Symptom definition:

• The 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. The sting involves injecting venom into the human from the bee's stinger
• The main symptoms are pain, swelling and redness at the sting site
• A severe allergic reaction is called anaphylaxis
• First aid advice for anaphylaxis: Give epinephrine injection if you have an anaphylactic kit. Inject it into the muscle of the upper outer thigh
• Learn more about other types of insect bites, tick bites, spider bites, fire ant bites

Call 911 Now (your child may need an ambulance for symptoms of alaphylaxis):

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

Call your doctor now (night or day) if:

• Your child looks or acts very sick
• Hives or swelling occur elsewhere on the body
• More than 10 stings
• Sting inside the mouth

Call your doctor within 24 hours (during regular office hours) if:

• You think your child needs to be seen
• Sting looks infected (red streaking from the sting area, yellow drainage) Note: Infection doesn't start until at least 24 to 48 hours after the sting. Any redness in the first 24 hours is due to venom
• Swelling is huge or spreads beyond wrist or ankle

Call your doctor during weekday office hours if:

• You have other questions or concerns

Parent care at home if:

• Normal bee sting and you don't think your child needs to be seen

Home care advice for bee sting:

1. Try to remove the stinger (if present): Use a fingernail or credit card edge to scrape it off. Don't pull it off. (Reason: squeezes out more venom). If the stinger is below the skin surface, leave it alone. It will be shed with normal skin healing.

2. Meat tenderizer: Apply a meat tenderizer-water solution on a cotton ball for 20 minutes (Exception: Near the eye). This neutralizes the venom and decreases pain and swelling. If not available, apply aluminum-based deodorant or a baking soda solution for 20 minutes. For persistent pain, massage with an ice cube for 10 minutes.

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

4. Antihistamine: If the sting becomes itchy, give a dose of Benadryl.

Expected course:

• Severe pain or burning at the site lasts one to two hours.
• Normal swelling from venom can increase for 24 hours following the sting. The swelling disappears after three to five days.

Call your doctor if:

• Develops difficulty breathing or swallowing mainly during the two hours after the sting (call 911)
• Swelling becomes huge or spreads beyond the wrist or ankle
• Sting begins to look infected
• Your child becomes worse or develops any of the "Call Your Doctor" symptoms.

Parent Care for Pediatric Symptoms. Copyright © 2005. Barton D. Schmitt, MD, FAAP