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

• Bee or Yellow Jacket Sting
• Spider Bite
• 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