Shiraz Ghadir Mother and child hospital

Definition

Child was stung by a honeybee, bumblebee, hornet, paper wasp, or yellow jacket
Over 95 percent of stings are from honey bees or yellow jackets

Local reactions

The sting involves injecting venom into the human from the bee’s stinger.
The main symptoms are pain, itching, swelling and redness at the sting site.
Severe pain or burning at the site lasts 1 to 2 hours. Itching often follows the pain.
Swelling: Normal swelling from venom can increase for 24 hours following the sting. Stings of the upper face can cause severe swelling around the eye, but this is harmless.
Redness: Bee stings can normally become red. That doesn’t mean they are infected. Infections rarely occur in stings.
The redness can last 3 days and the swelling 7 days.

Anaphylactic reaction

A severe life-threatening allergic reaction is called anaphylaxis
The main symptoms are difficulty breathing and swallowing starting within 2 hours of the sting
Anaphylactic reactions to bee stings occur in 4 out of a 1,000 children
The onset of widespread hives or facial swelling alone following a bee sting is usually an isolated symptom, not the forerunner of anaphylaxis. Your child’s doctor will decide.

See more appropriate topic (instead of this one) if

Not a bee, wasp or yellow jacket sting, see insect bites

First aid advice for anaphylaxis: epinephrine (pending EMS arrival)

If you have epinephrine (Epi-pen or Twinject), give it now.
Do this while calling 911 (Reason: life-saving advice).
Over 66 pounds (30 kg): 0.3 mg. Auto-inject Epi-Pen or give 0.3 ml Twinject.
33-66 pound (15-30 kg) child: 0.15 mg. Auto-inject Epi-Pen Jr. or give 0.15 ml Twinject.
Less than 33 pounds (15 kg) child: Give dosage recommended by your doctor. (or 0.1 ml if you have an epinephrine ampule).
Inject it into the muscle (IM) of the upper outer thigh.
Can be given through clothing if necessary.
Benadryl: After giving epinephrine, give oral Benadryl or other antihistamine, if the child is able to swallow.

First aid advice for anaphylactic shock

Lie down with feet elevated.

When to Call Your Doctor

Call 911 Now (Your Child May Need an Ambulance) If

For any of the following symptoms of anaphylaxis, note that anaphylaxis usually starts within 20 minutes, and always by 2 hours following a sting.
Wheezing or difficulty breathing
Hoarseness, cough or tightness in the throat or chest
Difficulty swallowing or drooling
Speech is confused or slurred
Passed out or very weak
Previous severe allergic reaction to bees, yellow jackets, etc. (not just hives)

Call your doctor now (night or day) if

Your child looks or acts very sick
Hives or swelling occur elsewhere on the body
Sting inside the mouth
Sting to the eye
Abdominal pain or vomiting
More than 5 stings/10 pounds (5 kg) of weight (teens over 50 stings)
Fever and sting looks infected (spreading redness)
You think your child needs to be seen urgently

Call your doctor within 24 hours (between 9 a.m. and 4 p.m.) if

You think your child needs to be seen, but not urgently
Over 48 hours since the sting and redness now becoming larger (Note: infection is uncommon and doesn’t start until at least 24-48 hours after the sting. Any redness starting in the first 24 hours is due to venom)
Swelling is huge (e.g., spreads beyond a joint such as the wrist or ankle)

Call your doctor during weekday office hours if

You have other questions or concerns

Parent care at home if

Normal local reaction to yellow jacket or bee sting and you don’t think your child needs to be seen

Home Care Advice for Bee or Yellow Jacket Sting

Try to remove the stinger (if present)

Only honey bees leave a stinger.
Use a fingernail or credit card edge to scrape it off.
If the stinger is below the skin surface, leave it alone. It will be shed with normal skin healing.

Meat tenderizer

Apply a meat tenderizer-water solution on a cotton ball for 20 minutes (EXCEPTION: near the eye). This may neutralize the venom and decrease pain and swelling.
If not available, apply aluminum-based deodorant or a baking soda solution for 20 minutes.

Local cold

For persistent pain, massage with an ice cube for 10 minutes.

Pain medicine

Give acetaminophen (e.g., Tylenol) or ibuprofen immediately for relief of pain and burning.

Antihistamine

If the sting becomes itchy, give a dose of Benadryl. (See Dosage chart)

Hydrocortisone cream

For itching or swelling, apply 1% hydrocortisone cream to the sting area 3 times per day. (No prescription needed)

Expected course

Severe pain or burning at the site lasts 1 to 2 hours. Normal swelling from venom can increase for 24 hours following the sting. The redness can last 3 days and the swelling 7 days.

Call your doctor if

Develops difficulty breathing or swallowing (mainly during the 2 hours after the sting) (call 911)
Redness lasts over 3 days
Swelling becomes huge or spreads beyond the wrist or ankle
Sting begins to look infected
Your child becomes worse

And remember, contact your doctor if your child develops any of the “Call Your Doctor” symptoms.

References

Betten D, Richardson W, Tong, T, Clark R. Massive honey bee envenomation-induced rhabdomyolysis in an adolescent. Pediatrics. 2006; 117(1): 231-235.
Booker, G. Insect stings. Pediatr Rev. 2005;26(10):382-383.
Derlet RW, Richards JR. Cellulitis from insect bites: a case series. Cal J Emerg Med. 2003;IV(2):27-30.
Golden DB, Kagey-Sobotka A, Norman PS, et al. Outcomes of allergy to insect stings in children with and without venom immunotherapy. N Engl J Med. 2004;351:668-674.
Krakowski A., Golden D. Hymenoptera stings: A practical guide to prevention and management. Contemp Pediatr. 2005;23(8):30-37.
Moffitt JE, et.al. Joint Task Force on Practice Parameters. Stinging insect hypersensitivity: A practice parameter update. J Allergy Clin Immunol 2004; 114:869-886.
Schuberth KC. How dangerous are insect stings? Contemp Pediatr. 1989 May;6:69-88.
Schumacher MJ, et al. Rate and quantity of delivery of venom from honeybee stings. J Allergy Clin Immunol. 1994;93:831-835.
Sellinger CR. Immunotherapy for insect stings. Pediatr Rev. 1993;14:246.
Sherman RA. What physicians should know about Africanized honeybees. West J Med. 1995;163:541-546.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D. Clinical content review provided by Senior Reviewer and Healthpoint Medical Network.

Last Review Date: 6/1/2011

Last Revised: 8/1/2011 2:48:43 PM

Content Set: Pediatric HouseCalls Symptom Checker

Version Year: 2012