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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

Hornet
Hornet

Paper Wasp
Paper Wasp

First Aid - Shock
First Aid - Shock

Wasp
Wasp

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

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
HOME CARE ADVICE FOR BEE OR YELLOW JACKET STING

  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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