INSECT BITES

Main Symptoms

  • 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.
  • This topic excludes bees, ticks and spiders.
  • A severe life-threatening allergic reaction is called anaphylaxis

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WHEN TO CALL YOUR DOCTOR FOR INSECT BITES

Call 911 Now (your child may need an ambulance) (for symptoms of anaphylaxis)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 (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 < 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 after 2 hours of pain medicine
  • 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 or concerns

Parent Care at Home If:

  • Normal insect bite and you don't think your child needs to be seen
  • Insect repellents (eg, DEET), questions about
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HOME CARE ADVICE 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 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.
  2. 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. 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 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.
  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 > 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

  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:
    • DEET is a very effective insect repellent. It also repels ticks.
    • Use 30% DEET for children and adolescents (AAP recommendation 2003) (30% DEET protects for 6 hours)
    • Use 10% DEET if the parents have undue concerns about DEET. (Limitation: 10% DEET is only effective 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 (eg, eye glasses), and leather.
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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.

Pediatric HouseCalls Online. Copyright © 2000-2004 Barton Schmitt, M.D. FAAP

Reviewed 8/2004

Revised 7/2004

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