Red Flags & When to Go In Person for Hives in Children

Audience: pediatric

Hives, also known as urticaria, are raised, itchy red or skin-colored welts that can appear suddenly on a child's skin. They often result from allergic reactions, infections, or other triggers. While many cases of hives are mild and can be managed safely through telemedicine, some situations require urgent in-person medical evaluation. Parents and caregivers should watch for warning signs such as difficulty breathing, swelling of the face or throat, or hives that persist or worsen despite treatment. Telemedicine can help assess mild hives, provide guidance on symptom relief, and determine if further care is needed. However, if serious symptoms or red flags appear, immediate in-person care is essential to ensure the child's safety.

Red flags — go in person / ER

• Difficulty breathing, wheezing, or shortness of breath — seek emergency care immediately.
• Swelling of the face, lips, tongue, or throat — go to the emergency room right away.
• Hives spreading rapidly or covering most of the body, or signs of anaphylaxis such as dizziness or loss of consciousness — call emergency services promptly.

What telemedicine can do

• Evaluation of mild hives through video examination.
• Providing advice on symptom relief and medication use.
• Assessing possible triggers based on history.
• Monitoring progress and advising on follow-up care.

What telemedicine cannot do

• Emergency situations such as breathing difficulties or anaphylaxis.
• Severe swelling of the face or throat.
• Rapidly spreading hives with systemic symptoms.
• Hives accompanied by high fever or signs of infection requiring laboratory tests or in-person evaluation.

What Are Hives?

Hives are raised, itchy bumps or welts that appear on the skin. They can vary in size and shape and often come and go quickly. In children, hives may be caused by allergies to foods, medications, insect bites, infections, or other triggers. The rash can be uncomfortable but usually is not dangerous on its own.

When to Use Telemedicine for Hives

Telemedicine is a helpful way to evaluate mild hives in children. A healthcare provider can look at the rash through video, ask about symptoms and recent exposures, and suggest treatments such as antihistamines. This approach can save time and reduce stress for families when symptoms are mild and there are no warning signs.

Red Flags That Need In-Person Care

Certain signs mean your child needs urgent medical attention in person:

If any of these occur, call emergency services or go to the nearest emergency room immediately.

How to Prepare for a Telemedicine Visit

Before your telemedicine appointment, prepare the following:

After the Telemedicine Visit

After your telemedicine visit, follow the care plan provided:

Managing Hives at Home

For mild hives without red flags, you can help your child by:

How to prepare for your tele-visit

• Find a well-lit, quiet place for the telemedicine visit.
• Have your child’s rash visible for the provider to see clearly on camera.
• Note the time when hives first appeared and any possible triggers or exposures.
• List all medications and supplements your child is currently taking.
• Prepare to describe any other symptoms such as swelling, breathing difficulty, or fever.
• Have a thermometer ready to check for fever if needed.
• Write down any questions or concerns you want to discuss with the provider.

After your tele-visit

• Follow the healthcare provider’s instructions for medications and care.
• Monitor your child’s symptoms closely for any changes or worsening.
• Avoid known triggers that may cause hives.
• Keep your child comfortable with cool compresses and loose clothing.
• Seek immediate in-person care if any red flag symptoms develop.
• Schedule follow-up appointments if recommended by the provider.

FAQs

Can telemedicine diagnose the cause of my child's hives?

Telemedicine providers can often identify likely causes based on your child's history and appearance of the rash. However, some causes may require in-person tests or specialist evaluation.

When should I give my child antihistamines for hives?

You may give age-appropriate antihistamines as recommended by a healthcare provider to help reduce itching and rash. Always follow dosing instructions carefully.

Are hives dangerous for children?

Most cases of hives are not dangerous and resolve on their own or with simple treatments. However, if hives are accompanied by breathing problems or swelling of the face or throat, it can be life-threatening and requires emergency care.

Can infections cause hives in children?

Yes, infections such as viral illnesses are common triggers for hives in children. If your child has a fever or other signs of infection, seek medical advice.

How long do hives usually last?

Hives often last a few hours to a few days. If they persist longer than six weeks, this is called chronic urticaria and should be evaluated by a healthcare provider.

Sources

1. Hives (Urticaria) — MedlinePlus | U.S. National Library of Medicine / National Institutes of Health.
2. Urticaria and Angioedema — Mayo Clinic.
3. Allergic Reactions — Centers for Disease Control and Prevention (CDC).
4. Urticaria (Hives) in Children — American Academy of Pediatrics (AAP).

This telemedicine guidance is for educational purposes only and is not a substitute for in-person medical care. If your child has severe symptoms or red flags, seek emergency medical attention immediately.