Bee or Yellow Jacket Sting

Pediatric HouseCalls Online

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

See More Appropriate Topic(instead of this one) If

•  Not a bee, wasp or yellow jacket sting, see INSECT BITES

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 AIDAdvice for Anaphylactic Shock

• Lie down with feet elevated.

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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 9am and 4pm) 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

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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.
   • 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 may neutralize 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.  

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.