Bee or Yellow Jacket Sting

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Definition

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 4 out of a 1,000 children
The onset of widespread hives or facial swelling alone following a bee sting is usually an isolated symptom, not the forerunner of anaphylaxis. Your child’s doctor will decide.

If not, see these topics

First Aid:

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

If you have epinephrine (Epi-pen or Twinject), give it now.
Do this while calling 911 (Reason: life-saving advice).
Over 66 pounds (30 kg): 0.3 mg. Auto-inject Epi-Pen or give 0.3 ml Twinject.
33-66 pound (15-30 kg) child: 0.15 mg. Auto-inject Epi-Pen Jr. or give 0.15 ml Twinject.
Less than 33 pounds (15 kg) child: Give dosage recommended by your doctor. (or 0.1 ml if you have an epinephrine ampule).
Inject it into the muscle (IM) of the upper outer thigh.
Can be given through clothing if necessary.
Benadryl: After giving epinephrine, give oral Benadryl or other antihistamine, if the child is able to swallow.

First Aid Advice for Anaphylactic Shock

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 (5 kg) of weight (teens over 50 stings) Fever and sting looks infected (spreading redness) You think your child needs to be seen urgently
	Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
	You think your child needs to be seen, but not urgently Over 48 hours since the sting and redness now becoming larger (Note: infection is uncommon and doesn'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 a joint such as the 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

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.
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.
Local Cold: For persistent pain, massage with an ice cube for 10 minutes.
Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen immediately for relief of pain and burning.
Antihistamine: If the sting becomes itchy, give a dose of Benadryl. (See Dosage chart)
Hydrocortisone Cream: For itching or swelling, apply 1% hydrocortisone cream to the sting area 3 times per day. (No prescription needed)
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.
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.