Treatment of Ant Bites in Pediatric Patients
For most pediatric ant bites, treatment includes washing the area with soap and water, applying cold compresses, topical antihistamines or corticosteroids, and oral antihistamines for itching. Severe allergic reactions require immediate epinephrine administration and emergency care.
Initial Assessment and Management
Local Reactions (Most Common)
- Clean the affected area with soap and water
- Apply cold compresses to reduce swelling and pain
- Use topical antihistamines or low-potency corticosteroids to reduce itching
- Administer oral antihistamines (age-appropriate dosing) for more significant itching
- Monitor for signs of secondary infection
Moderate to Severe Local Reactions
- For non-purulent cellulitis, Cephalexin with dose adjusted for children by weight for 5-6 days 1
- For penicillin-allergic patients, Clindamycin with dose adjusted for children by weight for 5-6 days 1
Management of Fire Ant Stings (Special Consideration)
Fire ant stings require specific attention due to their unique venom and reaction pattern:
- Remove any visible ants immediately
- Clean area with soap and water
- The characteristic sterile pustules should be left intact to prevent secondary infection 2
- Apply cold compresses and topical corticosteroids to reduce inflammation
- Administer oral antihistamines for itching
Systemic Allergic Reactions
Immediate Management
- For anaphylaxis: Administer epinephrine via auto-injector (pediatric dose 0.15mg for <30kg, 0.3mg for ≥30kg) 3
- Provide supplemental oxygen if needed
- Administer IV fluids for hypotension
- Consider systemic corticosteroids and antihistamines as adjunctive therapy
Follow-up Care for Systemic Reactions
- Refer to allergist for evaluation
- Immunotherapy with fire ant whole-body extracts is recommended for children who have experienced systemic reactions to fire ant stings and have positive skin test responses or allergen-specific serologic test results 4
- For children 16 years or younger who have experienced only cutaneous reactions to fire ant stings, immunotherapy might not be required 4, 5
Prevention Strategies
- Apply insect repellents containing DEET (concentrations no greater than 20%-30% for children) 1
- Have children wear protective clothing (long sleeves, pants, socks, closed-toe shoes) 1, 6
- Socks provide significant protection against fire ant stings, as fire ants are unable to sting through most commercially available socks 6
- Avoid grassy and wooded areas where possible 1
- Inspect children frequently for ants when outdoors 1
- Shower or bathe promptly after potential exposure 1
Important Considerations
- The natural history of cutaneous-only systemic reactions from fire ants in children is generally benign, with studies suggesting these reactions usually do not progress to more serious reactions 4, 5
- Most children (65%) with previous large local or generalized cutaneous reactions to fire ant stings do not develop more severe reactions with subsequent stings 5
- Avoid folk remedies such as petroleum jelly, nail polish, or burning methods to remove attached mites or ants 1
When to Seek Emergency Care
Instruct parents to seek immediate medical attention if their child develops:
- Difficulty breathing
- Swelling of face, lips, tongue, or throat
- Widespread hives or rash
- Dizziness or fainting
- Persistent vomiting
These signs may indicate a severe allergic reaction requiring emergency treatment with epinephrine and other supportive measures 3.