Bee Stings

Dear Lisa,

I was taking care of a friend’s child and he got stung by a bee. I didn’t know if he was allergic to bee stings or not. What are you supposed to do if a child gets stung by a bee? What would happen if a child was allergic to bee stings?

“What is the treatment for Bee Stings?”

Dear “What is the treatment for Bee Stings?”,

When a bee stings a child, venom is injected from the bee into the child’s skin which may cause an allergic reaction. If a child is allergic two types of reactions can occur. One type is a generalized reaction which is the more serious type of reaction that can lead to anaphylaxis. An anaphylactic reaction can be life threatening and requires immediate medical attention. The other type of reaction is called a localized reaction. This type of reaction is not life threatening and is limited to the area that was stung.

When a child gets stung by a bee, the first thing that you should do is look for signs of a generalized reaction. The signs of a generalized reaction include nausea, vomiting, wheezing, difficulty breathing, itching all over the body, body rash and swelling especially on the face or around the lips. If signs of a generalized reaction occurs contact your local Emergency Medical System immediately. A generalized reaction typically occurs within minutes to an hour after a bee sting, but can occur up to 6 hours later. (1)

The signs of a localized reaction include redness, itching and swelling at the site of the sting. You may see a black dot at the site of the bite which is the detached stinger. A localized reaction does not involve rashes or symptoms on other parts of the body. In some cases a localized reaction may spread. If you notice that the redness and swelling from a bee sting is spreading you should seek medical attention for an evaluation. Redness or swelling that extends beyond two joints of an extremity needs special attention and usually requires treatment with steroids. Increased reddness and swelling at the site may also be a sign of a skin infection. Other signs of a skin infection include fever, warmth at the site, increasing pain, discharge or red lines on the skin.

The first step in treating a bee sting is removing the stinger. If a stinger is present the child was stung by a honeybee. If there is no stinger present then the child was stung by a yellow jacket(which is more likely to cause anaphylaxis), a wasp or hornet. (2) In order to remove the stinger you can flick it off using a credit card by scraping the edge of the card against the skin. Once the stinger is removed, wash the area with warm soapy water and pat dry. It is important to wash the site in order to prevent a skin infection. Next, apply cold compresses or ice to relieve the pain and itching. If you have meat tenderizer in the home, you can make a paste by adding a few drops of water to the powder and apply the paste to the site. Meat tenderizer contains enzymes that destroy insect venom (3) and reduces inflammation and edema. (4) Continually monitor the child for signs of a generalized reaction and watch for increased redness or swelling at the site of a localized reaction.

You can be proactive in preventing bee stings by avoiding insect breeding grounds such as orchards and flower beds. Avoid dressing your children in brightly colored clothes which can attract bees and instead have them wear white or light colored clothing. Always make sure that children playing outdoors wear shoes. Many children get stung on the foot when they walk outdoors on the grass. Bees are attracted to scents therefore avoiding heavily scented soaps, lotions, perfumes or cosmetics may keep the bees away. If you have bee hives or nests on your property have them removed by a professional exterminator with experience in destroying hives.

If a child is allergic to bee stings, he should wear a medic alert bracelet so that adults and health care workers will be aware of the potential for a reaction. (5) It is important for children with a bee allergy to carry an Epipen or emergency epinephrine with him at all times. In addition, all adults caring for a child with a bee allergy should be trained to properly administer the medication in case a reaction occurs. (5) A good way to learn is with an Epipen Trainer. You can obtain an Epipen trainer from your pharmacist or doctor. An Epipen trainer is a device with no medication or needle so that it can be used over and over again for training. It is a good idea to practice with an Epipen trainer so that you can become more comfortable and familiar with the device in case of an emergency. If a generalized reaction does occur, you should administer the Epipen immediately and then call 911 or your local EMS.

For more information about a Medic Alert bracelet contact:
www.medicalert.org

(1)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. W.B. 2nd ed. Philadelphia, PA:Saunders Company. 1994:1633-1644.
(2) Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984:1016-1025.
(3)Von Witt R. “Topical Aspirin for Wasp Stings”. Lancet. 1980; 2:1369.
(4)Gaunder B. Insect Bites and Stings: Managing Allergic Reactions. Nurse Practitioner. 1986;11:16-28.
(5)Food Allergy and Anaphylaxis Network. Anaphylaxis. Available at: http://www.foodallergy.org/anaphylaxis/index.html .
Accessed July, 2006.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

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