Most insect bites can and should be avoided. Children too young for repellents should be kept under mosquito netting when outdoors and older children should have at least their clothing sprayed with a safe insect repellent before going out in the "buggy" seasons. A thorough bath and examination at the end of the day can also rid your child's body of bugs that haven't feasted yet or are about to take another bite.

The type of reaction that occurs depends on the species of the insect that bites your child. In fact, not all insects bite - some tear (tsetse flies), some cause a local allergic reaction (cockroaches) some leave body parts behind which results in the child's immune system walling off the foreign bits by forming a lump called a granuloma, some cause systemic disease (Lyme tic). Most reactions are the result of a defensive response by our immune systems to the saliva or venom of the insect resulting in the formation of a papule - a small, usually itchy or painful bump, that signals to us that there are "bugs" around. It is interesting to know that it is never the first time when a child has a bug bite that she has been met by this insect type. It requires multiple "visits" before a reaction generally occurs to a bug bite and in time most children develop some immunity to the insect so that by adolescence most insect bites are minor in comparison to those of young childhood.

Some insects attack repeatedly in the same area, like fleas. Others, like mosquitos, bite randomly here and there. The initial reaction in a sensitized child is the formation of a raised area called a wheal and then redness develops and within hours a bump appears. This may later become hardened and painful and if scratched with unclean hands, secondarily infected and inflamed. Beetles and spiders can cause deep bullous lesions that may infect the deeper layers of skin and turn deep colors associated with pain more than itching.

Treatment is basically aimed at relieving the itching. Cool compresses and soothing lotions in addition to oral antihistamines are usually effective. Topical anti-histamine creams are usually not helpful and in severe situations oral steroids for short course can be necessary. Prevention with repellents containing DEET (diethyl-meta-toluamide) may protect against mosquitos, fleas, flies, chiggers, and ticks but are useless against bees, wasps and hornets. Examine your pets carefully, clean crawlspaces regularly and decontaminate areas like sheds which are frequented by birds and other animals.

On rare occasions a child may have a severe allergic response to an insect bite, known as anaphylaxis. It is an acute, potentially life-threatening reaction. Most commonly, bee stings are the cause of this level of reaction in children. First the child may notice tingling around the mouth followed by a flush of warmth and difficulty swallowing. There may be general itchiness and swelling and various degrees of nasal congestion, hoarseness, itchy watery eyes and wheezing. Abdominal cramps and diarrhea may occur and a child may even lose consciousness from sudden low blood pressure.

Most fatal events are the result of airway obstruction. It is essential to seek immediate medical attention and for children who are known to be highly allergic to insects, avoidance and constant availability of an adrenaline injection is essential. Children with a history of anaphylaxis should also wear an identification bracelet indicating their allergy. Children should also avoid using perfumes or wearing bright or pastel colored clothing outdoors. Immunotherapy to insect bites is of questionable help and may even be dangerous. 50% of adults treated for this experience local reactions and 7% had serious systemic reactions when given allergy shots for mosquito desensitization. There has been some success with careful bee sting venom immunotherapy but again there is some risk involved in the treatment.

Most insect bites result in only minor local reactions, usually soothed with simple measures and mostly of no long term risk. Prepare for the bug season by dressing appropriately and using relents when possible.

Description

The type of reaction that occurs depends on the species of the insect. In fact not all insects "bite". Some tear (tsetse flies), some cause a local allergic reaction by leaving saliva behind (cockroaches), some leave body parts behind which results in an immune system formation called a granuloma, and some can cause systemic disease (tics). Most reactions are the result of a defensive response by our immune systems to the saliva or venom of the insect resulting in the formation of a papule, a raised, itchy bump.

Why?

Repeated exposure to the insects "bite" is necessary for the reaction to occur. Scratching the bumps may increase the irritation but does not spread the bumps. Some insects bite repeatedly in the same area, like fleas. Others such as mosquitos, bite randomly as they land here and there.

Usual course

The initial reaction in a sensitized child is the formation of a raised area called a wheal and then redness develops and within minutes or hours a bump appears. This may become hardened and painful and if scratched with unclean hands, secondarily inflamed and infected. Beetles and spiders can cause deep bulbous lesions that may infect the deeper layers of skin. Most insect bites result in only minor local reactions, usually soothed with simple measures and usually resolve in 1-3 days.

Treatment

Most care is aimed at reducing the pain and itchiness associated with the bite. Cool compresses and soothing lotions, in addition to oral antihistamines are usually effective. Topical anti-histamines are not usually helpful and in the case of multiple, open bites, may even add toxicity to your treatment. In severe situations short course oral steroids may be needed though this is very rare.

Prevention

Insect repellents containing DEET (diethyl-meta-toluamide) may protect against mosquitos, fleas, flies, chiggers, and ticks, but are useless against bees, wasps and hornets. Infants should be protected with lightweight netting when outdoors and older toddlers should have their clothing sprayed with DEET a few minutes before venturing outside. A thorough bath and examination at the end of the day can also rid your child's body of bugs that haven't yet "feasted" and help to find tics that have embedded and need to be promptly removed. Examine your pets thoroughly as well and clean out attics and crawlspaces regularly during the "buggy" season. Decontaminate sheds which are frequented by birds and insects that build nests such as wasps on a regular basis, at night, when the insects are less likely to attack.

When to call the doctor

If your child has bites that are oozing or excessively painful you may need to seek further treatment for infection. If your child shows any alteration of consciousness after being bitten or has any respiratory distress as can develop in allergic children after even a single bee-sting, immediate emergency care must be sought.