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Instructions

• Instructions for new users

Call 911 Now If:

• 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

NOTE: Anaphylaxis can occur with bee, yellow jacket, wasp, or fire ant stings (rarely with other insects). Onset usually is within 20 minutes

First Aid Advice for Anaphylaxis

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

Call Your Doctor Now If:

• Your child looks or acts very sick
• Hives or swelling elsewhere on the body
• More than 20 fire ant stings in a child < 1 year old

Call Your Doctor Within 24 Hours If:

• You think your child needs to be seen
• Severe pain is not improved after 2 hours of pain medicine
• New redness or red streak occurs around the bite after the first 24 hours

Call Your Doctor During Weekday Hours If:

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

Home Care (Read "Call Your Doctor…" first):

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 4 times a day until the itch is less severe, then switch to calamine lotion.
• 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.

Painful Insect Bites

• Rub the bite for 15 to 20 minutes with a cotton ball soaked in a meat tenderizer solution. 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 for 20 minutes.
• Give acetaminophen (e.g. Tylenol) or ibuprofen for pain relief. Antihistamines don't help relieve pain.

Antibiotic Ointment

If the insect bite has a scab on it and the scab looks infected, apply an antibiotic ointment 4 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 4 times per day until healed.

Caution: For spreading infections (redness or red streaks), your child needs to be seen.

Expected Course

Most insect bites itch or hurt for 1 to 2 days. The swelling may last a week.

Call Your Doctor If:

• Severe pain persists > 2 hours after pain medicine
• Infected scab doesn't clear after 48 hours of antibiotic ointment
• Bite looks infected (redness, red streaks, increased tenderness)
• Your child becomes worse or develops any of the "Call Your Doctor…" symptoms

Insect Repellents

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 (eg, chiggers, no-see-ums, mosquitoes).
• Insect repellents containing DEET are effective in preventing many insect bites. Read the label carefully.

DEET

• DEET is a very effective insect repellent. It also repels ticks.
• 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.
• Age limits: if < 2 months old, avoid all DEET products (AAP 2003).
• Don't apply DEET to the hands if the child has thumbsucking or fingersucking (Reason: prevent ingestion).
• Apply to exposed areas of skin. Do not apply to eyes, mouth or irritated areas of skin. Do not apply to skin that is covered by clothing.
• 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.

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 before putting them on.
• 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.

Picaridin Products

• Picaridin is a newly approved repellent that is equivalent to 10% DEET.
• It can safely be applied to skin or clothing.