Bites, stings & summer outdoors: What parents need to know

Written by: Dr. Cathryn Kuzyk

Spending time outdoors is a cherished part of summer for children and parents, but insect bites and stings sometimes dampen the experience. They are usually just a minor nuisance, but sometimes they can lead to serious medical problems such as spreading a disease or causing a severe allergic reaction. Being prepared by brushing up on prevention, assessment, and treatment is worthwhile for all parents and caregivers.

 Mosquitoes can spread some diseases because they can transfer blood into your body from other infected people or animals they’ve bitten. In Alberta, some mosquitoes carry the West Nile virus, which can cause a three- to ten-day illness called West Nile Fever. Rarely will it cause severe neurological symptoms or a brain infection that can be fatal. Wasps and bees do not carry diseases, but the venom they inject is very irritating to your skin and can be deadly if you are severely allergic.

 A normal reaction to a mosquito bite is redness, swelling, and itch that appears within 20 minutes. The small, firm lump can worsen for a day or two, then heals within ten days. After a couple of summers of very noticeable reactions, children often become desensitized, resulting in smaller reactions. Applying a cold, wet cloth or a cloth wrapped around a small ice pack often helps relieve the discomfort, and over-the-counter creams or lotions with calamine or pramoxine can reduce itching.

 Rarely, a child will have a larger-than-usual local allergic reaction, with the area of redness and swelling getting bigger over eight to 12 hours to a size as large as 10cm in diameter. They may also develop a low-grade fever and feel unwell. Taking your child to a doctor or nurse practitioner is appropriate, since antihistamines, cortisone cream, or even steroid medication may be needed. Parents often worry that the bite is infected, but remember that infections typically take several days, not hours, to develop.

To lower the chance of your small children getting mosquito bites you can:

• Avoid taking them outside during dawn and dusk, when mosquitoes are most active.
• Drain any standing water near your home, such as in wading pools, to reduce mosquito breeding areas. 
• Cover as much of their skin as possible and practical with socks, shoes, long-sleeved shirts, and long pants. Light-colored clothing is helpful.
• Use insect repellent lotion, cream, or spray.
• There is no significant evidence that any foods they eat or avoid make any difference in their attractiveness to mosquitoes.

Products that contain DEET (N,N-diethyl-3-meta-toluamide) or Icaridin (Picaridin) are the most effective repellents. Neither should be used on children under the age of six months; for this age group, the use of mosquito nets on strollers is recommended. 

Children aged six months to two years can use ten percent DEET once daily. Those aged two to 12 years can use ten percent DEET up to three times daily, and by age 12 they can use up to 30 percent DEET, following the product label instructions for adults. Icaridin products up to 20 percent can be used on all children over six months. Products with minimal or no effectiveness are citronella, plant oils (for example, soybean, geranium, sandalwood), and wrist, neck, and ankle bands that contain insect repellent.

To use repellents properly:

• Apply to exposed skin (not under clothing) as well as to clothing and hats. 
• Do not apply to the child’s hands as they may get repellent in their eyes or mouth.
• Apply sunscreen, if needed, before applying repellent.
• Avoid skin that is sunburned, has a wound, or has eczema.
• To apply to their face, put the repellent on your hands and apply it, avoiding the areas directly around their eyes and mouth.
• Have your child take a bath before they go to bed and wash any clothing that has been sprayed.
• Wasp and bee stings are more painful and potentially more deadly than mosquito bites. These insects do not pass on diseases but can cause a severe allergic reaction called anaphylaxis. They usually sting only when threatened, such as when they are hit, swatted, or stepped on. If there is one close by, slowly move your child and yourself away. If your child is stung, flick or scrape the stinger out of the skin and apply a cold compress. Pain relievers such as ibuprofen or acetaminophen can be given if needed. The swelling, redness and pain from these stings usually improve within a few hours.

In ten percent of cases, a sting will cause a large local reaction, worsening over a day or two and getting up to 10cm in diameter. If this happens, it does not mean it is infected and does not mean that your child will develop anaphylaxis with the next sting. They should, however, be seen by a health care provider as they may require further treatment and a referral for allergy testing.

Symptoms of anaphylaxis, which would prompt you to immediately call 911, include difficulty breathing, hoarse voice, swollen eyes, tongue, lips or face, hives, vomiting or diarrhea and feeling lightheaded. The paramedics will give your child epinephrine and take them to an emergency department for further treatment and observation. Follow-up will include getting an epinephrine device for emergency use in the future and being referred to an allergist.

Now, feeling informed and prepared, go out and enjoy the summer with your kids!

Cathryn is a family physician, mother of four and a grandmother of six.

See our related articles:

• Get Out and Play the Summer Safe Way!
• Soothing the Stings, Bites and Burns of Summer
• First aid tips to teach kids