What is the management for a centipede (arthropod) bite in a 1-year-old child?

Management of Centipede Bite in a 1-Year-Old Child

For a centipede bite in a 1-year-old, immediately apply ice or cold compresses to the bite site for pain relief, clean the wound with copious amounts of water, and administer age-appropriate doses of acetaminophen or ibuprofen for pain control. 1

Immediate First Aid Measures

Pain Management (Primary Concern)

• Apply ice or cold compresses to the bite site for 10-20 minutes to reduce local pain and swelling 2
• Place a thin towel barrier between the ice and skin to prevent cold injury 2
• Hot water immersion (40°C/104°F) may be beneficial if the child tolerates it, as this has shown effectiveness for arthropod envenomations, though evidence is stronger for jellyfish stings 2, 1
• Administer acetaminophen (15 mg/kg) or ibuprofen (10 mg/kg) for systemic pain control 2

Wound Care

• Irrigate the bite site liberally with copious amounts of water or saline to remove any venom and reduce infection risk 2, 3
• Clean thoroughly but avoid harsh antiseptics that may damage tissue 3
• Look for the characteristic double puncture marks from the centipede's fangs to confirm the diagnosis 4

Observation and Monitoring

Expected Local Symptoms

• Pain (universal finding, may be severe) 1
• Localized erythema and swelling (occurs in 40-50% of cases) 1
• Symptoms typically resolve within 48 hours without intervention 5, 1

Red Flags Requiring Emergency Care

• Call emergency services immediately if the child develops:
  • Difficulty breathing or respiratory distress 2
  • Altered mental status, confusion, or decreased responsiveness 2
  • Muscle rigidity or severe systemic symptoms 2
  • Signs of severe allergic reaction (urticaria, angioedema, bronchospasm) 2

When to Seek Medical Evaluation

• Pain extending beyond the bite site or becoming uncontrolled 2
• Development of significant swelling, progressive erythema, or signs of secondary bacterial infection 4
• Any systemic symptoms beyond local pain 5

Important Clinical Considerations

Antibiotic Therapy

• Antibiotics are NOT routinely indicated for centipede bites, as the initial reaction is due to venom toxicity, not infection 2
• Consider antibiotics only if secondary bacterial infection develops (rare complication with Gram-positive cocci, particularly in tropical species) 4
• If infection occurs, amoxicillin-clavulanate is first-line 3

Tetanus Prophylaxis

• Ensure tetanus immunization is current - administer 0.5 mL DTaP intramuscularly if the child's vaccination status is incomplete or unknown 3

Corticosteroids

• Topical or systemic corticosteroids may be considered for severe local reactions with extensive swelling, though evidence is limited to case reports 6
• This parallels management of large local reactions to insect stings 2

Common Pitfalls to Avoid

• Do NOT apply suction devices - these are ineffective and may worsen tissue damage 2
• Do NOT apply pressure immobilization bandages - unlike snake bites, this is not indicated for centipede bites 2
• Do NOT prescribe prophylactic antibiotics - the swelling is from venom-induced inflammation, not infection 2
• Do NOT dismiss severe pain - centipede bites can cause moderate to severe pain requiring adequate analgesia 1

Prognosis

Most centipede bites in children resolve completely within 24-48 hours with supportive care alone, with no long-term sequelae 5, 1. Severe complications like necrotizing fasciitis are extraordinarily rare and primarily reported with large tropical species 4.