Prevention is the best strategy. This does not mean that you should keep your child indoors (outdoor play and nature are good for children), but taking some straightforward measures to prevent bites will go a long way. Long (but light) clothing will minimize the amount of skin exposed to potential biting insects, especially if you tuck the pants legs into socks to prevent insects from making their way up legs. Hats — and for babies, mosquito netting over a stroller or carrier — can also help.
Insect repellents are safe and effective for children over 2 months old. Although there is limited evidence that “natural” repellents (such as citronella and other essential oils) have some effectiveness, the best results have been found from those containing DEET or picaridin. DEET lasts about two to five hours (depending on the concentration used — you don’t need more than 30 percent), and picaridin about three to eight hours. Follow the instructions on the packaging carefully to apply it safely and with the best results.
You may hear advice about using garlic, vitamins, ultrasonic devices, repellent wristbands, and other such solutions, but none of these has been shown to be effective. Stick with what works.
Reactions to bites
Most issues involving insect bites have to do with reactions to the bites. They can vary from a little bit of redness all the way to severe allergic reactions. It may come as a surprise to learn that health-care providers often can’t tell what kind of insect bit your child based on the appearance of the bite. Even bites by two mosquitoes of the same species can result in two very different reactions. You’ll be relieved to know that much of the time, knowing what insect caused the bite is not important.
Usually, reactions consist of small amounts of redness, swelling and itching. These are harmless and primarily annoying. Sometimes, in a phenomenon known as a large local reaction, the redness and swelling can be a few inches in size. These often occur in the first few hours after a bite, and the concern is often that the bite has become infected. This is unlikely, especially if it itches. It’s unusual for an infection to develop so quickly, particularly spreading evenly in all directions from the bite.
These can be handled via a brief application of ice, topical steroids like 1 percent hydrocortisone (available without a prescription), and oral antihistamines, which can help reduce the itching. The swelling and redness will usually go away without any intervention within three to four days.
Still, infections do happen — either a local bacterial infection or an insect-carried infection. Local infections also present with redness and swelling, but usually develop a day or two after the bite. There is less itching, and there might be a pocket of pus (or draining pus) present, which is a sign that an infection is present. There might also be a streak of red heading away from the bite site, rather than an even red circle around that location. Any of these should be evaluated by a health-care practitioner to judge whether treatment is necessary.
Then there are infections that affect the whole body, and are often transmitted by biting insects. These include Lyme disease, Zika virus, Ehrlichiosis, and others. For the most part, the typical insect bite will not transmit these illnesses, so don’t panic. While these are not unheard-of illnesses, they are also relatively rare compared with the many bites that occur. Most winged insects are unlikely to transmit disease, so unless you notice concerning symptoms — such as fever, fatigue, or an unusual rash — it’s best not to worry about the usual trivial insect bite.
Ticks are a somewhat different matter — they don’t fly, but will attach themselves to skin and can transmit diseases such as Lyme and others. Luckily, most tick-borne diseases need a longer amount of time to transmit — for some diseases, as little as two hours, and for others, as long as 24, 72, or even 96 hours. This means that the assiduous use of insect repellent as well as frequent tick checks will make a huge difference in preventing disease. If a tick has attached, remove it carefully, using tweezers to pull the tick straight out. Finding and removing ticks early will prevent infection from occurring. And again, do remember that not all ticks carry disease!
When to call your pediatrician
Call your pediatrician if your child seems to be ill and not merely uncomfortable due to the itching from a bite. Fever, fatigue, joint pain or an unusual rash are all good reasons to call. Evaluation may still determine that there is nothing serious at hand, but when unusual symptoms are present, reassurance can be very valuable to concerned parents.
Dipesh Navsaria is a primary-care pediatrician who works extensively with the American Academy of Pediatrics and is an associate professor of pediatrics at the University of Wisconsin School of Medicine and Public Health. Find him on Facebook and Twitter.