As our children spend more time outside during summer vacation, it is likely they will encounter insects and bugs. Exposure to these pests often causes alarm, some discomfort, and possible pain if a bite or sting occurs. Usually these are short-lived annoyances as most children have only mild reactions. The reaction a person has depends on the nature of the insect and the individual’s sensitivity to a specific bite or sting. The insect “saliva” left behind from a bite and the “venom” injected by a sting both cause a release of histamines and other substances in the skin that result in a local reaction. Only in rare cases do serious allergic reactions called anaphylaxis occur that requires immediate medical treatment. Let’s take a closer look at the details by answering some basic questions.
What happens if my child is bitten or stung by an insect?
Bites from mosquitos, chiggers, fleas, and bedbugs cause itchy red bumps with the size varying from a small dot to the size of a quarter. Bites around the eyes usually swell more and for longer (up to 2 days). Mosquito bites occur in exposed areas whereas fleas and bedbugs prefer to bite under clothing such as along the waist. Horseflies, fire ants, blister beetles, and centipedes usually cause a painful red bump. Fire ant bites often form a pimple or a blister within a few hours of the bite. In sensitive young children blisters are more likely to occur even with a fleabite. Spider bites are usually painless and rarely cause severe reactions. The two exceptions are the Black Widow and the Brown Recluse bites. Even these spider bites do not hurt initially. Within a few hours of a Black Widow bite, the individual will begin to experience pain, stiffness, fever, chills, nausea and abdominal pain. The reaction to a Brown Recluse bite is more localized. Pain, blistering, and ulcers may form at the site as well as general fever, nausea and fatigue. If a bite of this type is suspected, medical attention should be sought as soon as possible.
Bee, wasp, and hornet stings cause immediate pain and swelling. Although harmless most of the time, the affected area will stay painful and itchy for a few days. The swelling may increase over this time as well. Although scorpion stings are the most feared, they seldom cause severe problems. There is often a stinging pain at the site with some tingling and possible numbness after the pain subsides. A variable amount of swelling may occur the next day.
What should I do for a bite or sting?
If the bite is itchy, apply calamine or baking soda paste to the area of the bite. For those areas that seem very itchy, try applying 1% hydrocortisone cream to the spot. If your child scratches the area excessively, your doctor may advise giving some oral diphenhydramine (Benadryl®). Keep your child’s fingernails clean and cut short to help avoid a secondary infection.
If your child disturbs a beehive, get him/her away from it as quickly as possible. The base of a bee sting emits an alarm “hormone” that makes the other bees go into attack mode and sting. For bee stings it is important to remove the stinger left behind as soon as possible. Scrape it horizontally with a credit card or fingernail. Do not use tweezers since this will cause more venom to be released in the skin and worsen the reaction. For all stings including those from a scorpion, wash the area with soap and water. Soak a cotton ball with a baking soda solution and apply to the site for 15 minutes. Follow this by applying a cold compress containing ice for at least the same amount of time. Acetaminophen and/or ibuprofen may be given for pain. Give a dose of diphenhydramine as well to minimize the swelling that will occur over the next 2-3 days.
When should I take my child to the doctor after a bite or sting?
Severe reactions are unusual but are more likely to occur due to stings in children who have already shown significant problems with allergies. Signs of a severe allergic reaction include hoarseness of voice; trouble breathing; hives or itching all over the body; swelling of the eyes, lips or genital area; and/or feeling of weakness. If any of these symptoms occur, immediate medical attention is indicated. Give a dose of diphenhydramine if readily available. This is a situation where an injection of epinephrine (Epipen®) is indicated to treat the allergic reaction known as anaphylaxis.
A more common complication of an insect bite is a secondary bacterial infection. Since both the bite and an infection can cause redness and swelling, sometimes it is difficult to tell if an infection is also present. If the swelling or redness worsens more than 2 days after the bite, if there is streaking redness away from the site, if the area becomes more painful and tender to touch, and/or a fever develops, a visit to the doctor is warranted due to concern for infection.
How do I prevent bites and stings?
Although it is impossible to avoid all insect bites or stings, minimize potential exposure by applying some basic principles. Avoid areas where insect like to hang out such as garbage cans, stagnant water, uncovered food, and gardens especially where there are blooming plants. Dress your child in long sleeves and pants when you think they might be exposed. Mosquitos are especially prevalent at dusk. Also avoid bright colored clothing or floral prints since bees especially see this is an invitation to sting. Avoid scented soap, perfume, or hair spray as this also attracts insects.
The best prevention is to apply an insect repellant. One of the most effective ingredients in an insect repellant is DEET (N, N-diethyl-m-toluamide). It can be used in children over the age of 2 months and can be applied only once per day. An alternative to DEET is Picaridin. It has a more pleasant odor and leaves no oil residue like DEET; however, it must be applied about every 4 hours to be as effective. Be sure to check the label to insure the insect repellant you purchase contains one of these two ingredients. Citronella prevents mosquito bites but is not effective against other insects. Many of us have friends or family members who swear by a home remedy or the use of an everyday product or lotion marketed for other reasons. Although these remedies may scare bugs away for a short period of time, they have not been proven to be effective for very long. The American Academy of Pediatrics recommends that repellants used in children over six months of age should contain 30% DEET or 5-10% Picaridin and be applied before going outdoors.
Although bites and stings are nuisances, they should not prevent anyone from having fun outside. Just follow some basic rules such as wearing insect repellant along with your sunscreen. And remember… have fun but be safe.