Knowing how to prevent and treat common insect bites and stings, and knowing when not to overreact, can help keep your kids safe and healthy.
Symptoms of Bug Bites and Stings in Children
The symptoms that can be caused by insect bites depend on the type of insect and how sensitive you are to it. Symptoms can vary from mild swelling, pain, itchiness and redness to large blisters or life-threatening anaphylactic reactions.
Localized vs. Systemic Bug Bite Reactions
Reactions that stay localized to the site of the bite or sting are usually not serious. More serious signs and symptoms of anaphylaxis, a type of life-threatening reaction, can include trouble swallowing, throat and chest tightness, low blood pressure (hypotension), diaphoresis (sweating), dizziness, weakness, itching, hives, wheezing, and difficulty breathing. These symptoms usually develop fairly quickly and usually within 30 minutes of being stung. You should seek immediate medical attention or activate your local emergency services if your child has these symptoms following an insect bite or sting.
Common Bug Bites and Stings
Mosquito bites commonly cause itchy red bumps, which can vary in size from being very small to 1/2 inch. They usually also have a central raised area. Fire ants are notorious for causing severe local reactions, including pustules or pimples and red, swollen, and extremely itchy areas, which may turn into blisters. They often bite multiple times, most commonly on the feet and legs. A large number of bites, more than 10-20, in a young infant can lead to serious reactions and may require medical attention. Bees, wasps, yellow jackets, and hornets usually cause painful red bumps. Honey bees have a barbed stinger and usually leave it behind at the site of the sting. The stinger will usually appear as a black dot inside the bite if it has been left behind. More serious local reactions can cause swelling of an entire limb. Unlike other bites, tick bites are painless and usually don’t itch. Bedbugs also usually cause painless bites, which then become itchy. Since bedbugs usually only come out to feed at night, and they feed infrequently (often just weekly), they can be hard to detect. Chiggers or harvest mites also commonly bite children, especially in the southern United States, where they are found in grasses and bushes. Chigger bites usually occur on the legs and along the belt line and can appear as small red bumps and are extremely itchy. Chigger bites are often confused with chickenpox infections. Flea bites also commonly affect children, causing multiple, grouped red bumps with a central area of crusting. Spider bites cause a lot of fear in parents, but rarely cause serious reactions in children. Only two spiders in the United States, the black widow spider, and the brown recluse spider usually cause poisoning. These spiders can be readily identified by their characteristic markings, including the red or orange hourglass shape on the abdomen of the black widow spider and the violin-shaped markings on the back of the brown recluse. These bites are usually painless or cause mild irritation. More serious reactions usually occur quickly and within 3-12 hours and can include muscle pain, diaphoresis (sweating), nausea, vomiting, headache, and high blood pressure.
Papular Urticaria
Papular urticaria is a delayed hypersensitivity type reaction to many bites and stings. Children, usually between the ages of 2 and seven years, with this condition, will commonly develop multiple small, red itchy bumps in clusters on the upper arms, shoulders and other exposed areas. New crops of bumps commonly appear and each last about 2-10 days.
How to Prevent Bug Bites and Stings
To help prevent your child from getting bitten or stung by insects, you can:
Make sure to keep as much of her skin covered with clothing as possible, including a long sleeve shirt, long pants, socks, and a hat. Wear light-colored clothing, so as not to attract bugs. Avoid using any scented soaps or other products on your baby, since the fragrances can also attract insects. Use an insect repellent regularly. Commonly used insect repellents that can usually be safely used in children include those with less than 10% DEET, or others with citronella or soybean oil. Apply insect repellents to clothing instead of to skin so that it won’t be absorbed. Wash off insect repellents as soon as possible. Follow the instructions, including age restrictions on any insect repellent you are considering using. Avoid areas where insects nest. Do daily tick checks of your child’s body when he has a possible exposure, especially when camping or hiking, so as to prevent tick-borne diseases, such as Lyme disease. Remember that insect repellents do not protect against most stinging insects, including wasps, bees and fire ants. Use window and door screens to prevent insects from getting inside your house.
Treatment
Most children with insect bites or stings only need symptomatic treatment for the symptoms of pain and itching.
Anaphylaxis
Some children who are allergic to the venom in the insect sting can develop more serious anaphylactic reactions. Since this type of reaction is life-threatening, treatment should be started as soon as possible and you should activate your local emergency medical services. An injection of epinephrine is the main treatment for anaphylactic reactions. Children with a history of anaphylactic reactions should have an auto-injector of epinephrine available for immediate administration, but you should still call 911. Since children do not always outgrow these types of reactions, an evaluation by a Pediatric Allergist can be helpful to confirm the allergy (skin and/or RAST testing) and consider venom immunotherapy (allergy shots). These shots can protect your child from having future reactions to an insect bite or sting. Children usually begin with weekly shots of a gradually increasing strength of insect venom. This is followed by monthly maintenance shots so that the protection lasts. Children with anaphylactic reactions should be given an emergency kit with an epinephrine autoinjector and they should wear an identification tag, such as a MedicAlert bracelet.
Bee Stings
Unlike other insects that sting, the honey bee leaves its stinger behind. Proper removal of this stinger following a honey bee sting can help prevent worsening symptoms. What you should not do includes pulling the stinger out with tweezers or pinching it out with your fingers, since this can inject more venom and cause a worsening reaction. Instead, use a credit card or dull blade to scrape it out.
Symptomatic Treatment
Most insect bites and stings only cause local reactions, including redness, swelling, pain, and itching. After you thoroughly wash the area with soap and water, other symptomatic treatments that may help your child feel better to include applying:
An ice pack or cool compress A meat tenderizer solution, which can be made by mixing one part meat tenderizer and 4 parts of water. This is especially helpful for painful stings from bee, wasp or ant. For best effect, soak a cotton ball in the meat tenderizer solution and use it to rub the area of the bite for 15-20 minutes. A baking soda paste A topical steroid or other topical anti-itch creams, such as Calamine lotion, to the area
Other medications, including an oral antihistamine for itching, such as diphenhydramine (Benadryl), and/or pain medications, such as ibuprofen or acetaminophen, may also help. More extensive local reactions may sometimes require a short course of an oral steroid. Antibiotics may be needed if the bite becomes infected.
Is It Infected?
Insect bites and stings are commonly misdiagnosed as an infection. Or if the initial bite or sting is identified, the resulting redness and swelling are confused as a secondary cellulitis. While both conditions can cause similar symptoms, the local reaction to a bite or sting usually begins quickly and generally within 6 to 24 hours of the bite. A secondary infection usually occurs after the first 24 hours and can cause spreading redness, especially red streaks, and fever.
