Coping with insect bites

Specialist Pediatrician Dr Sara Khawaja on how to deal with insect bites

Interview, Health

Specialist Pediatrician Dr Sara Khawaja from FamilyFIRST Medical Center tells us how to deal with insect bites.

What is the most problematic insect bite?
We are fortunate that the UAE has very few problematic insects or other arthropods like spiders. Scorpions are found only in the desert here and scorpion stings are rare. Generally, bees and wasps are potentially the most dangerous insects, especially in children who are allergic to their stings but I have yet to come across a child stung by a bee or wasp here in Dubai. Mild reactions caused by bites from mosquitoes, fleas and ants commonly bring children to the clinic. These reactions result from the injection of venom or other substances into the skin. The venom or insect’s saliva causes itching and sometimes triggers an allergic reaction. Most reactions to insect bites are mild, causing little more than an annoying itching or stinging sensation and mild swelling and redness that disappears within a day or so.

Is there anything that parents can do to prevent or treat swelling caused by insect bites?
Insect bites should be treated by washing the wound with soap and water to minimise the possibility of infection. Follow this with application of a cloth-covered ice pack. Topical anti-histamine or hydrocortisone creams applied sparingly to the area of the bite relieve swelling and itching. These creams should not be spread over large areas. Try to discourage your child from scratching or picking bites as this can lead to infection. In the case of a bee or wasp sting, attempt to remove the stinger to prevent release of more venom. Offer a pain-reliever like paracetamol to a child with a painful sting.

Is there a big difference between ant and mosquito bites?
Ants sting and mosquitoes bite! Most people confuse an insect bite with a sting. A bite is usually from insect mouth parts and occurs when an insect wants to feed or is agitated and needs to defend itself. Bites from mosquitoes, fleas, bed bugs and mites are more likely to cause itching than pain.
Stings, on the other hand, are delivered by an animal’s sharp stinger organ of offense or defense. It is connected to a venom gland and inflicts a wound by piercing causing pain, swelling, redness and rarely severe allergic reactions. Animals with a stinger include ants, bees, wasps and scorpions.

Do kids experience worse reactions dependent on their age?
No, not really. Most children who are frequently bitten by mosquitoes become less sensitive with time. Other children become increasingly allergic with repeated bites.

What precautions can parents follow to ensure kids are protected and to prevent getting bitten? Are there certain times during the day that kids are more at risk of getting bitten?
Many species of mosquitoes bite between dusk and dawn so if your kids are playing outside in the evening dress them in light clothing that covers most of the body. Avoid fragranced lotions and soaps. It also helps to stay away from stagnant water. If mosquitoes are a problem in your area or if your child is allergic to mosquito bites, use an insect repellant on exposed areas of skin. Your doctor or pharmacist can help select the most appropriate one. A child who has experienced a severe reaction to a bee or wasp sting should carry an epinephrine auto-injector at all times as the risk of recurrence is 40 to 60 per cent.

What symptoms should parents look out for that could signal a trip to the doctor?
I usually advise parents to seek medical help in the following cases:

• Hives (scattered itchy, red bumps on the skin) – this is a delayed reaction to an insect bite.

• The bite appears infected. There would be swelling, redness with or without pus, tenderness, warmth of the area, and sometimes fever. This type of swelling is firm or hard and can easily be differentiated from the usual soft swelling in a mild reaction to a bite. Infected bites happen when the skin has been broken from scratching.

• Scorpion sting – these are rare and only happen on trips out into the desert. Victims usually recover well and complications are rare, but a trip to an Emergency Department is still warranted particularly in the case of small children.

• Severe, life-threatening reactions to insect stings or bites (anaphylaxis). These are rare but getting immediate medical help is of paramount importance as severe anaphylaxis can be fatal within 30 minutes.

The occurrence of any of the following signs and symptoms after an insect sting or bite can indicate a severe reaction and should prompt immediate evaluation at a hospital Emergency Department: Facial or tongue swelling; Sensation of the throat closing or difficulty talking or swallowing; Difficulty breathing, wheezing; Abdominal pain, nausea and vomiting; Feeling dizzy or fainting – this is from a drop in blood pressure (shock).

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