Insect Bites

Insect Bite
 
 
 

Definition
  • Bite from an insect (bug)
 
Symptoms
  • Insect bites usually cause a small red bump.
  • Often, it looks like a hive (one large one or several small ones).
  • Sometimes, a small water blister occurs in the center of the bump. This is common in younger children.
  • Bites can be itchy, painful or both.
 
Types of Insect Bites
  • Itchy Insect Bites. Bites of mosquitoes, chiggers (harvest mites), fleas, and bedbugs usually cause itchy, red bumps.
  • Painful Insect Bites. Bites of horseflies, deer flies, and gnats usually cause a painful, red bump. Fire ants, harvester ants, blister beetles, and centipedes also cause a painful, red bump. Within a few hours, fire ant bites can change to blisters or pimples.
 
Cause
  • When an insect bites, its secretions are injected into the skin.
  • The red bumps are the body's reaction to the secretions.
 
Prevention of Insect Bites
 
  1. General Tips:
    • Wear long pants, a long-sleeved shirt and a hat.
    • Avoid being outside when the bugs are most active. Many insects that cause itchy bites are most active at sunrise or sunset. Examples are chiggers, no-see-urns, and mosquitoes.
 
  1. DEET Products: Use on the skin.
    • DEET is a good bug repellent. It also repels ticks and other insects.
    • US AGE limit: no age restrictions for DEET products (AAP).
    • Canada AGE limit: if under 6 months old, avoid DEET products (CPS).
    • US: For newborns to 2 years old, use 10% DEET. After 2 years old, can use 30% DEET.
    • Canada: For children 6 months to 12 years old, use 10% DEET. After 12 years old, can use 30% DEET.
    • Protection: 10% DEET protects for 2 hours. 30% DEET protects for 6 hours.
    • Don't put DEET on hands if your child sucks on their thumb or fingers. (Reason: prevent swallowing DEET.)
    • Warn older children who apply their own DEET to use less. A total of 3 or 4 drops can protect the whole body.
    • Put it on exposed areas of skin. Do not use near the eyes or mouth. Do not use on skin that is covered by clothing. Don't put DEET on sunburns or rashes. Reason: DEET can be easily absorbed in these areas.
    • Wash it off with soap and water when your child comes indoors.
    • Caution: DEET can damage clothing made of man-made fibers. It can also damage plastics (such as eye
 
glasses) and leather. DEET can be used on cotton clothing.
 
  1. Permethrin Products: Use on clothing.
    • Products that contain permethrin work well to repel insects and ticks. Examples of these products are Duranon or Permanone.
    • Unlike DEET, these products are put on clothing instead of skin.
    • Put it on shirt cuffs, pant cuffs, shoes and hats.
    • You can also use it on other outdoor items (mosquito screens, sleeping bags).
    • Do not put permethrin on the skin. Reason: Sweat changes it so it does not work.
 
 
Care Advice
 
 
 
 
  1. Overview:
    • Most insect bites cause a red bump. Some are larger (like a hive). Some have a small water blister in the center. These are normal reactions to an insect bite.
    • A large hive at the bite does not mean your child has an allergy.
    • The redness does not mean the bite is infected.
    • Here is some care advice that should help.
  2. Itchy Insect Bites:
    • Steroid Cream. To reduce the itching, use 1% hydrocortisone cream. No prescription is needed. Put it on 3 times a day until the itch is gone. If you don't have, use a baking soda paste until you can get some.
    • If neither is available, use ice in a wet washcloth for 20 minutes.
    • Also, you can put firm, sharp, direct, steady pressure on the bite. Do this for 10 seconds to reduce the itch. A fingernail, pen cap, or other object can be used.
    • Allergy Medicine for Itching. If itching becomes severe, give a dose of Benadryl. No prescription is needed. Age limit: 1 year and older.
    • If Benadryl is needed for more than a day, switch to a long-acting antihistamine (such as Zyrtec or store brand cetirizine.) Age limit: 6 months and older.
    • Cetirizine dosing for 6 months or 2 year: 2.5 ml every 24 hours. For 2 years and older, follow package directions for dosing.
  3. Painful Insect Bites:
    • Soak a cotton ball in a baking soda solution. Rub the bite with it for 15 to 20 minutes. Do this once. This will usually reduce the pain.
    • You can also use an ice cube in a wet washcloth for 20 minutes.
    • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed.
    • For painful bites, allergy medicines don't help.
  1. Antibiotic Ointment:
    • If the bite has a scab and looks infected, use an antibiotic ointment. An example is Polysporin. No prescription is needed. Use 3 times per day. (Note: Usually impetigo is caused by scratching bites with dirty fingers).
    • Cover the scab with a Band-Aid to prevent scratching and spread.
    • Wash the sore and use the antibiotic ointment 3 times per day. Do this until healed.
 
  1. What to Expect:
    • Most insect bites are itchy for several days.
    • Any pinkness or redness usually lasts 3 days.
    • The swelling may last 7 days.
    • Insect bites of the upper face can cause severe swelling around the eye. This is harmless.
    • The swelling is usually worse in the morning after lying down all night. It will improve after standing for a few hours.
 
Call Your Doctor Back If...
 
 
 
 
  • Infected scab not better after 48 hours of antibiotic ointment
  • Bite looks infected (spreading redness gets bigger after 48 hours)
  • You think your child needs to be seen
  • Your child becomes worse
 
This handout is intended for informational purposes only and should not be used as a substitute for the care and advice of a medical professional. The accuracy of the information contained in this handout is not guaranteed and there may be variations in treatment that your doctor or nurse may recommend based on individual facts and circumstances.
 
Copyright 2000-2024 Schmitt Pediatric Guidelines LLC Author: Barton Schmitt MD, FAAP
Provided by ClearTriage