Most reactions to insect bites and stings are mild, causing redness, itching, stinging or minor swelling. Insect bites or stings can rarely result in severe reactions. Some insects may also carry disease, such as ticks with Lyme disease.

Insect bites can result in:

•      - Red bumps:  some are large, similar to a hive, but this does not mean your child has an allergy
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•           - Sometimes, a small water blister occurs in the center of the bump. This is common in younger children
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•      -Itchy bites:  usually caused by mosquitoes, mites, fleas, and bedbugs
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•           -Painful bites:  usually caused by horseflies, deer flies, and gnats
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  •                -Fire ants, harvester ants, blister beetles, and centipedes also cause a painful, red bump, but within a few hours, fire ant bites can change to blisters or pimples.

When is medical attention needed?

Though very rare, you should seek IMMEDIATE treatment at an Emergency Department or call 911 if your child experiences an anaphylactic reaction (difficulty breathing, swelling of the face) within 2 hours of an insect bite or sting.

You should contact your child’s pediatrician if:

•      - The bite was from a tick or spider
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•      - Your child has severe pain and is not better 2 hours after taking pain medicine
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•      - The bite becomes red more than 24 hours after the bite
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•      - There is a scab that looks infected and/or drains pus

What can I do to keep insects away?

The best way to avoid insect bites and stings is prevention.

•      - If you live in an area where ticks are common (Northeast and Midwest), be sure to wear protective clothing (long pants, long-sleeved shirt, etc) when you and your child may be exposed (i.e. hiking, camping, wooded areas, high grasses, marshes)
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  •           - If you find a tick on your child, call your child’s pediatrician, who may want you to save the tick in a sealed container or zip-locked bag for identification later.
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  •           - Use tweezers to grasp the tick firmly at its head, next to the skin.
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  •           - Pull firmly and steadily upward until the tick lets go (do not twist or jerk the tick), then swab the bite site with alcohol.
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•      - Avoid being outside when bugs are most active. Many insects that cause itchy bites are most active at sunrise or sunset (i.e. mosquitoes)
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•      - Use products containing N,N-diethyl-meta-toluamide also commonly known as DEET to repel ticks and other insects
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  •           - Can use in children 2 months of age and older
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  •           - Apply to exposed skin only
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    •                - Do not apply on the hands or near the mouth or eyes
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  •           - The concentration of DEET in a product indicates how long the product will be effective, so a higher concentration means it will be effective for a longer period of time
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  •           - Wash off with soap and water when your child comes indoors
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•      - Permethrin Products (i.e. Duranon®)
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  •           - Repels tickets and insects
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  •           - Unlike DEET, these products are put on CLOTHING instead of skin.
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  •           - You can use it on other outdoor items mosquito screens, sleeping bags
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  •           - Do not put permethrin on the skin (because sweat changes it so it does not work)
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•      - Picaridin Products:
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  •           - Equal to 10% DEET
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  •           - It can safely be put on skin or clothing

What is the best way to remove a bee stinger?

Bee and wasp stings:

•      - A bee will usually leave behind a stinger attached to a venom sac. Try to remove it as quickly as possible using a scraping motion, without pinching the venom sac at the end.
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•      - Wasps don't leave their stingers in the skin after stinging.
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•      - Wash the area carefully with soap and water. Do this two to three times a day until the skin is healed.
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•      - Apply an ice pack wrapped in a cloth or a cold, wet washcloth for a few minutes.

What can be done for itching or pain from bites and stings?

Painful Insect Bite Treatment:

•      - Combine 1 tablespoon of baking soda with just enough water to make a paste. Apply this to the bug bite for 15 to 20 minutes before washing away. This will usually reduce the pain.
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•      - You can also use ice cubes in a wet washcloth for 20 minutes.
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•      - Acetaminophen or ibuprofen can be used to help with pain. Please consult your healthcare provider for appropriate dosing.
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•      - Allergy medicines do not help with painful bites.

Itchy Insect Bite Treatment:

•      - Steroid cream (over-the-counter) – 1% hydrocortisone cream.  Can apply 3 times a day until the itch is gone.
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•      - Calamine lotion or those containing colloidal oatmeal can also help soothe itchy skin.
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•      - Allergy medicine (over-the-counter) – If the bite is still itchy, over the counter allergy medicines may be used under the direction of your pediatrician.
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  •           - Also available as cream and gels.  Never use a cream or gel product if also using an allergy medicine by mouth

Usually, the signs and symptoms of a bite or sting disappear in a day or two. If you're concerned — even if the reaction is minor — call your pediatrician.

References:

1. Mayo Clinic Staff. Insect Bites and Stings: First aid. Updated Feb 20, 2015. Available online at: http://www.mayoclinic.org/first-aid/first-aid-insect-bites/basics/art-20056593

2. Barton D Schmitt. Insect Bites. Updated 2015. Available online at: http://www.seattlechildrens.org/medical-conditions/symptom-index/insect-bites/

3. Larissa Hirsch. Bug Bites and Stings. Updated April 2014. Available online at: http://kidshealth.org/en/parents/insect-bite.html

4. Fight the Bite for Protection from Malaria, Guidelines for DEET Insect Repellent Use. CDC. Available online at:  http://www.cdc.gov/malaria/toolkit/DEET.pdf

4. Halsey NA, Abramson JS, Chesney JP, et al. Prevention of lyme disease. Pediatrics. 2000;105(1):142-7.

5. Beware of bug bites and stings. FDA. Updated 2008. Available online at:  http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM225621.pdf