Hives in Children

What are hives in children?

Hives (urticaria) are bumps on your skin that occur suddenly. They're common in children and usually form on their chest, stomach or back. Hives may cause discomfort, but they’re temporary and should leave no scars or bruising.

Are there different types of urticaria in children?

Hives may be acute or chronic:

• Acute hives last anywhere between a few hours or days and six weeks.
• Chronic hives may last for more than six weeks. In some cases, they go away only to reappear a few days later.

What do hives look like?

Hives are often reddish. But they may appear purple or grey on dark skin. They may also:

• Appear in groups.
• Be large or small.
• Blend to cover large areas of skin.
• Change shape.
• Come and go.
• Form rings.
• Have a pale center.
• Look like mosquito bites.

What do hives feel like?

In some children, hives cause no discomfort.

Urticaria in children sometimes causes symptoms that include:

• Fussiness in young children.
• Itching.
• Stinging sensation.
• Swelling in the hands, feet, eyes or lips.

A small number of children have signs of a life-threatening allergic reaction (anaphylaxis). These include:

• Difficulty breathing or swallowing (dysphagia).
• Dizziness or loss of consciousness.
• Drooling.
• High fever.
• Joint pain.
• Swelling in the tongue or throat.
• Vomiting.

How do hives form?

Hives occur as part of an immune system response. When the body perceives a foreign substance, it releases histamines. These chemicals protect the body against germs but can irritate delicate tissue.

This causes irritation that makes blood vessels expand and sometimes burst. When this happens, fluid (plasma) leaks out, leading to raised patches of skin.

Which children get hives?

Any child can experience hives. Children with allergies are at a higher risk.

What causes hives in children?

In as many as half of cases, hives have no cause.

When a cause is identified, it could be an allergic reaction to:

• Chemicals found in detergents, lotions and other household products.
• Dust.
• Food, especially milk, tree nuts or shellfish.
• Latex.
• Mold.
• Pets and other animals.
• Pollen.

Other potential causes of urticaria in children include:

• Infections, like the common cold or strep throat.
• Insect bites or stings.
• Tight-fitting clothes.
• Reactions from radiation therapy.
• Viruses, including SARS-CoV-2, the virus that causes COVID-19.

Rare causes of hives include:

• Exercise.
• Exposure to cold or heat.
• Medication reactions.
• Stress.
• Sunlight.

What treatments help children with hives?

The treatment that’s right for your child depends on the type of hives, symptoms and severity. For acute hives with mild symptoms, treatment might not be necessary.

Children with chronic hives or acute hives and bothersome symptoms may need treatment. Medications like antihistamines can control the itch and slow the spread of hives. Your child’s healthcare provider may recommend:

• Cetirizine liquid or tablets.
• Diphenhydramine liquid, capsules or tablets. (Can make your child sleepy.)
• Fexofenadine orally disintegrating tablets.
• Loratadine tablets.

Children with signs of anaphylaxis need emergency treatment to halt the allergic reaction. Care may include an epinephrine injection.

How soon will my child feel better?

With acute hives, your child may start feeling better within a few hours. Hives may begin to fade within a few hours or days. Chronic hives take longer to heal. Your child may need additional treatments to relieve discomfort.

What else can I do to help my child feel comfortable?

Steps you can take to help your child while they heal include:

• Avoiding heat and sun exposure.
• Applying cool compresses or giving your child a cool shower or bath.
• Covering hives with calamine lotion.
• Turning on a fan or exposing your child to cool air.

When should I bring my child to a healthcare provider for hives?

A single episode of hives without severe symptoms or discomfort doesn't need medical attention. If your child is uncomfortable, can't sleep or hives cover a large area of their body, contact their healthcare provider. If there’s a trigger or cause of the hives, talk to your healthcare provider to determine if you should avoid it or if further testing is needed.

If your child has signs of anaphylaxis, call for an ambulance right away. Don't attempt to drive to the hospital.

Chronic hives require medical attention. Allergy testing or other assessments may be necessary to determine the cause. And your child may need a combination of antihistamines to treat them.

A note from Cleveland Clinic

Urticaria in children is common and can have many causes. The appearance of hives may concern you, but they often don't cause symptoms. Children with mild symptoms may feel better with the help of antihistamines. Some cases last several weeks and require medical attention and possibly additional testing. In rare instances, hives cause a life-threatening allergic reaction. Nearly all children with hives make a full recovery and have no scars.