How to Treat Hives in Children

There's nothing fun about a kid with hives. The itchy red rash is can be caused by an infection, an allergic reaction, or even an unknown cause, but it might be difficult to find the trigger, says Jon McCullers, M.D., pediatrician-in-chief at Le Bonheur Children's Hospital in Memphis.

Hives can usually be treated at home with over-the-counter remedies, and they often disappear within 24 hours. In rare cases, you might need to visit your child's pediatrician to manage the rash.

Keep reading for the lowdown on hives, including what usually causes them, how to treat them, and if there's any way to prevent them.

What Causes Hives?

While hives are usually caused by an allergy, infection, or an unknown cause. Trying to pinpoint the actual culprit can be tricky. A mild case of hives usually clears up within 24 hours, so you have the best chance of identifying the offender during this timeframe. Start by retracing your child's steps. Did they use a new soap, get a bug bite, eat a new food, or come in contact with a poisonous plant?

You'll also notice that the littlest children don't often get hives. "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 age 2, they 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.

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.

Symptoms of Hives in Kids

Simply put, hives are a red rash on the skin; the red spots are called welts. "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.

In those with brown or black skin, hives can be the same color as your skin, or slightly darker or lighter, according to the American Academy of Dermatology Association.

Hives can develop anywhere on the body, including the back, chest, upper arms, upper legs, and abdomen. Kids are prone to many different kinds of rashes, but one telltale sign of hives is itchiness. Here are some other characteristics of hives in kids and toddlers:

• Hives can cover either a small or large portion of body.
• The rash can be local or generalized, meaning it either stays in one area or spreads all over.
• Hives 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.
• Hives show up quickly. When something triggers hives, the typical reaction time can be within minutes or a couple of hours.
• Hives are itchy, though some people describe the sensation as burning or stinging.
• The hives blanch on light or medium skin, which means they turn white when you press on them.

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 symptoms. 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 for Children and Toddlers

Wondering how to treat hives in children and toddlers? Start by changing your child's clothing and washing their skin, which may remove some of the allergen. Loose-fitting cotton attire can reduce irritation, according to the American Academy of Dermatology Association.

Encourage kids not to scratch the hives. "It's not a dangerous rash. You just want to keep your child from making it worse," says Dr. McCullers.

Generally, parents can manage hives from home with over-the-counter antihistamines like Claritin or Zyrtec. "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 0.5% or 1 % topical cortisone cream could help take some of the sting out.

The American Academy of Dermatology Association recommends applying a cool compress to skin (made with a clean washcloth and cold water), using lukewarm water when bathing, and washing with a gentle, fragrance-free soap. Adding colloidal oatmeal to your kid's bath can also ease the symptoms of hives; follow the instructions on the packaging.

In most cases, hives go away within 24 hours, says Dr. Kenner-Bell. This is especially true for hives that affect only a small part of the body.

When to See a Healthcare Provider for Hives

Kids should be seen by their doctor if their hives are severe, or they're not responding to at-home treatment. "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," says Dr. McCullers.

Hives accompanied by angioedema also require 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 Methods

To prevent hives, the best course of action is identifying 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."

If there are any suspicions of possible allergic triggers, a blood test will look for antibodies that formed in response to antigens that 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 Dr. Kenner-Bell. "The result is hives on the surface of the skin."