Treatment of Bug Bites in Children
For uncomplicated bug bites in children, apply cold compresses, topical hydrocortisone cream (for children 2 years and older), and oral antihistamines for symptom relief. 1, 2
Initial Assessment and Management
Immediate Care
- Remove stinger immediately if present (speed of removal is more important than method) 1
- Clean the wound thoroughly with soap and water 1
- Apply ice or cold packs with a thin barrier between ice and skin to reduce pain and swelling 1
Symptom Management
- For children 2 years and older: Apply hydrocortisone cream to affected area no more than 3-4 times daily 2
- For children under 2 years: Consult a doctor before using topical hydrocortisone 2
- Oral antihistamines can help alleviate itching and discomfort 1, 3
- Acetaminophen or NSAIDs may be used for pain relief 1
Special Considerations
Mosquito Bites
- Loratadine (0.3 mg/kg) has been shown to decrease whealing by 45% and pruritus by 78% in mosquito-bite-sensitive children 3
- Loratadine also reduces the size of 24-hour delayed bite lesions 3
Bed Bug Bites
- Typically present as pruritic, erythematous maculopapules in clusters or linear distribution 4
- Treatment is mainly symptomatic with topical pramoxine and oral antihistamines 4
- Topical corticosteroids can be used for significant eruptions 4
When to Seek Medical Attention
Signs of Allergic Reaction
- Monitor for signs of allergic reactions, including:
- Local reactions: extensive swelling, severe itching
- Systemic reactions: difficulty breathing, hives away from bite site, swelling of face/throat, dizziness 1
- Intramuscular epinephrine is the first-line treatment for severe allergic reactions (0.01 mg/kg up to 0.3 mg in children) 1
Signs of Infection
- Increasing redness, warmth, swelling, pain
- Pus or drainage from the bite site
- Fever or systemic symptoms
Prevention Strategies
- Have known insect nests removed by professionals
- Avoid wearing bright colors or flowery prints
- Wear protective clothing (long pants, long sleeves, closed shoes) 1
Important Caveats
- Routine antibiotic prophylaxis is not indicated for uncomplicated insect stings/bites 1
- Tetanus prophylaxis is not routinely needed after simple insect stings unless tetanus vaccination is not current 1
- For children with history of systemic reactions to insect stings, consultation with an allergist-immunologist is recommended 1
- Topical reactions such as itching or mild burning can persist for many days and are not a reason for re-treatment 5