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Should Your Child See a Doctor?

Insect Bites

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Definition

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

Symptoms 

  • Insect bites usually cause a small red bump.
  • Often it looks like localized hives (one large one or several small ones)
  • Sometimes a small water blister occurs in the center of the bump, especially in younger children.
  • Itchy Insect Bites: Bites of mosquitoes, chiggers (harvest mites), fleas, and bedbugs (or bed bugs) 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.

First Aid Advice for Anaphylaxis - Epinephrine (pending EMS arrival) 

  • If you have epinephrine (Epi-pen or Twinject), give it now.
  • Do this while calling 911 (Reason: life-saving advice).
  • Over 66 pounds (30 kg): 0.3 mg. Auto-inject Epi-Pen or give 0.3 ml Twinject.
  • 33-66 pounds (15-30 kg) child: 0.15 mg. Auto-inject Epi-Pen Jr. or give 0.15 ml Twinject.
  • Less than 33 pounds (15 kg) child: Give dosage recommended by your doctor (or 0.1 ml if you have an epinephrine ampoule).
  • Inject it into the muscle (IM) of the upper outer thigh.
  • Can be given through clothing if necessary.
  • Benadryl: After giving epinephrine, give oral Benadryl or other antihistamine if the child is able to swallow.

First Aid Advice for Anaphylactic Shock 

  • Lie down with feet elevated.

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. Onset usually is within 20 minutes.
  • Anaphylaxis can occur with bee, yellow jacket, wasp, or fire ant stings. Anaphylactic reactions are very rare following other insect bites.

Mosquito Bites: Types of Reactions 

  • In North America, mosquito bites are usually just an annoyance, causing very itchy red skin bumps. Often, it looks like localized hives (one large one or several small ones).
  • When a mosquito bites an individual, various chemicals are injected into the skin. The red bumps are actually the body's allergic reaction to these chemicals. The skin reaction can look like a hive.
  • Suspect mosquito bites if there are bites on other parts of the body. Mosquito bites of the upper face can cause eyelid to swell up for several days. With bites, the swelling can be pink as well as large (especially age 1-5 years).
  • However, the mosquito can sometimes be a carrier of blood-borne diseases (e.g., West Nile Virus).

When to Call Your Doctor for Insect Bites

Call 911 If…

 
  • For any of the following symptoms of anaphylaxis, onset usually is within 20 minutes and always by 2 hours following the bite.
  • Difficulty breathing or is wheezing
  • Hoarseness or cough with rapid onset
  • Difficulty swallowing, drooling or slurred speech with rapid onset
  • Previous severe life-threatening allergic reaction to same insect bite
  • Difficult to awaken
  • Confused thinking or talking.

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Stiff neck (can't touch chin to chest)
  • 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 9 am and 4 pm) 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 around the bite begins over 48 hours (2 days) after the bite
  • Redness or red streak around the bite becomes larger than 1 inch

Call Your Doctor During Weekday Office 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

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

Home Care Advice for Insect Bites


Treatment for Insect Bites

  1. Reassurance:
    • Most insect bites result in a red bump. Some are larger (like a hive). Some have a small water blister in the center. These are normal reactions to an insect bite.
    • A large hive at the bite site does not mean your child has an allergy.
    • The redness does not mean the bite is infected.
  2. Itchy Insect Bites (including all mosquito bites):
    • Steroid Cream: To reduce the itching, use 1% hydrocortisone cream (no prescription needed). Apply 4 times a day until the itch is gone. If not available, apply a baking soda paste until you can get some..
    • 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 to reduce the itch. A fingernail, pen cap, or other object can be used.
    • Antihistamine: If the bite is very itchy after local treatment, try an oral antihistamine such as Benadryl (no prescription needed). Sometimes it helps, especially in allergic children. See dosage table.
  3. Painful Insect Bites:
    • Rub the bite for 15 to 20 minutes with a cotton ball soaked in a baking soda solution once. This will usually reduce the pain.
    • You can also 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.
  4. Antibiotic Ointment: If the insect bite has a scab on it and the scab looks infected, apply an antibiotic ointment such as Polysporin 3 times per day (no prescription needed).
    • 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.
  5. Expected Course:
    • Most insect bites are itchy for several days.
    • Any pinkness or redness usually lasts 3 days.
    • The swelling may last 7 days.
    • Insect bites of the upper face can cause severe swelling around the eye, but this is harmless.
    • The swelling is usually worse in the morning after lying down all night. It will improve after standing for a few hours.
  6. 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 (new rednesss starts after 48 hours)
    • Your child becomes worse

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

References

  1. Brimhall CL and Esterly NB. Summertime, and the critters are biting. Contemp Pediatr. 1994;11(7);62-77.
  2. Hardwick WE, et alKing WD, Royall JA, Petitt BA, Tilden SJ. Near-fatal fire ant envenomation of a newborn. Pediatrics. 1992; 90:622-624.
  3. Hebert AA and Carlton S. Getting bugs to bug off: A review of insect repellents. Contemp Pediatr. 1998;15(6):85-95.
  4. Hernandez RG, Cohen BA. Insect bite-induced hypersensitivity and the SCRATCH principles: a new approach to papular urticaria. Pediatrics. 2006;118:e189-e196.
  5. Siddiqui S, Sanker Raj VM, Feinberg AN. Chigger bites: A 5-year-old male with an intensely pruritic maculopapular rash. Pediatr Rev. 2009;30(1):26-29.
  6. Thomas I, Kihiczak GG, Schwartz RA. Bedbug bites: a review. Int J Derm. 2004;43:430-433.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 9/23/2010 2:53:09 PM

Copyright 1994-2011 Barton D. Schmitt, M.D.

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