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Hives are one of the most common skin conditions in the world. Even newborns and toddlers can be affected. The good news is that while hives can look alarming, they're not contagious, and they usually go away in a few days.

Here's a rundown of answers to common questions.

Do hives look different in children?

No. Hives look much the same in children as they do in adults. These raised, red, or skin-colored bumps appear suddenly on the skin, usually on the chest, stomach, or back, and look like mosquito bites, with a center that typically turns white if you press on it. Hives have a flat surface, don't blister, and can crop up individually or in a cluster called a "wheal." Sometimes, hives are accompanied by swelling -- called angioedema -- of the face (eyes and lips), arms, or legs.

How do I know for sure that my child has hives?

Your child's doctor can help, but one of the biggest clues is itchiness. Since your baby or toddler won't be able to tell you how they're feeling, you'll need to watch for scratching behavior. It's also important to keep track of the location and size of your child's bumps and wheals, how long they last, and when and where they reappear. Take photos.

What is the cause?

Children who have hay fever, asthma, eczema, or food allergies are known to be at higher risk of hives. However, in almost half of children with hives, the cause is never identified.

Topping the list of known culprits are viral and bacterial infections, with hives appearing during or shortly after a common cold, the flu, strep throat, or even COVID-19. Drugs such as antibiotics, anticonvulsants, and ibuprofen are the next most common cause of hives in children. Other triggers include vaccinations; insect bites; bee and wasp stings; foods such as milk, eggs, tree nuts, and shellfish; and exposure to allergens such as pollen, dust, mold, mildew, pet dander, household products, and latex.

How long will my child's hives last?

Individual hives tend to fade within 24 hours, but in some children they may be noticeable for several days or longer. When hives last for less than 6 weeks, doctors refer to them as "acute urticaria." This type of hives is the most common kind in children. Two other types of hives -- "chronic spontaneous urticaria" and "chronic idiopathic urticaria" -- come and go for 6 weeks or longer. These longer-lasting hives are usually seen in adults between the age of 20 and 40.

Are there safe and effective treatments for hives in children?

Yes. Avoiding known triggers is the first step. However, even if you don't know what caused your child to break out in hives, the symptoms can be safely and effectively controlled with a non-sedating, second-generation H1-antihistamine. In fact, new research indicates that these antihistamines control symptoms better, and at lower doses, in children younger than 12 years of age than in adolescents and adults.

The most recent guideline for the management of hives recommends the following non-sedating second-generation H1-antihistamines for the treatment of hives in children:

• Bilastine (Blexten)
• Cetirizine (Zyrtec)
• Desloratadine (Clarinex)
• Fexofenadine (Allegra-D)
• Levocetirizine (Xyzal)
• Loratadine (Claritin)
• Rupatadine (Rupafin)

Note, though, that first-generation H1-antihistamines such as diphenhydramine (Benadryl) are no longer recommended for the treatment of hives in children due to central nervous system side effects such as sedation.

What if antihistamines don't work?

When hives symptoms aren't adequately controlled by a non-sedating antihistamine, omalizumab (Xolair), an injectable prescription medication, is safe and effective in children 12 years of age and older.

Additional Resources:

Read previous installments in this series:

For Your Patients: All About Hives

For Your Patients: Understanding the Many Different Types of Hives

For Your Patients: How Will My Doctor Diagnose Hives?

For Your Patients: What's the Best Treatment for Hives?

For Your Patients: Is Stress Causing My Hives?

For Your Patients: Is It Safe to Treat Hives During Pregnancy?

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.