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Insect Bites

There are many different biting or stinging insects and other bugs. Creatures that bite, like mosquitoes and gnats, are usually feeding on a person’s blood. The blood sucking insects often inject a tiny amount of their saliva during the bite. The saliva helps to numb the person’s skin and to dissolve red blood cells so they are easier to remove. The redness, swelling, and itching of a mosquito or gnat bite comes from the child’s body reacting to the insect’s saliva.

Insects like bees and wasps sting to defend themselves or their hives. They do not bite. The stinger is a tiny hollow needle that injects a very small amount of venom into the skin. The venom causes intense pain right away, and later may cause swelling and itching. Bees leave their stingers in the person, but wasps do not. A small number of children become allergic to bee and wasp stings. They may have allergic reactions ranging from itchy bumps on other parts of their body (hives) to severe trouble breathing and life-threatening shock. Many ants also sting, but their venom is different from bee and wasp venom. Allergies to ant stings are very rare.

Other biting and stinging creatures, like spiders, scorpions, and centipedes, are not truly insects. Like the bees and wasps, they sting (or sometimes bite) in self-defense, and they inject some venom. There are only two dangerous species of spider in North America, the Black Widow and the Brown Recluse, and though they are found in most states in the US, their bites are very rare. Other spider bites usually cause only tiny red bumps that may itch or burn, but are not dangerous. Scorpion stings make children very irritable and anxious, and can cause increased heart rate and, rarely, seizures. You can learn about tick bites and their consequences at our Children’s Health Topics page on Tick Bites.

What is the biggest concern with Insect Bites?

Most children and parents are mainly concerned about the pain of a bite or sting. If you child got into a nest or hive, s/he may have many stings on his or her body. Allergic reactions to bee and wasp stings are our other big concern. A mild allergic reaction produces red, itchy, and sometimes painful welts called hives in body areas other than where the sting occurred. More serious allergic reactions can cause trouble breathing, wheezing, swelling of the throat, and even collapse and shock. If your child had any sign of an allergic reaction with this sting, please talk with your doctor about the right steps to prevent a future reaction that could be more serious.

Even children who don’t have an allergic reaction often have swelling of the area or even of an entire arm or leg. This swelling is uncomfortable but not dangerous.

Insect Bite treatments

We usually treat a child who has only one or several stings just by giving some pain medicine like acetaminophen (Tylenol® and others) or ibuprofen (Motrin® or Advil® and others) and putting cool compresses on the sting. If the stinger is still in your child’s skin, you can remove it carefully by scraping away from the skin with a pocket knife or a credit card. This will prevent injecting any more venom from the sac that is still attached to the stinger. Swelling continues to increase for up to 24 hours. For this reason, remove any rings, bracelets, or other jewelry if the sting is on an arm or leg, to prevent them from getting stuck. Meat tenderizer does not provide any benefit, and can make the skin sore near the bee sting.

Children with insect bites usually only need something to control the itching. Diphenhydramine (Benadryl® and others) is a good anti-itching medication. Use it as directed on the package. The main side effect is drowsiness, which can actually be an advantage if your child is unable to sleep because of the itching. Some children scratch the bites so badly that they bleed or become infected. You can help prevent this by giving the medication regularly, and by keeping the child’s skin clean. You can help to prevent infected bites by keeping your child’s fingernails cut and clean. If a bite gets increasingly red, swollen or painful, or if it develops a yellow- or honey-colored crust, it is probably infected. Wash the area with warm soapy water, and apply an antibiotic ointment like Polysporin, then cover it with a bandage. Please call your doctor if you think a bite is infected. You may need to use a local or an oral antibiotic.

If your child had any of the signs of an allergic reaction, please be sure to discuss these with your doctor. If your child had only a mild allergic reaction, your doctor may have instructed you to use an antihistamine, like diphenhydramine (Benadryl®) to help with itching and to prevent the reaction from getting worse. If your child had an allergic reaction that was more than mild, you may have spent the night in the hospital for observation.

The EpiPen®

If your doctor was concerned that your child may have a serious allergy to bee or wasp stings, s/he may have given you a prescription for an “EpiPen®,” a device to inject epinephrine (adrenalin). Epinephrine is life-saving if you give it within the first few minutes of a sting, in a child who is known to have a moderate or severe allergy. The EpiPen Jr. is for children who weigh less than 60 pounds, and the adult EpiPen is for larger children and teens. Please be sure to fill the prescription right away. Keep the EpiPen someplace where you can get at it right away. Older children should keep their EpiPen with them whenever they go into places where bee or wasp stings seem likely. The side effects of using the Epi-Pen are a rapid heart rate, dry mouth, and mild trembling.

The EpiPen can be life-saving, but your child must use it within the first few minutes after a sting. Many people keep several different EpiPens in places the child often visits (one at home, one at school, one at camp, etc). Check the expiration date when you fill the prescription, and mark your calendar for the date it needs to be replaced. Your doctor can provide a practice EpiPen that does not contain a needle or medicine. You and your child should practice using it regularly. Then, if your child needs to use it for real, s/he will know what s/he needs to do, how much pressure it takes to trigger the injection, and so forth. When an EpiPen expires, don’t throw it away immediately! Use it to practice giving the injection into an orange. This will provide more regular practice for your child, and will prevent the EpiPen from accidentally injuring someone else.

Dangerous Insect Bite Symptoms

Your doctor sent your child home because s/he is not having a serious allergic reaction. Still, it is good to watch your child for the first 24 hours after a sting to be sure that a reaction does not develop. Here are some signs of a serious reaction:

  • Difficulty breathing or speaking
  • A feeling of swelling or tightness in the throat or chest
  • A hoarse voice
  • Wheezing (whistling breath sounds)
  • Increasing puffiness or swelling of the face or arms and legs
  • Increasing numbers of red wheals or hives
  • Extreme irritability in a toddler or infant
  • Lethargy (inappropriate sleepiness)

If any of these occur, please be sure to call your doctor’s office right away. If your child or infant is difficult to awaken or seems unconscious, go directly to the emergency room.

Signs of an infected bite or sting include:

  • Redness, swelling, or pus coming from the bite or sting
  • A honey-colored crust developing around the area
  • Increasing pain after the first 24 hours
  • Red streaks from the bite towards the body
  • Fever

If any of these occur, please be sure to call your doctor’s office right away.

Other points of concern

Children who have allergic reactions to bee or wasp stings should learn how to avoid being stung. Most children with these allergies outgrow them with time, but it is impossible to predict how bad the next sting might be. Your child does not have to avoid the outdoors, or stop doing any activities, even if s/he has an allergic reaction to stings, if s/he can learn to avoid the sting, and what to do if a sting does happen.

Other Conditions that Might Be Present

There aren’t many conditions that mimic insect bites or stings. It is common for a child not to know exactly what kind of creature bit or stung him or her. Sometimes, mosquito or gnat bites can get infected without the child remembering being bitten. This can cause puzzlement among parents and doctors.