Bee or Yellow Jacket Sting

Symptoms

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

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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 widespread hives or facial swelling alone following a bee sting is usually an isolated symptom, not the forerunner of anaphylaxis

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See More Appropriate Topic (instead of this one) If

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

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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

• Lie down with feet elevated.

Should I Call?

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

Care at Home

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.

Photo Example

Bee Sting of Upper Arm

This photo shows the typical localized reaction to a bee sting. There is mild redness in an oval 4 inches (10 cm) wide of the left upper arm.

Bee Sting of Left Hand

Moderate swelling of left hand from a bee sting that occurred the day before.

First Aid - Removing a Stinger

The stinger looks like as a tiny black dot in the center of the sting. There are several different methods of removal. Removing the stinger quickly is more important than the type of removal used.

• You can scrape it out with a credit card or finger nail.
• You can also use adhesive tape.
• If only a small fragment remains, don't worry about it. It will shed with the skin.

Note: In many cases no stinger will be present. Only bees leave their stingers. Wasps, yellow jackets, and hornets do not. Source: LMS Inc., Copyright 2000-2009. Self Care Decisions, LLC. Used by Permission.

Wasp

Honeybee Collecting Pollen

Hornet

Bald-faced "hornet" (Dolichovespula maculata).

Source: Wikimedia Commons

Permission is granted to copy, distribute and/or modify this document under the terms of the GNU Free Documentation License.

This is a public domain image file from Wikimedia Commons. Wikimedia is a freely licensed media repository.

First Aid - Shock

• Lie down with the feet elevated (Reason: counteract shock).

Note: In this illustration the individual in shock is laying down and his feet have been placed up on a stack of blankets.