From the Guidelines
Pediatric snakebite symptoms include pain, swelling, and redness at the bite site, along with potential systemic effects such as nausea, vomiting, difficulty breathing, abnormal bleeding, and neurological symptoms, and treatment should prioritize keeping the child calm and immobilizing the bitten limb at heart level while seeking immediate medical attention. The symptoms of a snakebite in children can vary depending on the species of snake, the amount of venom injected, and the child's size, with smaller children potentially experiencing more severe effects due to a higher venom-to-body mass ratio 1.
Initial Treatment
Treatment begins with keeping the child calm and immobilizing the bitten limb at heart level while seeking immediate medical attention, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. It is also reasonable to rest and immobilize the bitten extremity and minimize exertion by the person who was bitten if it does not delay access to emergency medical care 1.
What Not to Do
It is essential to avoid certain actions when treating a snakebite, including:
- Applying tourniquets, which can worsen local tissue injury 1
- Cutting the wound or attempting to suck out venom, which can cause tissue injury and is not effective in venom removal 1
- Applying ice to the snakebite wound, which is of unproven benefit and may be harmful in some situations 1
- Using suction, electric shock, or pressure immobilization bandaging, which are potentially harmful and not recommended for use in North America 1
Hospital Treatment
At the hospital, treatment typically involves antivenom administration, which is dosed the same for children as adults because it neutralizes venom based on amount injected, not patient size. Supportive care includes:
- Pain management with acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours)
- Intravenous fluids
- Tetanus prophylaxis if needed
- Antibiotics only if infection develops Close monitoring of vital signs, coagulation parameters, and organ function is essential, as the severity of symptoms depends on the snake species, amount of venom injected, time to treatment, and child's size 1. Psychological support for both child and family is also important during recovery.
From the Research
Symptoms of Pediatric Snakebite
- Local effects: pain, swelling, bruising, and redness at the bite site 2
- Systemic effects: coagulopathy, cardiovascular instability, respiratory distress, and neurological impairment 2, 3
- Common complications: pulmonary edema, compartment syndrome, cellulitis, and disseminated intravascular coagulation 3
Treatment of Pediatric Snakebite
- Prehospital first aid: immobilization, wound cleaning, and removal of constricting items 2
- Definitive medical and surgical care: administration of antivenom, management of coagulopathy, and treatment of systemic effects 2, 4, 5
- Monitoring: close observation for at least 12 hours, even if there are no signs of clinical envenomation 3
- Antivenom treatment: administration of antivenom to patients requiring clinical staging, and consideration of continuous intravenous dosing in cases of recurrent coagulopathy 6, 5