Hives in Children: Causes, Treatment and When It's an Emergency

Hives are raised, itchy red or pale welts that appear suddenly on the skin and often fade within hours, only for new ones to appear somewhere else. In children they are most often triggered by a viral infection, and less often by a food, medicine or insect sting. Most hives are harmless and clear on their own. But hives with trouble breathing, a swollen face or tongue, or repeated vomiting can be a serious allergic reaction, and need an ambulance straight away.

What do hives look like?

Hives, also called urticaria, have a recognisable pattern:

• raised bumps or patches, often with a pale centre and a red edge
• very itchy, sometimes with a stinging or burning feeling
• different sizes, from a few millimetres to several centimetres, and sometimes joining into large patches
• any part of the body can be affected
• each welt usually fades within 24 hours, but new ones keep appearing, so the rash seems to move

Some children also have angioedema, which is swelling under the skin, often around the eyes, lips, hands or feet. It looks puffy and feels tight or tingly rather than itchy.

What causes hives in children?

Often no cause is ever found. When there is one, the most common are:

1. Viral infections. Colds, tummy bugs and other viruses are the most common cause of hives in young children. The hives usually appear during or just after the illness.
2. Foods. Milk, egg, peanuts, tree nuts, sesame, wheat, fish and shellfish are common triggers. Food hives usually appear within minutes to two hours of eating.
3. Medicines. Antibiotics and some pain medicines can cause hives. Always tell the doctor about any medicine your child has taken recently.
4. Insect stings and bites.
5. Contact. Plants, latex, pet saliva or some skin products can cause hives where they touch the skin.
6. Physical triggers. Heat, cold, sweating, sunlight, pressure from tight clothes or scratching can set off hives in some children.

If hives follow a food, a sting or a medicine within a short time, note exactly what your child had and when, and tell the doctor. A photo of the rash is helpful, because hives often fade before the appointment.

Are hives dangerous?

Usually not. Most hives are a short-lived skin reaction with no other symptoms, and they clear within a few days. They become an emergency only when they are part of a wider allergic reaction, called anaphylaxis, which affects breathing or circulation.

When are hives an emergency?

What can I do at home for hives?

For mild hives with no other symptoms:

• Note what your child ate, touched or took in the hours before.
• Keep your child cool, in loose cotton clothes. Heat makes hives itch more.
• Use a cool, damp cloth on itchy areas.
• Trim nails to limit scratching.
• Ask your pediatrician about a non-drowsy antihistamine, which is often used to ease itching and the rash. Give only the medicine and dose the doctor recommends for your child’s age and weight.
• Avoid a suspected trigger until the doctor has seen your child.

Antihistamines help the itch but do not treat the cause. Do not use creams or home remedies on broken skin without asking.

How long do hives last?

It depends on the type:

Acute hives

last less than 6 weeks, and most clear within days. These are by far the most common in children and are usually linked to an infection.

Chronic hives

last longer than 6 weeks, with welts appearing on most days. These are less common in children and are worth a proper assessment.

Does my child need an allergy test?

Not usually. For a single episode that followed a cold, tests are rarely helpful. A doctor considers testing when hives come back, follow a specific food or medicine, or are part of a serious reaction. The doctor decides which test, if any, makes sense. A positive test alone does not prove allergy, so results need to be read with the story of what happened.

Do not cut foods out of your child’s diet because of a suspected link before talking to the doctor, as unnecessary avoidance can cause problems of its own. Our guides to food allergy in children and eczema in babies and children explain more. The NHS also has a clear overview of hives.

When to see a doctor

How we can help at myPediaclinic

Dr. Medhat Abu-Shaaban, Consultant Pediatrician and Medical Director, and Dr. Tala Belbeissi, Consultant Pediatrician, see children with hives and other allergic skin and food reactions through our allergies and eczema service. We examine your child, take the history of what happened, explain the likely cause and, where needed, advise on tests or a referral and write a plan for what to do next time. Consultations at our clinic in Dubai Healthcare City are available in English and Arabic.

Frequently asked questions