How to Treat Hives in Children and Common Causes

Got Benadryl? Learn what causes hives in kids and the best treatment for toddlers suffering from this itchy rash.

There's nothing fun about a kid with hives. And if you're reading this, that kid is probably yours. You're wondering what's causing them, how to treat them, and if there's any way to prevent them.

Read on. We've compiled a guide to all things hives.

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What Causes Hives?

"Hives in children is almost always an allergic reaction," says Jon McCullers, M.D., pediatrician-in-chief at Le Bonheur Children's Hospital in Memphis. But trying to pinpoint the actual allergy could be tricky. A mild case of hives usually clears up within 24 hours, so you have the best chance of identifying the trigger here.

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It's a small window, making it easier to retrace your child's steps. Did she use a new soap, get a bug bite, eat a new food, or come in contact with a poisonous plant? These are a few of the most common triggers:

  • Medication
  • Food
  • Pollen and pet irritants
  • Insect bites or stings, specifically from bees, yellow jackets, mosquitoes, chiggers, and fleas
  • Poison ivy
  • Metals from jewelry
  • Lotions and soaps

"We hardly ever see hives with small infants because allergic reactions are triggered by the immune system," explains Dr. McCullers. "You need to have multiple exposures in order to have the allergy itself." By the time a child reaches about 2, she will either have built up a tolerance for something or developed an allergy to it.

"Immune systems become more mature, and capable of a reaction, the older a child gets," says Dr. McCullers.

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Hives Symptoms

Simply put, hives are a red rash that's starting to itch. The red spots, also called welts, can cover either a small or large portion of body. They could be as small as a pinpoint or as large as a dinner plate. In the case of the larger welts, the red areas have joined together to form even larger patches called plaques.

Kids are prone to many different kinds of rash illnesses but one telltale sign of hives is that it itches, too.

"Parents should look for small, red raised bumps that can join together to form larger welts," says Brandi M. Kenner-Bell, M.D., F.A.A.D., F.A.A.P., assistant professor of pediatrics and dermatology at Northwestern University's Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago.

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Another indicator of hives is how quickly the rash can show up. When something triggers hives, the typical reaction time can be within minutes or a couple of hours. The rash can be local or generalized, meaning it either stays in one area or spreads all over, explains Dr. McCullers.

Occasionally, hives can be accompanied by angioedema, swelling beneath the surface of the skin, says Dr. Kenner-Bell: "It can occur with various types of hives and can be quite serious." Parents should pay particular attention to any swelling that could lead to serious respiratory systems. Angioedema can cause swelling of the throat or tongue, wheezing, difficulty breathing, and tightness in the chest, says Dr. Kenner-Bell. If you see any of those symptoms in your child, contact a doctor immediately.

Hives Treatment

Generally, parents can manage treatment from home with over-the-counter antihistamines such as Benadryl. "Antihistamines can make some children sleepy and others hyperactive," says Dr. McCullers. "If the side effects of a drug are too extreme, your doctor can recommend or prescribe another."

Also, a .5 or 1 percent topical cortisone cream could help take some of the sting out. "It's not a dangerous rash. You just want to keep your child from making it worse," says Dr. McCullers, who adds that applying cold compresses can also help.

"In most cases, hives go away within 24 hours," says Dr. Kenner-Bell, especially hives that affect only a small part of the body. "Kids should be seen by their doctor if their hives are more severe," says Dr. McCullers. "If they're all over the body, are accompanied by uncontrollable itching or extreme swelling, or last for an extensive period of time, see your doctor."

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Hives accompanied by angioedema also requires a doctor's attention. The doctor may need to prescribe a stronger antihistamine or an oral steroid to take the swelling down. And in the rare case that an allergic reaction becomes life-threatening, your child might need a shot of epinephrine to reverse the reaction quickly.

Finally, if the rash looks like hives but doesn't act like hives, let a doctor check it out. "The itchiness almost always means it's hives," says Dr. McCullers. "So, if it doesn't itch, it could be another rash illness and your doctor should see it right away."

Hives Prevention

The best course of action is to try to identify the trigger.

"We start by asking what new things a child has been exposed to," explains Dr. McCullers. This could include a new food, a new soap, or a new piece of jewelry. "After that, we move on to allergy testing on the skin," he says.

If you can identify the trigger, then avoiding it should keep hives away. But there's a chance that your kid could outgrow an allergy, or, more specifically, build up immunity against it. "But for really severe reactions, lifelong avoidance is the best course of action," says Dr. McCullers. "You can't risk having another reaction again while testing to see if the allergy has gone away."

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If there are any suspicions of possible allergic triggers, a blood test will be done to look for antibodies that have been formed in response to antigens that have entered the body and caused the immune system to react by releasing histamine. "Histamine causes the walls of the blood vessels to leak plasma to the surrounding tissues," explains Brandi M. Kenner-Bell, M.D., F.A.A.D., F.A.A.P., assistant professor of pediatrics and dermatology at Northwestern University's Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago. "The result is hives on the surface of the skin."

Hives are usually categorized as acute or chronic. Acute hives are common in kids and are most likely caused by an allergic reaction. Chronic hives (lasting more than six weeks) are much more of a mystery, but they're also very rare in children.

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