Insect Bites

1. Reassurance:
   
   • Most insect bites result in 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 site does not mean your child has an allergy.
   • The redness does not mean the bite is infected.
2. Itchy Insect Bites (including all mosquito bites):
   
   • Steroid Cream: To reduce the itching, use 1% hydrocortisone cream (no prescription needed).  Apply 4 times a day until the itch is gone. If not available, apply a baking soda paste until you can get some.
   • If neither is available, apply an ice cube in a wet washcloth for 20 minutes.
   • Also apply firm, sharp, direct, steady pressure to the bite for 10 seconds to reduce the itch.  A fingernail, pen cap, or other object can be used.
   • Antihistamine: If the bite is very itchy after local treatment, try an oral antihistamine such as Benadryl (no prescription needed). Sometimes it helps, especially in allergic children. See Dosage table.
3. Painful Insect Bites:
   
   • Rub the bite for 15 to 20 minutes with a cotton ball soaked in a baking soda solution once. This will usually reduce the pain.
   • You can also apply an ice cube in a wet washcloth for 20 minutes.
   • Give acetaminophen (e.g., Tylenol) or ibuprofen for pain relief. See Dosage table.
   • Antihistamines don't help.
4. Antibiotic Ointment:
   
   • If the insect bite has a scab on it and the scab looks infected, apply an antibiotic ointment such as Polysporin 3 times per day (no prescription needed). (Note: usually impetigo caused by scratching with dirty fingers).
   • Cover the scab with a Band-Aid to prevent scratching and spread.
   • Repeat washing the sore, the antibiotic ointment and the Band-Aid 3 times per day until healed.
   • Caution: For spreading infections (redness or red streaks), your child needs to be seen.
5. Expected Course:
   
   • 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, but 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.
6. Call Your Doctor If:
   
   • Severe pain persists over 2 hours after pain medicine
   • Infected scab doesn't improve after 48 hours of antibiotic ointment
   • Bite looks infected (spreading redness starts after 24 hours or becomes larger after 48 hours)
   • Your child becomes worse

Prevention of Insect Bites

1. Prevention:
   
   • Wear long pants, long-sleeved shirts and a hat
   • Avoid being outside when the insect is most active. Many insects that cause itchy bites are most active at sunrise or sunset (e.g., chiggers, no-see-ums, mosquitoes).
   • Insect repellents containing DEET are effective in preventing many insect bites. Read the label carefully.
2. DEET Products: Apply to skin.
   
   • DEET is a very effective mosquito repellent. It also repels ticks and other bugs.
   • The American Academy of Pediatrics (2003) has approved the use of DEET in a concentration of 30% or less for all children over 2 months of age. Use 30% DEET if you need 6 hours of protection. Use 10% DEET if you only need protection for 2 hours.
   • Don't apply DEET to the hands if the child sucks on their thumb or fingers.
     (Reason: prevent ingestion)
   • Warn older children who apply their own repellent that a total of 3 or 4 drops can protect the whole body.
   • Apply to exposed areas of skin. Do not apply to eyes or mouth. Do not apply to skin that is covered by clothing. Don't put any repellent on areas that are sunburned or have rashes because the DEET is more easily absorbed in these areas.
   • Remember to wash it off with soap and water when your child returns indoors.
   • Caution: DEET can damage clothing made of synthetic fibers, plastics (e.g., eye glasses), and leather. DEET can be applied to cotton clothing.
3. Permethrin Products: Apply to clothing.
   
   • Permethrin-containing products (e.g., Duranon, Permanone) are highly effective mosquito repellents. They also repel ticks.
   • An advantage over using DEET is that they are applied to clothing instead of skin.
   • Apply it to shirt cuffs, pant cuffs, shoes and hat.
   • You can also put it on other outdoor items (shoes, mosquito screens, sleeping bags).
   • Do not apply permethrin to skin, as it will lose effectiveness very quickly.
4. Picaridin Products:
   
   • Picaridin is a newly approved repellent that is equivalent to 10% DEET
   • It can safely be applied to skin or clothing

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.