Clinical Reference Systems: Pediatric Advisor 10.0
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DESCRIPTION

Bites of mosquitoes, chiggers (harvest mites), fleas, and bedbugs usually cause itchy, red bumps. The size of the swelling can vary from a dot to a centimeter (half inch). The larger size does not mean that your child is allergic to the insect bite. Mosquito bites near the eye usually cause massive swelling for 2 days.

Clues that a bite is a mosquito bite are itchiness, a central raised dot in the swelling, presence of the bite on a surface not covered by clothing, summertime, and the child's being an infant (because an infant can't protect himself). Some mosquito bites in sensitive children form hard lumps that last for months. In contrast to mosquitoes, fleas and bedbugs don't fly; therefore, they crawl under clothing to nibble. Flea bites often turn into little blisters in young children.

Bites of horseflies, deerflies, gnats, fire ants, harvester ants, blister beetles, and centipedes usually cause a painful, red bump. Within a few hours, fire ant bites change to blisters or pimples.

HOME CARE

1. Itchy insect bites

   Apply calamine lotion or a baking soda paste to the area of the bite. If the itch is severe (as with chiggers), apply nonprescription 1% hydrocortisone cream four times a day. Another way to reduce the itch is to apply firm, sharp, direct, steady pressure to the bite for 10 seconds. A fingernail, pen cap, or other object can be used. Encourage your child not to pick at the bites or they will leave marks.

2. Painful insect bites

   Rub the area of the bite with a cotton ball soaked in meat-tenderizer solution for 20 minutes. (Avoid the area around the eyes.) This will relieve the pain.

   If you don't have any meat tenderizer, baking soda is a fair substitute. If these substances are not available, an ice cube may help. Give acetaminophen or ibuprofen for pain relief.

PREVENTION

1. Mosquitoes and chiggers

   Many of these bites can be prevented by applying an insect repellent sparingly to the clothing or exposed skin before your child goes outdoors or into the woods. Repellents are essential for infants (especially those less than 1 year old) because they cannot bat the insects away.

2. Bedbugs

   The bed and baseboards can be sprayed with 1% malathion, but young children must be kept away from the area because this substance is somewhat poisonous. You may need to call in an exterminator.

3. Fleas

   Usually you will find the fleas on your dog or cat. If the bites started after a move into a different home, the fleas are probably from the previous owner's pets. Fleas can often be removed by bringing a dog or cat inside the house for 2 hours to collect the fleas (they prefer living on the dog or cat to living in the carpet) and then applying flea powder or soap to the animal outdoors. Careful daily vacuuming will usually capture any remaining fleas.

4. Precautions with DEET insect repellents

   Insect repellents containing DEET must be used with caution. DEET can be absorbed across the skin into the bloodstream and products with high concentrations can cause seizures or coma. Young children may also have reactions to DEET from licking it off the skin. To prevent harmful reactions, take the following precautions:

   • Use DEET products formulated for children. These contain 10% or less DEET. Even adults don't need more than a 30% DEET concentration.
   • Apply repellent mainly to clothing and shoes.
   • To prevent contact with the mouth or eyes, don't put any repellent on the hands.
   • Don't put any repellent on areas that are sunburned or have rashes because the DEET is more easily absorbed in these areas.
   • Warn older children who apply their own repellent that a total of three or four drops can protect the whole body.
   • Because one application of repellent lasts 4 to 8 hours, apply it no more than twice a day.
   • If repellent is put on the skin, wash it off after your child comes indoors.

CALL YOUR CHILD'S PHYSICIAN IMMEDIATELY IF:

• A bite looks infected (red streaks, increased tenderness).

CALL YOUR CHILD'S PHYSICIAN DURING OFFICE HOURS IF:

• Itching or pain is severe after treatment.
• You have other questions or concerns.