Treating insect bites and stings...and when to call the doctor

June 19, 3:53 PMLA Parenting ExaminerRebecca Lacko

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When children are playing outdoors, it's all fun and games until someone is stung or bit by an insect or spider.  What are the most common insect bites and how can you avoid them? What are good treatment options? When should you call the doctor?

Insect and spider bites

Ouch, what was that?! Teach your child the difference between spiders and insects. While most bites and stings require the same treatment, it helps to know who was the culprit. Insects have three body parts, six legs, and antennae. Spiders (arachnids) have only two body parts, eight legs, and do not have antennae.

The most common types of bites or stings are from bees, wasps, spiders, mosquitoes, fleas, and ants. According to the Mayo Clinic, most reactions to insect and spider bites are mild, causing little more than an annoying itching or stinging sensation and mild swelling that disappear within a day or so. A delayed reaction may cause fever, hives, painful joints and swollen glands. It is also possible to experience both the immediate and the delayed reactions from the same insect bite or sting. Only a small percentage of people develop severe reactions (anaphylaxis) to insect venom. Signs and symptoms of a severe reaction include:

• Facial swelling
• Difficulty breathing
• Abdominal pain
• Shock

Big troublemakers include bees, wasps, hornets, yellow jackets and fire ants, and should be carefully avoided. Bites from mosquitoes, ticks, biting flies and some spiders also can cause reactions, but these are generally milder. Most insect bites and stings only cause local reactions, including redness, swelling, pain and itching.

According to About.com's Pediatrics, after thoroughly washing the affected area with soap and water, treatment that may help your child feel better include applying:

• an ice pack or cool compress
• a meat tenderizer solution, which can be made by mixing one part meat tenderizer and 4 parts of water. This is especially helpful for painful stings from bee, wasp or ant. For best effect, soak a cotton ball in the meat tenderizer solution and use it to rub the area of the bite for 15-20 minutes.
• a baking soda paste
• a topical steroid or other topical anti-itch cream, such as Calamine lotion, to the area

Other medications, including an oral antihistamine for itching, such as diphenhydramine (Benadryl), and/or pain medications, such as ibuprofen or acetaminophen, may also help. (Be sure to check with a pharmacist for the correct product for your child's age and/or weight.)  More extensive local reactions may sometimes require a short course of an oral steroid. Antibiotics may be needed if the bite becomes infected.

What if you or your child has a severe reaction to an insect sting or bite? According to the Mayo Clinic, severe reactions may progress rapidly.
Dial 911 or call for emergency medical assistance if the following signs or symptoms occur:

• Difficulty breathing
• Swelling of the lips or throat
• Faintness
• Dizziness
• Confusion
• Rapid heartbeat
• Hives
• Nausea, cramps and vomiting

Take these actions immediately while waiting with an affected person for medical help:

1. Check for special medications that the person might be carrying to treat an allergic attack, such as an auto-injector of epinephrine (for example, EpiPen). Administer the drug as directed — usually by pressing the auto-injector against the person’s thigh and holding it in place for several seconds. Massage the injection site for 10 seconds to enhance absorption.
2. Have the person take an antihistamine pill if he or she is able to do so without choking, after administering epinephrine.
3. Have the person lie still on his or her back with feet higher than the head.
4. Loosen tight clothing and cover the person with a blanket. Don’t give anything to drink.
5. Turn the person on his or her side to prevent choking, if there’s vomiting or bleeding from the mouth.
6. Begin CPR, if there are no signs of circulation (breathing, coughing or movement).

If your doctor has prescribed an auto-injector of epinephrine, read the instructions before a problem develops and also have your household members read them.

According to Dr. Sears in San Clemente, Calif., you should take precaution before a bite becomes infected. Flea bites and mosquito bites usually don’t require any special measures to prevent infection of the surrounding skin. Insect bites will normally have some amount of redness and swelling, as well as a bit of clear drainage. Spider bites, however, tend to create a much larger area of redness and swelling. While this is normal, it does increase the risk of infection developing in the bite.

Before a bite becomes infected Follow these steps two or three times a day:

• Wash the bite with warm soapy water
• Apply some diluted hydrogen peroxide (mix ½ water with ½ peroxide)
• Wash off the peroxide after two minutes
• Apply an over-the-counter antibiotic ointment
• Ice applied to a large spider bite can decrease the pain and burning

Infected bites

Not sure if you have an infection? Symtoms of a bite gone bad include redness around the bite, increased swelling and pain,  and pus. If this occurs, follw these steps three times daily:

• Wash with warm soapy water
• Apply a hot washcloth to the area for 10 minutes
• Apply diluted hydrogen peroxide, then wash off after two minutes
• Apply diluted Betadine solution (mix ¼ of this over-the-counter brownish red antiseptic with ¾ water) and let it dry for two minutes
• Thoroughly wash off all Betadine
• Apply over-the-counter antibiotic ointment. If your doctor will call in a prescription strength ointment called Bactroban, then this may work better.

It may take one or two days for this treatment to start to improve the infection, but symptoms should continue to improve, not worsen.

More serious infection

If the redness and drainage continue to worsen, or you or your child develops fevers or red streaks extending out from the bite,  see your doctor right away. If it is after hours, page your doctor. Antibiotics will most likely be necessary.

Prevent bug bites and stings

According the the American Academy of Pediatrics (AAP), insect repellents come in many forms including aerosols, sprays, liquids, creams, and sticks. Some are made from chemicals and some have natural ingredients. And you should keep in mind that these types of repellents are for biting insects, not stinging insects.

The AAP sites the following as NOT EFFECTIVE for repelling insects:

• Wristbands soaked in chemical repellents
• Garlic or vitamin B1 taken by mouth
• Ultrasonic devices that give off sound waves designed to keep insects away
• Bird or bat houses
• Backyard bug zappers (Insects may actually be attracted to your yard.)

Tips for using repellents safely:

DO

• Read the label and follow all directions and precautions.
• Only apply insect repellents on the outside of your child’s clothing and on exposed skin.
• Spray repellents in open areas to avoid breathing them in.
• Use just enough repellent to cover your child’s clothing and exposed skin. Using more doesn’t make the repellent more effective. Avoid reapplying unless necessary.
• Assist young children when applying insect repellents on their own. Older children also should be supervised when using these products.
• Wash your children’s skin with soap and water to remove any repellent when they return indoors, and wash their clothing before they wear it again.

DO NOT

• Never apply insect repellent to children younger than 2 months.
• Repellents should not be sprayed directly onto your child’s face. Instead, spray a little on your hands first and then rub it on your child’s face. Avoid the eyes and mouth.
• Insect repellents should not be applied on cuts, wounds, or irritated skin.
• Don’t buy products that combine DEET with sunscreen. The DEET may make the sun protection factor (SPF) less effective. These products can overexpose your child to DEET because the sunscreen needs to be reapplied often.

For more information:

More info on treating spider bites.
More info on treating insect bites.
Check out this comprehensive list of treatments at BiteRemedy.
Make your own (natural!) bug repellent! Recipes for Earth-friendly, home-made, chemical-free bug repellents