Insect Bites and Repellents
Summertime not only brings warm weather, but also insects. As children spend more time outdoors, they become targets for some of these pests. Some of these insects are too small to see. Some are aggressive. Others only attack when frightened, bothered, or hunting.
Reactions to insect bites and stings can range from minor local irritation to severe, life threatening generalized reactions. The more severe reactions usually involve honeybees, hornets, wasps, yellow jackets and fire ants. The amount of poison injected, and an individual child’s sensitivity to it, will determine the extent of a reaction. The site of a sting or bite also influences the reaction. Stings on the face can cause more swelling than those on an extremity.
The mildest form of reaction produces a small red lump at the site of a bite or sting. It may itch or hurt for several hours, but usually disappears quickly. Occasionally, the swelling may be larger and last for more than a day. A more significant reaction can produce a red rash at the site of the bite or sting and the entire extremity may swell. There may be generalized itching, and your child may experience nausea, cramps and diarrhea. This is considered a generalized reaction and you should contact a physician. A life threatening reaction occurs when a child experiences massive swelling, trouble breathing and low blood pressure. Since this can be potentially life threatening, you should call 911. A reaction of this nature should be further evaluated by you and your physician.
Bites by mosquitoes, chiggers, fleas, and bedbugs usually cause itchy red bumps. The size of the bites may vary. A larger bite does not mean your child is allergic to the insect bite. Bites near the eye can cause a large amount of swelling for several days. A mosquito bite is itchy with a central raised dot in the swelling. They usually occur on skin not covered by clothing. Mosquito bites in sensitive children can cause hard lumps that last for months. Fleas and bedbugs do not fly and crawl under clothing to nibble. Flea bites can cause small blisters.
Horseflies, deerflies, gnats, spiders, some beetles and ants, and centipedes cause painful red bumps which can blister. Black fly bites are particularly painful, occur around the head and can cause bleeding.
Recently, a lot of attention has been focused on Lyme disease, which is transmitted by infected deer ticks. A target-like rash may develop between 3 and 30 days after a tick bite. Not everyone with Lyme disease displays this rash. A rash that appear immediately after a tick bite indicates an allergic reaction. Lyme disease can affect joints, skin, heart and nervous system producing many different symptoms.
Infected ticks must feed for 48 to 72 hours before the organism responsible for Lyme Disease (Borrelia burgdorferi) is transmitted. Thus a daily check for ticks is the best means of preventing the disease. Even in the areas where there has been a lot of Lyme disease, only about 20% of ticks are infected. The risk of developing Lyme disease in people who have recognized that they have been bitten by a deer tick that is subsequently shown to be infected with B burgdorferi is approximately 8-10%. Thus, the overall risk of developing Lyme disease is only about 1%. (from Robert S. Baltimore, MD and Eugene D. Shapiro, MD, Departments of Pediatrics, and Epidemiology and Public Health, Yale University School of Medicine)
Treating with antibiotics to prevent Lyme disease after a suspected bite has not been shown to prevent the disease and is not recommended even in areas with a very high incidence of Lyme disease. Wearing protective clothing, careful use of insect repellents, and careful inspection for tick bites after entering a tick infested area are the most reasonable precautions to take to prevent Lyme Disease. If a tick bite is noted, the tick should be carefully removed and saved if you want to have it checked for B burgdorferi. The area of the bite should be observed for about 1 month to watch for the development of the rash associated with Lyme disease. If you have any concerns about your symptoms, or the possibility that you have Lyme disease, you should contact your physician.
Once your child has a bite or a sting, there are several things you can do to make him or her more comfortable. Applying calamine lotion, a baking soda solution, 1% hydrocortisone cream, or "anti-itch" creams will help. Cold compresses or applying sharp, direct, firm pressure to the bite cuts down on the itching. If your child has a painful sting, applying a paste of meat tenderizer or ammonia decreases the pain and reaction. Ice is also helpful. An oral antihistamine may help decrease the itching and swelling associated with a bite.
The treatment of any bite or sting is prevention. If possible, children playing the woods, especially tick infested areas, should wear long clothing and tuck their pants into their shoes. Checking for ticks every few hours and at the end of the day is important. A brisk shower when back home is also effective in removing some ticks.
Have your child avoid areas such as stagnant water where insects like to dwell. Wear light, neutral color clothing. Avoid brightly colored clothing. Dark colors also attract insects and also make it difficult to spot ticks. Scented soap and perfumes attract insects. Move slowly and carefully around insects. Wild motions and swatting at them can increase the chances of an attack.
Insect repellents containing DEET are helpful in preventing insect bites. These must be used with caution since DEET can be absorbed through the skin into the bloodstream and can cause seizures or coma if used improperly. Use a repellent with less than 33% DEET. Use the repellent sparingly. Apply it mainly to clothing and shoes. Avoid contact with the mouth, eyes and hands (since they often go into young children’s’ mouths). Do not apply it to areas that are sunburned or have rashes because the DEET is more easily absorbed in these areas. Warn older children who apply their own insect repellent that a total of three or four drops can protect the whole body.
One application of repellent lasts 4-8 hours, so apply it no more than twice a day. If the repellent is applied to the skin, wash it off after your child comes indoors.
There are other insect repellents that do not contain DEET. Although they may not be as effective as DEET containing products, you may consider them for your child. If you have any questions about the use of repellents, please contact your physician.
Summertime is fun time for children of all ages. With some preventive measures, everyone should be able to have their fun outdoors.
