Treatment of Bed Bug Bites in Children
For bed bug bite reactions in children, symptomatic treatment with topical corticosteroids and oral antihistamines is the treatment of choice, as bed bug bites are self-limited and require no specific intervention beyond symptom relief. 1, 2
Primary Treatment Approach
Mild to Moderate Reactions
- Apply topical corticosteroids (such as hydrocortisone) to affected areas 3-4 times daily to control inflammation and pruritus, and to hasten resolution of lesions 2
- Topical hydrocortisone can be used in children 2 years and older, applied not more than 3-4 times daily 3
- For children under 2 years of age, consult a physician before applying topical corticosteroids 3
Pruritus Management
- Oral antihistamines should be given to alleviate itching and improve sleep quality 2, 4
- Topical pramoxine can be used as an additional anti-pruritic agent 2
- The pruritus is often the major complaint that impairs quality of life and sleep in affected children 5
Significant or Exaggerated Reactions
- For vesicles, urticarial wheals, bullae, or diffuse urticaria in previously sensitized children, topical corticosteroids remain the mainstay of treatment 2
- Oral corticosteroids may be considered for severe local reactions, though this is extrapolated from insect sting guidelines rather than bed bug-specific evidence 6
Important Clinical Considerations
What NOT to Do
- Antibiotics are not indicated unless secondary bacterial infection develops from scratching 6
- The initial reaction is allergic inflammation, not infection 6
- Avoid excessive use of insecticides in the home environment, as 111 illnesses (including one fatality) were reported from bed bug-related insecticide use, with pyrethroids implicated in 89% of cases 7
Natural Course
- Bed bug bite reactions are self-limited and resolve without specific treatment in most cases 2, 4
- Typical reactions include pruritic, erythematous maculopapules in clusters or linear distribution on exposed body areas 2
- A small red punctum at the center of the bite mark is characteristic 2
Eradication is Essential
While treating the bites symptomatically, identification and eradication of the bed bug infestation is paramount to prevent ongoing bites 1, 2:
- Consultation with a professional exterminator is recommended for complete eradication 2
- Integrated pest management combining nonchemical methods (vacuuming, hot water washing of linens, bed bug interceptors) and professional chemical treatment is most effective 2
- Keep affected areas clean, vacuum regularly, and wash linens in hot water 2
Emerging Evidence
For children with recurrent papular urticaria from bed bugs not responsive to conventional treatment, specific immunotherapy with whole body bed bug extract showed significant improvement in quality of life (DLQI reduction of 19.83 vs 9 in controls, p=0.03) and pruritus scores after 12 months 5. However, this remains investigational and is not standard practice.
Key Pitfalls to Avoid
- Do not prescribe antibiotics empirically without evidence of secondary infection 6
- Do not recommend or use insecticides without professional guidance, particularly in homes with young children, due to toxicity risk 7
- Do not confuse bed bug bites with other insect bites or dermatologic conditions—proper identification requires finding the bugs or characteristic bite patterns 2
- Avoid applying topical corticosteroids to the genital area or for diaper rash without physician consultation 3