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Pediatric - Insect Bites

Insect bites

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Female Mosquito
Female Mosquito

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 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.

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).

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.

If not, see these topics

First Aid:

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

  • Give epinephrine injection if the caller has an anaphylactic kit.
  • Do this while they call 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 pound (15-30 kg) child: 0.15 mg. Auto-inject Epi-Pen Jr. or give 0.15 ml Twinject.
  • < 33 pounds (15 kg) child: Give dosage recommended by your doctor (or 0.1 ml).
  • Inject it IM into the upper outer thigh. (SC is less effective)
  • Can be given through clothing if necessary.
  • Give oral Benadryl or other antihistamine if the caller has it and the child is able to swallow.

First Aid Advice for Anaphylactic Shock

  • Lie down with feet elevated.
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, drooling or slurred speech with rapid onset
  • Previous severe life-threatening 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 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 small red bump. Some are larger (like a hive) and some have a small water blister in the center. These are normal reactions to an insect bite.
    • This does not mean your child has an allergy or the bite is infected.
  2. 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.
    • Antihistamine: If the bite is very itchy after local treatment, try an oral antihistamine (e.g., Benadryl). Sometimes it helps, especially in allergic children.
  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 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.
  5. Expected Course:
    • Most insect bites are itchy for several days.
    • The swelling may last 7 days.
    • Insect bites of the upper face can cause severe swelling around the eye, but this is harmless.
    • Any pinkness or redness usually lasts 3 days.
  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 redness starts after 48 hours)
    • 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.

Disclaimer: This information is not intended 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: 1/19/2009

Last Revised: 6/25/2008

Content Set: Pediatric HouseCalls Online

Copyright 1994-2009 Barton D. Schmitt, M.D.

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