hives are an allergic reaction, usually to a virus, but also possibly to a food, medication, insect
bite, topical irritant (lotion, detergent, soap, plants, poison oak, etc.), or a wide range of other
substances. Approximately 80 percent of cases of childhood hives are caused by a virus, with or
without other symptoms such as fever, runny nose, cough, or sore throat. The child may also have
had one or more of these symptoms in the very recent past.
Hives are not contagious.
More than 10 percent of children will experience a case of hives during their childhood. The
average duration of a case of hives is 3 to 4 days, but it can be as brief as 24 hours or as long as 6
weeks, depending on the trigger.
Of the food triggers, the most common include: shellfish, peanuts or other nuts, eggs, and
strawberries. Food additives such as coloring dyes can also trigger hives. A food trigger does not
necessarily have to be a food the child has never had before.
Of medications, the most likely triggers are antibiotics, especially the penicillins and the sulfa
drugs. As with food triggers, a medication trigger for haves does not have to be a medication the
child has never had before.
Hives rarely progress into anything more severe or life-threatening. If that were to happen, it
would usually be very soon after the hives started appearing. The child would begin to experience
swelling of the mouth and throat, and then possibly of the airways, with wheezing and shortness
of breath. This is known as anaphylaxis, and is a medical emergency. Contact 911, or take your
child to the emergency department if very nearby.
Occasionally, hives can be chronic and recurring. Most often, this is a familial type of hives,
meaning that other members of the family also have chronic and recurring hives. Children with
these types of hives typically find them triggered by cold and/or pressure.
The best treatment for hives is Diphenhydramine, better known by its most common brand-name
form, Benadryl. Its main side effect is drowsiness. Benadryl may be given a maximum of four
times daily. Do not just wait until the hives return to give the next dose, but rather keep your child
on a scheduled dose of Benadryl every 6 hours for the first couple of days. Cool baths are also
often soothing for hives. Heat, such as hot showers and heat and sweat from playing outside on a
warm day, will often make hives and the itch worse.
Hives are rarely medically concerning. Medical attention is needed only if sign of anaphylaxis, or
if fever or joint swelling develop during a case of hives. If you suspect a medication as the trigger
for hives, contact our office to discuss whether a new medication needs prescribed. If indeed a
medication is the trigger, it is also important to note this on your child’s chart.

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