definition | The Pediatrician's Files

Definition: An itchy rash made up of raised pink spots with pale centers

Symptoms

* Raised pink bumps with pale centers (welts).

* Hives look like mosquito bites.

* Sizes of hives vary from ½ inch (12 mm) to several inches (cm) across.

* Shapes of hives are variable and change repeatedly.

* Itchy rash.

Causes:

* Widespread hives usually are caused by a viral infection. They can also be an allergic reaction to a food, a drug, an infection, an insect bite, or other substances. Often the cause is not found. Hives from foods usually resolve in 6 hours.

* Localized hives are usually caused by skin contact with plants, pollen, food, or pet saliva. Localized hives are not caused by drugs, infections, or swallowed foods.

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

* Difficulty breathing or wheezing

* Hoarseness or cough with rapid onset

* Difficulty swallowing, drooling, or slurred speech with rapid onset

* Severe life-threatening allergic reaction in the past to similar substance

Call Your Doctor Now (Night or Day) If:

* Your child looks or acts very sick

* Hives began after a bee sting, medicine, or high-risk food (eg, peanuts, fish), and no previous reactions

* Child younger than 1 year with widespread hives

Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm) If

* You think your child needs to be seen

* Severe hives (eg, eyes swollen shut, very itchy) not improved after second dose of Benadryl

* Fever or joint swelling is present

* Abdominal pain or vomiting is present

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

* Hives interfere with school or normal activities after taking Benadryl every 6 hours for more than 24 hours

* Food suspected as cause

* Hives have occurred 3 or more times and cause is unknown

* Hives last more than 1 week

Parent Care at Home If:

* Hives with no complications and you don’t think your child needs to be seen

Home care advice for hives:

1. Localized Hives

* For localized hives, wash the allergic substance of the skin with soap and water.

* If itchy, massage the area with a cold pack or ice for 20 minutes.

* Localized hives usually disappear in a few hours and don’t need Benadryl.

2. Benadryl for Widespread Hives

* Give Benadryl 4 times per day for widespread hives that itch (no prescription needed)

* If you only have another antihistamine at home (but not Benadryl), use that.

* Continue Benadryl 4 times per day until the hives are gone for 12 hours.

* Contraindication: Child is younger than 1 year (Reason: Benadryl is a sedative). Give your doctor a call for advice.

3. Food-Related Hives

* Foods can cause widespread hives.

* Sometimes hives are isolated to just around the mouth.

* Hives from foods usually are transient and gone in less than 6 hours.

4. Cool Bath: Give a cool bath for 10 minutes to relieve itching (CAUTION: Avoid causing a chill). Rub very itchy areas with an ice cube for 10 minutes.

5. Remove Allergens: Give a bath or shower if triggered by pollens or animal contact. Change clothes.

6. Avoid Allergens: If you identify a substance that causes hives (eg, a food), help your child avoid that substance in the future.

7. Contagiousness

* Hives are not contagious

* Your child can return to child care or school if the hives do not interfere with normal activities.

* If the hives are associated with an infection, your child can return to school after the fever is gone and your child feels well enough to participate in normal activities.

8. Expected Course: Hives from a viral illness normally come and go for 3 or 4 days, then disappear. Most children get hives once.

9. Call Your Doctor If :

* Severe hives persist after second dose of Benadryl

* Most of the itch is not relieved within 24 hours on continuous Benadryl

* Hives last more than 1 week

* Your child becomes worse

Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt

Definition:
Excessive crying, irritability, or fussiness in a child 3 months or older.
Child is too young to tell us or show us the cause for his crying. Crying is the only symptom.
If your child is crying from an illness or physical symptom, use that symptom checker instead of this one.

Causes:
Not caused by hunger—by this age, you should be able to recognize hunger. Main Cause: Coming down with an illness. Other Common Causes: * Overtired, stressed, whining, tantrums, and separation anxiety. * Always consider pain as a possible cause of persistent fussiness or crying. Inconsolable crying may be the only symptom initially in a young child with an ear infection or even appendicitis. * Painful causes include earache, blocked nose from a cold, sore throat, mouth ulcers, raw diaper rash, metal ulcer on tip of penis, constipatio, and hair wrapped around toe (take off socks and check).

Call 911 Now (Your Child May Need an Ambulance): If Not moving or very weak

Call Your Doctor Now (or in Alberta, Canada call 780-408-LINK):

* IF Your child looks or acts very sick

* Stiff neck or bulging soft spot

* Possible injury (especially head or bone injury)

* Very irritable, screaming child for longer than 1 hour

* You are afraid you or someone might hurt or shake your baby

* Your child cannot be comforted after trying this advice for 2 hours

* Crying interferes with sleeping for longer than 2 hours

Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm)

* If you think your child needs to be seen

* Pain (eg, earache) suspected as cause of crying

Call Your Doctor During Weekday Office Hours

* If you have other questions or concerns

* Mild, off-and-on fussiness (acts normal when not crying) continues more than 2 days

* Excessive crying is a chronic problem

Parent Care at Home If mild fussiness present fewer than 2 days and you don’t think your child needs to be seen

Home Care Advice for Mild, Consolable Crying:

1. Reassurance: Most infants and toddlers become somewhat irritable and fussy when sick or overtired. Crying tells us your child is not feeling well. If the crying responds to comforting, it’s probably not serious.

2. Comforting: Try to comfort your child by holding, rocking, or massaging her

3. Sleep: If your child is tired, put him to bed. If he needs to be held, hold him quietly in a horizontal position or lie next to him. Some overtired infants need to cry themselves to sleep

4. Undress Your Child: Sometimes part of her clothing is too tight or uncomfortable. Also check her skin for redness or swelling (eg, insect bite)

5. Discontinue Medicines:

* If your child is taking a cough or cold medicine, stop it

* The crying should stop within 4 hours

* Antihistamines (eg, Benadryl) can cause screaming and irritability in some children

* Pseudoephedrine (decongestant) can cause jitteriness and crying

6. Expected Course: Most fussiness with illnesses resolves when the illness does. Most fussiness caused by stress or change (eg, new child care) lasts less than 1 week

7. Call Your Doctor If:

* Constant crying lasts longer than 2 hours

* Intermittent crying lasts more than 2 days

* Your child becomes worse

Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt