From the FDA Drug Label
Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily children under 12 years of age: ask a doctor
For a 4-year-old child with itchy bites and sores, hydrocortisone (TOP) can be applied to the affected area not more than 3 to 4 times daily as it is indicated for itching of skin irritation, inflammation, and rashes in children 2 years of age and older 1.
- Fusidic acid (TOP) may also provide temporary relief of itching associated with minor skin irritations and rashes due to insect bites 2. However, it's essential to consult a doctor before administering any medication to a child, especially if they are under 12 years of age, as indicated for hydrocortisone (TOP).
From the Research
The treatment approach for a 4-year-old child with itchy bites and sores in a New Zealand general practice setting should focus on symptomatic relief, prevention of secondary infection, and identification of the cause. First-line treatment includes a mild topical corticosteroid such as 1% hydrocortisone cream applied thinly to affected areas twice daily for 3-5 days to reduce inflammation and itching, as supported by general medical knowledge and not specifically addressed in the provided studies 3, 4, 5, 6, 7. An oral antihistamine like cetirizine (2.5mg once daily for a 4-year-old) can help control itching, particularly at night. If signs of bacterial infection are present (increased redness, swelling, warmth, or yellow crusting), topical antiseptics like hydrogen peroxide 1% cream or mupirocin ointment should be applied three times daily for 5-7 days, considering the emergence of resistance to fusidic acid as noted in 4. For more severe infections, oral antibiotics such as flucloxacillin (125mg four times daily for 5-7 days) may be necessary, as discussed in 3. Parents should be advised to keep the child's fingernails short, discourage scratching, and use cool compresses for immediate itch relief. Identifying and addressing the source of bites (such as fleas, bed bugs, or scabies) is crucial for preventing recurrence. If scabies is suspected, permethrin 5% cream should be applied from neck down, left on for 8-12 hours, then washed off, with treatment repeated after 7 days. These interventions work by reducing the inflammatory response to bites, preventing histamine-mediated itching, and eliminating infectious agents that may colonize broken skin. Given the increasing incidence of serious skin infections in New Zealand children as reported in 7, and the importance of primary care in managing these conditions as highlighted in 6, a vigilant approach to diagnosis and treatment is essential. Moreover, considering the ethnic and socioeconomic disparities in the incidence of serious skin infections as noted in 5 and 7, healthcare providers should be aware of these factors when assessing and managing skin infections in children. The most recent and relevant study to guide treatment decisions in this context would be 4, which discusses the treatment of impetigo in children and the emergence of resistance to fusidic acid, emphasizing the need for alternative treatment strategies.