Insect Bites and Stings! What to Do and How to Avoid Them!

This post is by monthly contributor Naomi Cook.

I rang 000 once in a blind panic, all medical commonsense deserting me as my 10 month old daughter screamed inconsolably with pain; something had bitten her as I placed her into her highchair. The only evidence the creature had left behind was a scary-looking raised purple mound on her leg. We’d been to the park earlier that day hanging out under a shady tree when a small boy pointed to a spider he’d found, asking his mum if it was a funnel web. His mum casually looked over at it and mumbled “probably.” Meanwhile, I rapidly scooped up my daughter and left, images of those dangerous fangs flooding my mind.

As I was put ‘on hold’ and my daughter’s cries gradually calmed, I began to wonder if maybe, just maybe, I’d over-reacted…

What happens when a child gets bitten?
Once bitten, there will usually be a reaction. Reactions to insect bites can be classified in the following way:

1. Local: a local reaction will result in a red lump or raised area of skin where the bite occurred. There may be pain, swelling, redness and itching ³
2. Systemic: in addition to the local reaction, systemic symptoms from spreading venom can occur, there may be nausea, vomiting and headache³
3. Allergic: this will occur if the individual is allergic to the injected venom. The person affected may develop a rash or hives near to the bitten area or they may develop a generalized rash. If the reaction is anaphylactic they will have a drop in blood pressure making them dizzy and nauseous, they may also develop difficulties in breathing as swelling of the face occurs ^3*. All anaphylactic reactions need immediate medical attention. Common Insects causing anaphylaxis are Honey Bees, Wasps and Jack Jumper Ants ¹

What is the treatment for bites and stings?
Before treating, have a look for the insect/spider, try and take a photo if it is possible as it may help if further medical attention is needed.

1. Washing area with soap and water: this may not only remove any leakage of venom from the puncture site but will also clean away any dirt resting on the skin from fangs.
2. Ice/Cold compress ⁷: this will help to reduce local inflammation and acts as a natural local anesthetic
3. Pain relief (if necessary)
4. Application of creams: Pharmacies offer a variety of creams, including local anesthetic and antiseptic creams, these will temporarily calm itching and cleanse the area. Over the counter steroidal creams are available to reduce inflammation and therefore will gradually reduce itching permanently. Ask your pharmacist for advice if using a steroidal cream.
5. Antihistamine: not a necessity but can help reduce extreme redness and itchiness for a number of bites, especially at night ⁷
6. In rare cases, anti venom for systemic reactions (for Red Back and Funnel Web Spiders). Putting on a pressure bandage is only necessary for Funnel Web bites ².
7. Some bites, such as Spider bites may take a while to heal. Whilst healing, the wound site must be kept as clean as possible to reduce the chance of a secondary bacterial infection developing. Nursing tips include a daily change of dressing (twice daily will probably be necessary with a grubby toddler) and gentle cleaning of the area with normal saline.

When should I seek medical attention for a bite or a sting?

• You are at all worried about your child (there is no shame in over-reacting…just join the club!)
• Your child develops an allergic reaction to a bite or sting
• The wound site does not heal/gets worse. If the discomfort from the wound isn’t improving or you can see increased redness/swelling you should get a medical opinion to rule out/treat a bacterial infection ⁴

How to avoid bites and stings

Insect Repellent: Fending off the hordes

• Products available may include the following ingredients: DEET (diethyltolumide); Soybean; Citronella/Eucalyptus/Lemongrass/peppermint ^{5, 8}.
• Studies show that DEET based products are much better than any other product in repelling mosquitoes. Out of the non-DEET products soybean preparations have been shown to be useful with citronella and other ‘herbal’ products having limited efficacy ^{5, 8}.
• Concerns about the safety of DEET products have been contested in research ^{5, 6, 8}, and in areas where disease transmission from insects is possible are the recommended repellant.
• DEET products just applied to ankles and feet are also very effective ⁸. Adults should apply the product to their own hands first then to the child. Do not apply near the eyes or on sections of the child’s hands that may be in contact with the mouth ⁸.
• A product containing DEET must be washed off once child has come inside. N.B that DEET applied with a sunscreen may decrease its’ efficacy  ^{7, 8}
• Non-chemical  Protective Measures

Barrier Protection ⁸

• Wear long clothing, avoid bright, flowery colours (tough advice to follow considering children’s clothes are naturally bright) ⁷
• Fly Screens at home, netting where necessary ⁸
• Avoid perfumed soaps, shampoos and body lotions before going outside ^{7, 8}
• Avoiding playing outside at biting times i.e dusk and night time for mozzies ^{7, 8}(although in my local park they like to feast all day)
• Pour drinks into a cup to avoid wasps/bees flying into drinking cans

…Back to my daughter, well she suffered no ill effects from the bite; the wound was localized, she didn’t develop any systemic side effects, nor an allergic reaction. And once I’d washed the bite with soap and water I never had to touch it again. It healed after a few days, and she’d forgotten about it by the end of her lunch.

And I learnt to count to 10 before ringing triple 0!

I’d love to hear from you. Do you have any tips on how to prevent your children from coming into contact with spiders and other nasty creepy crawlies whilst at play? Any tips on repellents or protective measures you’ve used to fend of the drones of insects?

DISCLAIMER: The information contained in this article should NEVER be used as a substitute for the advice of a licensed physician. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please see a physician if you think you or your child are unwell.

References

1. Australasian Society of Clinical Immunology and Allergy: Allergic Reactions to Bites and Stings
2. Australian Museum: Spiders In The House and Garden
3. Australian Venom Research Unit: Unknown Insect
4. Fagan S, Berger D, Rahwan K, Awad S (2003) Spider Bites Presenting with Methicillin Resistant Staphylococcus Aureus Soft Tissue Infection Require Early Aggressive Treatment Surgical Infections 4:4 pp311-315
5. Fradin M & Day J (2002) Comparative Efficacy of insect repellants against mosquito bites, New England Journal of Medicine 347:1 pp 13-18
6. Goodyer L & Behrens R (1998) Short Report: Safety and Toxicity of Insect Repellants American Journal of Tropical Medicine and Hygiene 59 (2) pp323-324
7. London M, Ladewig P, Ball J and Bindler R (2007) Maternal and Child Nursing Care, Second Edition, Pearson, Prentice Hall, USA pp.1895-1896
8. Stauffer W, Kamat D, Magill A (2006) Traveling with Infants and Children. Part iv Insect Avoidance and Malaria Prevention Journal of Travel Medicine 10:4 pp225-240
   *I am without a good source that distinguishes between a systemic reaction and allergic reaction. I think it is important to highlight the difference between the two, this is demonstrated in the Australian Venom Research triage category.