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. 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 Jon McCullers, M.D., pediatrician-in-chief at Le Bonheur Children's Hospital in Memphis.
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 in children is almost always an allergic reaction," says Dr. McCullers. 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. 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?
It's harder to understand what causes hives that are either acute (lasting up to six weeks) or chronic (lasting more than six weeks). With acute hives, which are common in children, a food allergy or insensitivity is a likely culprit but certain medications can also bring them on. Look at your kid's diet and consider doing some allergy testing. Chronic hives are quite rare in children, says Dr. McCullers.
"Most cases of hives are mild and can be managed at home," says Dr. McCullers. The only symptom to treat is the rash or, more specifically, the itch. Benadryl is a good place to start. "Oral antihistamines are the easiest and safest way to treat acute hives," says Dr. Kenner-Bell. "And your pediatrician can prescribe something stronger if an over-the-counter medication isn't providing enough relief." 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.
Be sure to see the doctor if your child has a severe case -- in other words, if the rash does not respond to oral antihistamines or lasts for more than a few days. 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."
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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