Local Allergic Reaction to Insect (Child)

Your child is having a localized allergic reaction to an insect bite or sting. The venom or poison from an insect causes the body to release chemical substances. One substance, histamine, causes swelling and itching. Some children's immune systems are very sensitive to an insect sting or bite. Any insect can cause an allergic reaction. Usually the reaction is only at the site, but sometimes it can affect the entire body.

Common insect stings causing problems are wasps, yellow jackets, bees, hornets, and fire ants. Common bites are from spiders, mosquitoes, fleas, or ticks. Other types of insects may be more common in different parts of the country or world.

Symptoms include:

  • Rash, hives, redness, welts, blisters

  • Itching, burning, stinging, pain

  • Dry, flaky, cracking, scaly skin

  • Swelling around the bite or sting, sometimes spreading to other areas

The area may be very painful right after the sting or bite. Or pain may be felt later on. The skin may redden and swell. The pain may last a few days. There can also be itching. Depending on the type of insect, the area may become hard and develop surrounding red scales. Sometimes the skin may blister.

Symptoms often respond quickly to antihistamines, steroids, and pain medicine. Untreated, a localized allergic reaction may get better within a few hours. Or it may last several days.

Home care

Your child's healthcare provider may prescribe medicine to relieve swelling, itching, and pain. Follow the instructions when giving this medicine to your child.

  • If your child had a severe reaction, the provider may prescribe an epinephrine auto-injector. Epinephrine will stop the progression of an allergic reaction. Before you leave the hospital, be sure that you understand when and how to use this medicine.

  • Oral diphenhydramine is an antihistamine available at pharmacies and grocery stores. Unless a prescription antihistamine was given, this may be used to reduce itching if large areas of the skin are involved. Some over-the-counter antihistamines may cause drowsiness, so it may be best to give in the evening. Check with your child's provider for instructions before giving any medicine to your child.

  • Don’t use antihistamine cream on your child’s skin. It can cause a further reaction in some people.

  • Call your child's healthcare provider and ask what to use to help stop the itching.

  • You can use over-the-counter children's pain medicine to control pain, unless another pain medicine was prescribed. Check with your child’s healthcare provider about what type of pain control is best before giving anything to your child. Don’t give ibuprofen to a child younger than 6 months old. Don’t give aspirin (or medicine that contains aspirin) to a child younger than age 19 unless directed by the provider. Taking aspirin can put your child at risk for Reye syndrome. This is a rare but very serious disorder that most often affects the brain and the liver. It can sometimes lead to death.

General care

Try to identify and teach your child to stay away from the problem insect. Teach your child these things:

  • Don't walk in grass with sandals or without shoes.

  • Don't leave food uncovered when eating outside. Sweet treats like watermelon and ice cream attract insects.

  • Don't drink from uncovered sweetened drinks in cans when outside. Insects are attracted to soda cans and sometimes crawl inside them.

  • Don't wear bright-colored clothes with flowery prints and patterns when outside.

  • Don't wear perfume when outside. The smell of perfume can attract insects.

  • Be aware that honeybees nest in trees. Wasps and yellow jackets nest in the ground, in trees, or in roof eaves. Avoid garbage containers when outside.

  • Don't swat at flying insects.

Stings

Wasps, yellow jackets, and hornets don’t leave a stinger behind. But if a honeybee stings your child, a stinger may stay in the skin. The stinger of a honeybee releases a substance that will attract other bees to your child. So try to move away from the nest right away. Once your child is away from the nest, then remove the stinger as quickly as possible by doing the following:

  • Scrape the stinger out with a dull, straight edge, such as that of a credit card.

  • Don't use tweezers or your fingers to remove the stinger since that may squeeze more toxin from the stinger. 

  • Wash the affected area with soap and warm water 2 to 3 times a day. If there's a blister, don't break it. 

  • Next apply an ice pack for 5 to 10 minutes. To make an ice pack, put ice cubes in a plastic bag that seals at the top. Wrap the bag in a clean, thin towel or cloth. Don’t put ice directly on the skin.

  • Contact your child's provider. Ask what can be used to help decrease the swelling and itching in the affected area. 

  • To prevent an infection, don't scratch the affected areas. Always check the sting area for signs of an infection. This includes increased redness, swelling, or pain in the affected area. Fluid leaking from the affected area or a fever may also be signs of an infection.

Ticks

If you try to remove a tick, do the following:

  • Use a set of fine tweezers and grip the tick as close to the skin as possible.

  • Pull up using even, steady pressure. Don’t jerk or twist the tick. Don’t squeeze, crush, or puncture the tick’s body. Its bodily fluids may contain infection-causing organisms. Don’t use remedies such as nail polish, petroleum jelly, or heat to detach the tick from the skin. Remove as instructed rather than waiting for it to detach.

  • If any mouth parts of the tick remain in the skin, try to remove them with clean tweezers. If you can’t remove the mouth easily with tweezers, leave it alone and let the skin heal. 

  • After the tick is removed, clean the bite area with rubbing alcohol or soap and water. Also wash your hands with soap and clean, running water.

  • Dispose of a live tick by flushing it down the toilet. Or put it in a sealed container and completely cover it with alcohol. Never try to kill or crush a tick with your hand or fingers.

  • Tell your child's healthcare provider about recent tick bites. This is especially important if your child develops a rash, fever, or other symptoms.

After an allergic reaction

  • Keep a record of symptoms, when they occurred, and any problem insects. This will help your child's healthcare provider figure out future care for your child.

  • Tell all care providers and school staff about your child’s allergic reaction. Tell them how to use any prescribed medicine.

Follow-up care

Follow up with your child's healthcare provider, or as advised. Ask the provider about a safe insect repellent that can be used on your child's skin or clothes.

Call 911

Call 911 if any of these occur:

  • Trouble breathing or swallowing, wheezing

  • Cool, moist, pale or blue skin

  • New or worsening swelling in the face, eyelids, lips, mouth, throat, or tongue

  • Hoarse voice or trouble speaking

  • Confusion

  • Very drowsy or trouble waking up

  • Fainting or loss of consciousness

  • Rapid heart rate

  • Feeling dizzy or weak with a sudden drop in blood pressure

  • Feeling of doom

  • Belly pain, nausea, vomiting, or diarrhea

  • Seizure

  • Drooling

When to get medical care

Call your child’s healthcare provider right away if any of these occur:

  • The areas of itching, redness, or swelling spread.

  • Symptoms get worse or new symptoms occur.

  • Signs of infection appear, such as:

    • Spreading redness

    • Increased pain or swelling

    • Fever (see "Fever and children" section below)

    • Fluid or colored drainage from the affected area

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

  • Rectal. For children younger than 3 years old, a rectal temperature is the most accurate.

  • Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

  • Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

  • Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

  • Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least 4 years old.

Use the rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell them which type you used.

Below are guidelines to know if your young child has a fever. Your child’s healthcare provider may give you different numbers for your child. Follow your provider’s specific instructions.

Fever readings for a baby under 3 months old:

  • First, ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead: 100.4°F (38°C) or higher

  • Armpit: 99°F (37.2°C) or higher

Fever readings for a child age 3 months to 36 months (3 years):

  • Rectal, forehead, or ear: 102°F (38.9°C) or higher

  • Armpit: 101°F (38.3°C) or higher

Call the healthcare provider in these cases:

  • Repeated temperature of 104°F (40°C) or higher in a child of any age

  • Fever of 100.4° (38°C) or higher in baby younger than 3 months

  • Fever that lasts more than 24 hours in a child under age 2

  • Fever that lasts for 3 days in a child age 2 or older

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