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Pediatric - Bee or Yellow Jacket Sting

Bee or yellow jacket sting

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Bee Sting of Upper Arm
Bee Sting of Upper Arm

Bee Sting of Left Hand
Bee Sting of Left Hand

First Aid - Removing a Stinger
First Aid - Removing a Stinger

Honeybee Collecting Pollen
Honeybee Collecting Pollen


Paper Wasp
Paper Wasp

First Aid - Shock
First Aid - Shock


  • 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

Local Reactions

  • The sting involves injecting venom into the human from the bee's stinger.
  • The main symptoms are pain, itching, swelling and redness at the sting site.
  • Severe pain or burning at the site lasts 1 to 2 hours. Itching often follows the pain.
  • Swelling: Normal swelling from venom can increase for 24 hours following the sting. Stings of the upper face can cause severe swelling around the eye, but this is harmless.
  • Redness: Bee stings can normally become red. That doesn't mean they are infected. Infections rarely occur in stings.
  • The redness can last 3 days and the swelling 7 days.

Anaphylactic Reaction

  • A severe life-threatening allergic reaction is called anaphylaxis
  • The main symptoms are difficulty breathing and swallowing starting within 2 hours of the sting
  • Anaphylactic reactions to bee stings occur in 0.4% of children
  • The onset of generalized hives or facial swelling following a bee sting is usually an isolated symptom, not the forerunner of anaphylaxis

If not, see these topics

First Aid:

First Aid Advice for Anaphylaxis - Epinephrine and Antihistamine (pending EMS arrival)

  • Give epinephrine injection if the caller has an anaphylactic kit.
  • Do this while they call 911 (Reason: life-saving advice).
  • Over 66 pounds (30 kg): 0.3 mg. Auto-inject Epi-Pen or give 0.3 mg Twinject.
  • 33-66 pound (15-30 kg) child: 0.15 mg. Auto-inject Epi-Pen Jr. or give 0.15 mg Twinject.
  • < 33 pounds (15 kg) child: Give dosage recommended by your doctor (or 0.1 ml).
  • Inject it IM into the upper outer thigh. (SC is less effective)
  • Can be given through clothing if necessary.
  • Give oral Benadryl or other antihistamine if the caller has it and the child is able to swallow.

First Aid Advice for Anaphylactic Shock

  • Lie down with feet elevated.
When to Call Your Doctor

Call 911 Now (your child may need an ambulance) If
  • For any of the following symptoms of anaphylaxis, see FIRST AID. Anaphylaxis usually starts within 20 minutes, and always by 2 hours following a sting.
  • Wheezing or difficulty breathing
  • Hoarseness, cough or tightness in the throat or chest
  • Difficulty swallowing or drooling
  • Speech is confused or slurred
  • Passed out or very weak
  • Previous severe allergic reaction to bees, yellow jackets, etc. (not just hives)
Call Your Doctor Now (night or day) If
  • Your child looks or acts very sick
  • Hives or swelling occur elsewhere on the body
  • Sting inside the mouth
  • Sting to the eye
  • Abdominal pain or vomiting
  • More than 5 stings/10 pounds of weight (teens over 50 stings)
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think your child needs to be seen
  • Sting looks infected (red streaking from the sting area, yellow drainage) (Note: infection and cellulitis don't start until at least 24-48 hours after the sting. Any redness starting in the first 24 hours is due to venom)
  • Swelling is huge (e.g., 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 local reaction to yellow jacket or bee sting and you don't think your child needs to be seen

  1. Try to Remove the Stinger (if present):
    • Only honey bees leave a stinger.
    • Use a fingernail or credit card edge to scrape it off.
    • 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 may neutralize the venom and decrease 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.
  5. Hydrocortisone Cream: For itching or swelling, apply 1% hydrocortisone cream over-the-counter to the sting area 3 times per day.
  6. Expected Course: Severe pain or burning at the site lasts 1 to 2 hours. Normal swelling from venom can increase for 24 hours following the sting. The redness can last 3 days and the swelling 7 days.
  7. Call Your Doctor If:
    • Develops difficulty breathing or swallowing (mainly during the 2 hours after the sting) (call 911)
    • Redness lasts over 3 days
    • Swelling becomes huge or spreads beyond the wrist or ankle
    • Sting begins to look infected
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 1/19/2009

Last Revised: 5/31/2009

Content Set: Pediatric HouseCalls Online

Copyright 1994-2009 Barton D. Schmitt, M.D.

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