Insect Bite

Main Symptoms

• 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, gnats, fire ants, harvester ants, blister beetles, and centipedes usually cause a painful, red bump. Within a few hours, fire ant bites can change to blisters or pimples
• This topic excludes bees, ticks and spiders
• A severe life-threatening allergic reaction is called anaphylaxis

See More Appropriate Topic If

1. BEE OR YELLOW JACKET STING
2. SPIDER BITE
3. TICK BITE

Call 911 Now (your child may need an ambulance) (for symptoms of anaphylaxis) If

• Difficulty breathing or wheezing
• Hoarseness or cough with rapid onset
• Difficulty swallowing or slurred speech with rapid onset
• Previous severe allergic reaction to bite from the same type of insect
• NOTE: Anaphylaxis can occur with bee, yellow jacket, wasp, or fire ant stings (rarely with other insects). Onset usually is within 20 minutes but can occur up till 2 hours after the bite

First Aid Advice for Anaphylaxis

• Give epinephrine injection if you have an anaphylactic kit
• Inject it into the muscle of the upper outer thigh

Call Your Doctor Now (night or day) If

• Your child looks or acts very sick
• Hives or swelling elsewhere on the body
• More than 20 fire ant stings in a child < 1 year old

Call Your Doctor within 24 Hours (between 9 and 4) If

• You think your child needs to be seen
• Severe pain is not improved after 2 hours of pain medicine
• New redness or red streak occurs around the bite after the first 24 hours
• Scab that looks infected (drains pus or increases in size) not improved after applying antibiotic ointment for 2 days

Call Your Doctor during Weekday Office Hours If

• You have other questions or concerns

Parent Care at Home If

• Normal insect bite and you don't think your child needs to be seen

Home Care Advice for Insect Bites

1. Itchy Insect Bites (including all mosquito bites)
   • Apply calamine lotion or a baking soda paste
   • If the itch is severe, use 1% hydrocortisone cream. Apply 4 times a day until the itch is less severe, then switch to calamine lotion
   • Also apply firm, sharp, direct, steady pressure to the bite for 10 seconds. A fingernail, pen cap, or other object can be used
   • If the bite is very itchy after local treatment, try an oral antihistamine (e.g. Benadryl). Sometimes it helps, especially in allergic children
2. Painful Insect Bites
   • Rub the bite for 15 to 20 minutes with a cotton ball soaked in a bakind soda solution. This will usually relieve the pain (Caution: don't use near the eye)
   • If not available, use a baking soda solution on a cotton ball
   • If neither is available, apply an ice cube for 20 minutes
   • Give acetaminophen or ibuprofen for pain relief. See Dosage table. Antihistamines don't help
3. Antibiotic Ointment: If the insect bite has a scab on it and the scab looks infected, apply an antibiotic ointment 4 times per day
   • Cover the scab with a Band-Aid to prevent scratching and spread
   • Repeat washing the sore, the antibiotic ointment and the Band-Aid 4 times per day until healed
   • Caution: For spreading infections (redness or red streaks), your child needs to be seen
4. Expected Course: Most insect bites itch or hurt for 1 to 2 days. The swelling may last a week
5. Call Your Doctor If
   • Severe pain persists > 2 hours after pain medicine
   • Infected scab doesn't clear after 48 hours of antibiotic ointment.
   • Bite looks infected (redness, red streaks, increased tenderness)
   • Your child becomes worse or develops any of the "Call Your Doctor" symptoms