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We are starting to see a lot of insect bites on our delicious patients. Here is some information on how to evaluate and treat a bite or sting.

We cannot usually distinguish between an insect, spider or tick bite without seeing the actual offender in action.  However, these bites are all initially treated in the same way (providing symptomatic relief.)

Mosquito bites start as puffy, white bumps that appear a few minutes after the bite.  The bumps usually swell and turn redder, itchier over 24-48 hours, and can sometimes become quite large.  Occasionally there will be a small blister in the center. As the swelling goes down, the area may look like a ringed lyme rash, but the size does not increase as a lyme rash would.

Occasionally a mosquito bite causes a large area of swelling, soreness and redness that can last several days. This type of reaction is called “skeeter syndrome”. Using an antihistamine such as Zyrtec or Allegra for several days will help.

Tick bites are less likely to cause initial inflammation and redness, and are only an issue if followed (3-30 days later) by a steadily expanding, ringed, pain/itch free, flat rash that is present for at least several days (or an acute, febrile, flu like illness.)  If you are worried about a possible lyme rash, take a photo daily and come in if the area is increasing in size over several days. If you think the tick has been in place for more than 24-36 hrs, and appears engorged, make an appointment for an evaluation and possible preventative antibiotic treatment (bring the tick with you if possible.)

Bee and Wasp stings can cause similar reactions as mosquito bites, and the area may look worse 24-48 hours after the sting. A bee sting feels similar to a wasp sting, but the sting and a venomous sac will be left in the wound. You should remove this immediately by scraping it out using something with a hard edge, such as a bank card. Don’t pinch the sting out with your fingers or tweezers because you may spread the venom.

Black Fly bites are common in the northeast from April to July, especially in wet areas.  These flies secrete an anticoagulant (blood thinner) into the skin, which both numbs the area and causes bleeding.  The bites often look like blood blisters, and tend to be around the neck and ears, or by the ankles.  Localized swelling and itch can last as long as several weeks.

Spider Bites: THESE ARE VERY UNCOMMON IN CONNECTICUT!
The brown recluse is most commonly found in the South and is not native to any of the New England States. Brown recluse spider bites within 4 hours develop a “bull’s-eye” appearance, forming a blister in some cases. This blister may rupture in 8 to 36 hours, creating an ulcer or brown/black scabbed center. There is no special treatment or medication used to treat a brown recluse spider bite. If infection develops it is treated with antibiotics.

Black Widows may be found throughout New England, but true black widow spider sightings or bites are very uncommon. Very often, no serious symptoms develop. Occasionally, after 20 to 40 minutes the patient may develop a dull ache or numbing sensation near the bite site. Pain progresses and spreads to the abdomen (stomach cramps), back, and extremities. If muscle cramps develop or pain is severe, go to the nearest hospital for treatment of the symptoms.

Treatment:

When the reaction is mild, the majority of bites and stings can be treated at home. Wash the affected area with soap and water, and apply an ice pack to reduce pain and swelling. Topical anti-itch creams (Cortaid, Benadryl, or Calamine), oral pain relievers (acetaminophen or ibuprofen) and antihistamines (Benadryl, Zyrtec, or Allegra) may be used to control itch and swelling.

Benadryl, ibuprofen and acetaminophen dosages by weight can be found on the website https://saugatuckpeds.com/resource/medication-dosage-calculator/

If, after a few days, the bite develops a golden crust or scab, with some flaking and/or oozing, it may be infected. Please schedule an appointment if your child’s bites look suspicious.

Photos of various stings and bites can be found here
For more information on tick bites, click here.
For more information on bug repellents, click here.