Bee, Wasp, or Hornet Sting, Pediatric

Bee, Wasp, or Hornet Sting, Pediatric

Elsevier Patient Education © 2023 Elsevier Inc..
Last revised: September 27, 2023.

Bees, wasps, and hornets are part of a family of insects that sting. Normally, a sting will cause pain, redness, and swelling at the sting site. However, some people have an allergy to these stings, and their reactions can be much more serious.

What increases the risk?

Your child may be at greater risk of getting stung if he or she:

  • Provokes a stinging insect by swatting or disturbing it.

  • Wears strong-smelling soaps, deodorants, or body sprays.

  • Spends time outside in clothes that expose skin.

  • Plays outdoors, especially near flowers or fruit trees.

  • Eats or drinks outside.

What are the signs or symptoms?

The reaction to an insect sting can vary from a mild, normal response to life-threatening anaphylaxis. The sting site is often a red lump in the skin, sometimes with a tiny hole in the center, that may still have the stinger in the center of the wound.

Normal reaction

A normal reaction is experienced by most children after an insect sting. Symptoms include:

  • Pain, redness, and swelling at the sting site. These can develop over 24–48 hours.

  • Pain, redness, and swelling that may spread to a larger, connected area beyond the sting site. The spreading can continue over 24–48 hours.

Allergic reaction

An allergic reaction can vary in severity and can include symptoms in other parts of the body beyond the sting site. Children who experience an allergic reaction have a higher risk of having similar or worse symptoms the next time they are stung. Symptoms may include:

  • Hives, itching, and swelling.

  • Abdominal symptoms including cramping, nausea, vomiting, and diarrhea.

Severe symptoms that require immediate medical attention include:

  • Chest pain or tightness.

  • Wheezing or trouble breathing.

  • Swelling of the tongue, throat, or lips.

  • Trouble swallowing.

  • Hoarse voice or cry.

Anaphylactic reaction

An anaphylactic reaction is a severe, life-threatening allergy and requires immediate medical attention. The symptoms often include severe allergic reaction symptoms that develop rapidly and lead to:

  • A sudden and sharp drop in blood pressure.

  • Dizziness.

  • Loss of consciousness.

How is this diagnosed?

This condition is usually diagnosed based on your child’s symptoms and medical history as well as a physical exam. Your child may have an allergy test to determine whether he or she is allergic to the insect venom.

How is this treated?

If your child was stung by a bee, the stinger and a small sac of venom may be in the wound. Remove the stinger as soon as possible. Do this by brushing across the wound with gauze, a clean fingernail, or a flat card such as a credit card. This can help reduce the severity of the body’s reaction to the sting.

Normal reactions can be treated with:

  • Washing the area thoroughly with soap and water.

  • Applying ice to the area to reduce swelling.

  • Oral or topical medicine to help reduce pain and itching, if present.

Pay close attention to your child’s symptoms for several hours after he or she has been stung. Stay with your child to see if an allergic reaction develops. If allergic symptoms develop, oral antihistamines can be given and you will need to get your child medical help right away.

If your child has had an allergic reaction before, you or the adult with them may need to:

  • Use the auto-injector “pen” (pre-filled automatic epinephrine injection device)at the first sign of an allergic reaction.

  • Get medical help right away because the epinephrine is short-acting. It is intended to give your child more time to get to an emergency room.

Follow these instructions at home:

Bag of ice on a towel on the skin.
  • Wash the sting site 2–3 times a day with soap and water as told by your child’s health care provider.

  • Apply or give over-the-counter and prescription medicines only as told by your child’s health care provider. Do not give your child aspirin because of the association with Reye syndrome.

  • If directed, apply ice to the sting area.

    • Put ice in a plastic bag.

    • Place a towel between your child’s skin and the bag.

    • Leave the ice on for 20 minutes, 2–3 times a day.

  • Do not let your child scratch the sting area.

  • If your child had a severe allergic reaction to a sting:

    • Your child may need to wear a medical bracelet or necklace that lists the allergy.

    • Your child may need to carry an anaphylaxis kit or auto-injector “pen” at all times. You, your child’s caregiver, teachers, and other family members will need to know when and how to use the kit and medicine.

How is this prevented?

  • Make sure your child knows not to swat at stinging insects or disturb insect nests.

  • Do not use fragrant soaps or lotions on your child.

  • Have your child wear shoes, pants, and long sleeves when spending time outdoors, especially in grassy areas where stinging insects are common.

  • Keep outdoor areas free from nests or hives.

  • Keep food and drink containers covered when eating outdoors.

  • Have your child avoid playing near flowering plants, if possible.

  • If an attack by a stinging insect or a swarm seems likely in the moment, move your child away from the area or find a barrier between your child and the insect(s), such as a door.

Contact a health care provider if:

  • Your child’s symptoms do not get better in 2–3 days.

  • Your child has redness, swelling, or pain that spreads beyond the area of the sting.

  • Your child has a fever.

Get help right away if:

  • Your child who is younger than 3 months has a temperature of 100°F (38°C) or higher.

  • Your child has symptoms of a severe allergic reaction. These include:

    • Chest tightness or pain.

    • Wheezing or trouble breathing.

    • Light-headedness, dizziness, or fainting.

    • Itchy, raised, red patches on the skin beyond the site of the sting.

    • Abdominal cramping, nausea, vomiting, or diarrhea.

    • Trouble swallowing or a swollen tongue, throat, or lips.

These symptoms may be an emergency. Do not wait to see if the symptoms will go away. Get help right away. Call 911.

Summary

  • Stings from bees, wasps, and hornets can cause pain and swelling, but they are usually not serious. However, some children may have an allergic reaction to a sting. This can cause the symptoms to be more severe.

  • Watch your child carefully after he or she has been stung and look for signs of worsening symptoms.

  • Call your child’s health care provider if your child has any signs of an allergic reaction.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.

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