Urticaria, the medical term for hives, is a common skin reaction characterized by raised, red, itchy welts known as wheals. These lesions appear suddenly, often in clusters, and range in size from small spots to large patches on any part of the body. A distinguishing feature of hives is that the center of the wheal will momentarily turn pale, or “blanch,” when pressed, confirming temporary fluid leakage beneath the skin’s surface. Hives are a frequent occurrence in childhood, and while their appearance can be alarming, they are typically a temporary and isolated event.
Identifying Common Hives
The typical presentation of hives in children is acute urticaria, which is usually a short-lived occurrence. The most common trigger for this reaction is often not an allergy, but a mild viral infection, such as an upper respiratory illness. The body’s immune response to the virus releases histamine, causing the skin reaction.
Acute hives are transient, with individual wheals lasting less than 24 hours before fading without leaving a mark. New spots may appear as old ones disappear, making the rash seem to move across the body. Other common triggers include sensitivities to foods, temperature changes like heat or cold, or physical irritation. For example, dermatographism causes wheals to appear simply from scratching or rubbing the skin.
Emergency Signs Requiring Immediate Care
The primary concern with hives is whether they are an isolated skin issue or part of a systemic, life-threatening reaction called anaphylaxis. If hives are accompanied by any of the following symptoms, immediate emergency care is mandatory, and you should call 911.
Signs requiring immediate attention include:
- Difficulty breathing, such as wheezing, persistent coughing, or a high-pitched, noisy sound known as stridor.
- Facial swelling (angioedema), especially if it affects the lips, tongue, or throat, as this can rapidly obstruct the airway.
- Any sudden change in the child’s mental or physical state, including appearing dizzy, faint, or suddenly becoming pale and limp.
- Gastrointestinal distress, such as repetitive vomiting or severe, persistent abdominal pain.
These symptoms indicate the reaction is affecting internal organs and requires immediate intervention with an epinephrine auto-injector, if available, followed by emergency transport. The most concerning reactions typically occur swiftly, often within minutes to an hour of exposure to a trigger.
Managing Hives at Home
If the child is stable and the hives are not accompanied by severe symptoms, comfort measures can provide relief while the reaction runs its course. Applying a cool compress or a washcloth soaked in cold water directly to the affected area can help calm the itching. A lukewarm bath with colloidal oatmeal can also soothe widespread hives and reduce irritation.
It is helpful to dress the child in loose-fitting, soft clothing to minimize friction on the wheals. Over-the-counter antihistamines, such as cetirizine or loratadine, work by blocking the histamine released by the body, reducing itching and the formation of new hives. Consult with a pharmacist or pediatrician to confirm the correct dosage based on the child’s age and weight before administering any medication.
When to Call the Pediatrician
While many cases of hives resolve quickly at home, a professional assessment is necessary in some situations to rule out underlying issues. You should contact the pediatrician if individual hive lesions persist for longer than 48 hours, or if the overall rash continues to recur over several days. Hives that last for six weeks or more are classified as chronic urticaria and require investigation to identify the cause.
A doctor’s visit is also warranted if the hives are accompanied by other systemic complaints, even if they are not immediately life-threatening. This includes a persistent or high fever, swelling or pain in the joints, or symptoms that significantly disrupt the child’s sleep or daily activities. These persistent symptoms may indicate the hives are linked to a deeper issue, such as a low-grade infection or an autoimmune response.