Preventing, Recognizing and Treating Insect Bites and Stings

Springtime is prime time for insect bites and stings. Though most bites itch briefly and resolve themselves quickly, some bites can cause illness or allergic reactions, which can be dangerous. You should know what to look for and, more important, how to protect your little ones from getting bitten in the first place.

Most insect bites are simply annoying. But some bites, like that of a Lyme-disease-infected tick or a malaria-carrying mosquito, can cause disease. If you are spending time outdoors around your neighborhood, chances are you won’t even have to think about insects. Insects that carry disease are rare in urban areas in the United States, even when there are a lot of bugs. You can check with your doctor or the Centers for Disease Control and Prevention Web site to learn what insects and illnesses exist in a specific area.

Mosquito Bites

A mosquito, chigger, flea or ant bite feels irritated. At the bite site you will notice a raised red area, typically less than half an inch across, called a wheal. The wheal itches because it causes inflammation in the skin. Within a day or two, this will go away and the itch will also go away.

Sometimes, if these bites are scratched vigorously and the skin gets damaged, the area can become infected. Look for areas of worsening redness, pus discharge, red streaks and increasing pain or warmth. If it looks like the bite is becoming infected, see a doctor.

Spider Bites

Most spider bites look and heal just like mosquito bites. A few rare spiders can cause more serious reactions. Brown recluse spiders (and their relatives) are rare and hide out in basements and woodpiles. These bites can cause serious local reactions. You’ll notice that the bite site starts looking infected and becomes more painful.

Black widow spider bites are also rare but should be suspected if the child develops nausea, vomiting and severe stomach pain after a bite. It is very helpful to your doctor or emergency department if you can bring in the spider (dead or safely bottled) for identification.


Stings initially feel like a shot, and a young child may just start screaming without explanation. A sting, especially from a wasp or hornet, can produce a good deal of local swelling and redness – and a lot of itching.

Look out for signs of an allergic reaction (more common with stings): hives (red raised patches on the skin that itch), generalized skin redness and itchiness and nausea. Any throat tightness or tongue and lip swelling signifies a serious allergic reaction, and you should get your child to an emergency room immediately. Keep in mind that your child can get an allergic reaction even if she has not had one in the past.


If your child gets bitten by a bug, wash the area with soap and water. If it’s itching a lot, calamine lotion can help. If the bite is hurting or stinging, some ibuprofen (such as Children’s Motrin) or acetaminophen (such as Children’s Tylenol), dosed according to your child’s weight, can relieve the pain. An ice pack (or a bag of frozen peas) can immediately relieve the stinging and burning of a new bite.

If you can see a stinger in the skin, scrape it away using the edge of a credit card. In the case of a scorpion, for example, the stinger can continue to deposit poison until it is removed. Once the stinger is removed, wash with soap and water and apply an ice pack (or run cool water over the area).

If the itching is spreading or your child may have an allergic reaction, your pediatrician may recommend an antihistamine (such as Benadryl) to control the reaction. In cases of a severe allergic reaction, your child may need intravenous medication to stop the reaction.

An Ounce of Prevention

Choosing a safe and effective insect repellant for your children is very important. Not only will you protect them from having an itchy spring and summer, but you’ll protect them from all the associated risks of getting bitten. Of course, the best protection is simply covering up to prevent insects’ access to skin in the first place!

Bugs are attracted to skin odors and to carbon dioxide in our breath. Insect repellents such as DEET confuse the bug’s smell sensors so it can’t land and bite successfully. This means repellents are only effective at short distances.

The best repellent for the kids depends on your level of comfort and the risks of insect exposure. For example, in an area with tick-transmitted Lyme disease, using a repellant that is effective against ticks is very important. For a short summer walk in your neighborhood park, a short-acting repellant may be sufficient. Keep in mind that insect repellents do not protect against most stinging insects, including wasps, bees and fire ants.

Synthetic repellants, such as those with DEET or dimethyl phthalate, are extremely effective and are the most widely used repellants. The American Academy of Pediatrics (AAP) suggests it is acceptable to apply repellent with low concentrations of DEET to infants over 2 months old, though some experts recommend being more cautious with DEET repellents in children under 2 years old. If you have any doubts, consult your physician.

In children under age 2, apply DEET repellent only once a day. The AAP Committee on Environmental Health has updated its recommendation for use of DEET products on children, citing: “Insect repellents containing DEET (N,N-diethyl-m-toluamide, also known as N,N-diethyl-3-methylbenzamide) with a concentration of 10 percent appear to be as safe as products with a concentration of 30 percent when used according to the directions on the product labels.”

You can also put DEET repellant on your child’s clothing, but it may damage some synthetic fabrics such as polyesters and leather. The higher the DEET concentration, the longer acting the protection. Ten percent DEET offers about two hours of protection. Twenty-four percent DEET offers about five hours of protection. The National Pesticide Information Center also can provide detailed DEET information through a toll-free number, 1-800-858-7378, or via its Web site.

Natural repellants, including citronella and lemon eucalyptus, are considered safe for children older than 2 years but are not very effective against most insects. They offer some protection for one to two hours and are best used in areas where insects are somewhat irritating but where there is no risk of insect-borne disease.

Insecticides are the third category of repellants. Permethrin insecticides are safe to use around children because you apply them to their clothing or bedding, not directly on the skin. You can actually use permethrin on your tents, mosquito nets or sleeping bags without damaging the fabrics. It will continue to repel insects for weeks to months – even persisting through multiple washings. Permethrin is very effective against chiggers, ticks, mosquitoes, fleas and sand flies, and it helps prevent malaria when sprayed on netting. So permethrin is a good option in areas where insect-borne disease may be a risk.

This springtime, don’t let the bugs keep you and your children indoors! Dress your kids defensively and protect them with insect repellent so they can explore the buzzing world without getting bitten.

Protecting Your Kids (and Yourself) From Bites

  • Apply sunscreen to your child before applying insect repellant.
  • Dress kids in lightweight, long-sleeve shirts with fitted cuffs.
  • Dress kids in long socks and tuck pants into them, especially at dusk and dawn.
  • Choose light-colored fabrics, such as pastels, which attract fewer insects than dark colors.
  • Avoid perfumes, strongly smelling shampoos or scented soaps, which can attract insects.
  • At the end of the day, inspect your kids for ticks, including their armpits and groin.
  • If spending the night outdoors, use mosquito netting or a tent. Choose a site away from stagnant water, restrooms or other areas where insects gather.
  • In areas with insect-borne disease, spray tents and clothing with permethrin repellant.
  • Put up and seal the net or tent before high insect activity periods such as sunset. Before sleeping, vigilantly clear the tent of insects.
  • Always apply insect repellant for your child.
  • Apply repellents lightly – do not use more than you need.
  • Apply repellent only to clothing or to exposed skin, not under clothes.
  • Don’t apply repellent to your child’s hands (so it is less likely to get in his eyes and mouth).
  • If using a spray, make sure you are in a well-ventilated space so your child isn’t breathing in the spray.
  • If your child has a reaction to the repellent, take the bottle with you to the doctor’s office.
  • Apply insect repellants (with 10 to 30 percent DEET if risk of insect-borne disease) to exposed skin, avoiding the areas around the lips and eyes and any broken skin.
  • Wash children’s skin with soap and water once they no longer need the repellent protection.
  • If your child has had a serious reaction to an insect bite or sting in the past, talk to your doctor about carrying a self-injectable epinephrine kit in case of a life-threatening reaction.
  • Teach children to use caution in areas with potential insect hazards, such as anthills, wasp nests or spider hiding places – remember their best protection is to not disturb them!

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