Insect Bites

Pediatric HouseCalls Online

DEFINITION

• Child was bitten by an insect (bug)
• Most are mosquito bites
• This topic excludes bees, ticks and spiders

Types of Insect Bites

• Itchy Insect Bites: Bites of mosquitoes, chiggers (harvest mites), fleas, and bedbugs usually cause itchy, red bumps.
• Painful Insect Bites: Bites of horseflies, deer flies, gnats, fire ants, harvester ants, blister beetles, and centipedes usually cause a painful, red bump. Within a few hours, fire ant bites can change to blisters or pimples.

Anaphylaxis

• A severe life-threatening allergic reaction is called anaphylaxis
• The main symptoms are difficulty breathing and swallowing starting within 2 hours of the sting
• Anaphylaxis can occur with bee, yellow jacket, wasp, or fire ant stings (rarely with other insects). Onset usually is within 20 minutes.

See More Appropriate Topic (instead of this one) If

• BEE OR YELLOW JACKET STING
• SPIDER BITE
• TICK BITE

FIRST AID Advice for Anaphylaxis:

• Give epinephrine injection if you have an anaphylactic kit
• Inject it into the muscle of the upper outer thigh

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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. Onset usually is within 20 minutes and always by 2 hours following the bite.
• Difficulty breathing or wheezing
• Hoarseness or cough with rapid onset
• Difficulty swallowing or slurred speech with rapid onset
• Previous severe allergic reaction to same insect bite

Call Your Doctor Now (night or day) If

• Your child looks or acts very sick.

• Hives or swelling elsewhere on the body

• More than 20 fire ant stings in a child under 1 year old

Call Your Doctor Within 24 Hours (between 9am and 4pm) If

• You think your child needs to be seen.
• Severe pain is not improved 2 hours after pain medicine given
• New redness or red streak occurs around the bite after the first 24 hours
• Scab that looks infected (drains pus or increases in size) not improved after applying  antibiotic ointment for 2 days

Call Your Doctor During Weekday Office Hours If

• You have other questions and concerns
• Scab that looks infected (drains pus or increases in size) not improved after applying antibiotic ointment for 2 days

Parent Care at Home If

• Normal insect bite and you don't think your child needs to be seen
• Insect repellents (e.g., DEET), questions about

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HOME CARE ADVICE FOR INSECT BITES

 

Treatment for Insect Bites

1. Itchy Insect Bites (including all mosquito bites):
   • Apply calamine lotion or a baking soda paste.
   • If the itch is severe, use 1% hydrocortisone cream (no prescription).  Apply 3 times a day until the itch is less severe.
   • If neither is available, apply an ice cube in a wet washcloth for 20 minutes.
   • Also apply firm, sharp, direct, steady pressure to the bite for 10 seconds.  A fingernail, pen cap, or other object can be used.
   • If the bite is very itchy after local treatment, try an oral antihistamine (e.g., Benadryl).  Sometimes it helps, especially in allergic children.
2. Painful Insect Bites:
   • Rub the bite for 15 to 20 minutes with a cotton ball soaked in a meat tenderizer solution once. This will usually relieve the pain. (Caution: don't use near the eye)
   • If not available, use a baking soda solution on a cotton ball.
   • If neither is available, apply an ice cube in a wet washcloth for 20 minutes.
   • Give acetaminophen (e.g. Tylenol) or ibuprofen for pain relief. See Dosage table.
   • Antihistamines don't help.
3. Antibiotic Ointment: If the insect bite has a scab on it and the scab looks infected, apply an antibiotic ointment 3 times per day.
   • Cover the scab with a Band-Aid to prevent scratching and spread.
   • Repeat washing the sore, the antibiotic ointment and the Band-Aid 3 times per day until healed.
   • Caution: For spreading infections (redness or red streaks), your child needs to be seen.
4. Expected Course: Most insect bites itch or hurt for 1 to 2 days. The swelling may last a week.
5. Call Your Doctor If:
   • Severe pain persists over 2 hours after pain medicine
   • Infected scab doesn't improve after 48 hours of antibiotic ointment
   • Bite looks infected (redness, red streaks, increased tenderness)
   • Your child becomes worse

Prevention of Insect Bites

1. Prevention:
   • Wear long pants, long-sleeved shirts and a hat
   • Avoid being outside when the insect is most active. Many insects that cause itchy  bites are most active at sunrise or sunset (e.g.,. chiggers, no-see-ums, mosquitoes).
   • Insect repellents containing DEET are effective in preventing many insect bites. Read the label carefully.
2. DEET Products: Apply to skin
   • DEET is a very effective mosquito repellent. It also repels ticks and other bugs.
   • The American Academy of Pediatrics (2003) has approved the use of DEET in a concentration of 30% or less for all children over 2 months of age. Use 30% DEET if you need 6 hours of protection. Use 10% DEET if you only need protection for 2 hours.
   • Don't apply DEET to the hands if the child has thumbsucking or fingersucking (Reason: prevent ingestion)
   • Warn older children who apply their own repellent that a total of 3 or 4 drops can protect the whole body.
   • Apply to exposed areas of skin. Do not apply to eyes or mouth. Do not apply to skin that is covered by clothing. Don’t put any repellent on areas that are sunburned or have rashes because the DEET is more easily absorbed in these areas.
   • Remember to wash it off with soap and water when your child returns indoors.
   • Caution: DEET can damage clothing made of synthetic fibers, plastics (e.g., eye glasses), and leather. DEET can be applied to cotton clothing.
3. Permethrin Products: Apply to clothing
   • Permethrin-containing products (e.g., Duranon, Permanone) are highly effective mosquito repellents. They also repel ticks.
   • An advantage over using DEET is that they are applied to clothing instead of skin.
   • Apply it to shirt cuffs, pant cuffs, shoes and hat.
   • You can also put it on other outdoor items (shoes, mosquito screens, sleeping bags).
   • Do not apply permethrin to skin, as it will lose effectiveness very quickly.
4. Picaridin Products:
   • Picaridin is a newly approved repellent that is equivalent to 10% DEET
   • It can safely be applied to skin or clothing

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

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