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| |    Insect Bites and Stings by Lynn Cates, M.D., F.A.A.P. reviewed by Robert Needlman, M.D., F.A.A.P. All children will get insect bites or stings eventually. Although a sudden sting can frighten a child pretty badly, or the itching can be terrible, bites and stings usually are more of a nuisance than a serious problem because they heal completely without any special treatment. Sometimes, however, insect bites and stings can cause serious reactions around the bite itself (local reactions) or can affect the whole body (systemic reactions). Rarely, they can cause a severe allergic reaction called anaphylaxis, which can sometimes be fatal. For that reason, it's a good idea for parents to learn what to look for and when to seek professional help right away. In developed countries like the U.S., most insects that bite (e.g., mosquitoes, chiggers, flies, bedbugs, and fleas) and sting (bees, wasps, yellow jackets, hornets, and fire ants) do not transmit serious diseases like malaria or plague. A big exception is ticks, which, in certain parts of the U.S., can spread several diseases including Lyme disease, Rocky Mountain spotted fever (RMSF), and ehrlichiosis. Removing the insect or stinger Ticks should be removed carefully so that no parts are left in the skin. The best way to remove a tick is to grasp it as close to the skin as you can (so you don't leave the head) with clean tweezers and pull it gently but firmly straight out. Try not to twist it or squeeze its body, or more secretions may be released into the skin. If no tweezers are available, simply cover your fingers with a tissue and pull the tick straight out. Then wash your hands. Inspect the area carefully to be sure you removed the head. You should not cover the tick with petroleum jelly or nail polish, or try to burn it off with a match, because these strategies don't work and may in fact make it harder to remove the tick intact. If a bee or wasp stinger is left in the skin, don't try to pull it out--you may make the sting worse by squeezing more venom out of the stinger into the skin. Instead, gently scrape the skin with a dull straight edge, like the edge of a credit card or the non-cutting side of a dinner knife, to remove the stinger. Do not attempt to remove stingers or other insect parts by squeezing them out. Relieving the itch and pain You can try cold compresses, ice packs, or calamine lotion to help alleviate itching. An ice cube wrapped in a thin towel may work best. Some people find that a paste made from baking soda and water is soothing as well. You also can try over-the-counter hydrocortisone cream (follow the instructions on the label). Check with your child's practitioner to see if he recommends over-the-counter antihistamines like Benadryl for the itch and, if so, be sure to ask about the appropriate dose for her. Since antihistamines can make children sleepy, they might be particularly helpful if the itching keeps your child awake at night. You should know, however, that sometimes antihistamines make children hyper instead of drowsy. If the itching and swelling are severe, your child's practitioner may recommend a short course of corticosteroids. Used in this way, steroids are very safe; steroids used to treat allergic reactions are very different from the kind used by some bodybuilders. Try to teach your child not to scratch her bites, since this may lead to more damage to the skin around the bite and not only delay healing, but also increase the risk of infection. If you notice that she scratches while she sleeps, you can cover her hands with cotton socks or gloves. Also, keep her nails cut short. You can use ice cubes, ice packs, and pain medicines like acetaminophen (as is in Tylenol) or ibuprofen (as in Motrin) to help relieve stinging or pain. Preventing infections Since each bite or sting causes a small break in the skin, it is important to keep the area clean to prevent infections. Wash the area gently with mild soap and water right away, and then at least once or twice a day until it has healed completely. If there is an open sore, dab on some antibiotic ointment and cover the wound with a clean bandage. When to call for help right away Most bites and stings will cause some degree of allergic reaction at the site, including swelling, redness, and itching. A few will cause more prominent symptoms that can lead to serious complications, such as a blocked airway or anaphylactic shock. Anaphylactic reactions can be fatal in a matter of minutes, so it is important that you act very quickly. You should take your child to the nearest emergency room or call 911 immediately if your child has had a serious reaction to a bite or sting in the past, or if she develops any swelling of the mouth or face, experiences trouble breathing, hoarseness, or shows other signs of anaphylaxis. To know how to recognize an anaphylactic reaction, see our article "Anaphylaxis." You should also have your child seen right away if any of the following is true:
Other times that you should seek advice include if it looks like the bite or sting is becoming infected (e.g., your child has severe pain, develops a fever, the pain or swelling or redness grows after the first day, or the bite or sting continues to be painful and swollen for more than a couple of days), or if you are concerned about how your child looks or feels. You should also check with your child's practitioner if your child has been bitten by a tick and you live in an area that has Lyme disease, Rocky Mountain spotted fever, or ehrlichiosis. If you don't know what kind of tick it is, you can put it in a small bottle of alcohol and take it in to be identified.
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