›› The Perils of Parenting

Learning to Live with Things that Bite
Part 1: Insects & Arachnids

Margaret Morris, MD, FAAP
Chapel Hill Children’s Clinic

Summer brings a welcome break from winter’s colds and flu and springtime pollen, but it too has its perils. We share the outdoors in summertime with all manner of insects, arachnids, snakes (most are harmless, but if they’re not…), and sea and lake dwellers. With preparation and a little luck, we can all enjoy being outside. We share the earth with these creatures, and for the most part, they do us no real harm. In this article, I will talk about insects and arachnids. The next article will deal with snakes and jelly fish and other water-dwelling creatures that bite and sting.

Stinging insects

Prevention consists wearing lightweight clothing that covers well, avoiding scents (perfumes, scented laundry detergents and  fabric softeners, etc.) and using insect repellent. DEET-containing insect repellents are effective and safe for children if they contain less that 10% DEET. They can be applied to clothing as well as skin. Be sure give your child a bath that night. Other repellents are permethrins, Bite Blocker (a 2% soybean oil spray), and Skin So Soft (that contains citronella).

Mosquitoes, flies, fleas.
"Bug bites" can be impressive, but they are mostly annoying. In our area there is essentially no danger of serious disease from these insects. As for the “bite” itself, there is often a small central blister with a mound of red swollen skin around it. It can look very much like an infection or a boil, but the area doesn’t hurt when pressed. You usually know the child has been outside and exposed.  And most kids can tell you that it itches or you will see them scratch.

For itchy bites, try to treat them before they have been scratched open. You can hold a piece of ice or a cold wash cloth to the bite for a few minutes. If they haven’t been scratched open, you can put some 1% hydrocortisone cream (available over-the-counter) on them twice a day. For children over 2 years old, you can give them benedryl, especially at night. Keep the skin clean, the fingernails short, and watch out for infection.

Bees and wasps and their relatives, and stinging ants.
These bites hurt a lot. They almost always cause several inches of swelling and redness around the site of the actual sting that is very painful, especially when touched. This is a normal reaction (though not a pleasant one) and is called a local reaction. Sometimes a whole arm or leg is swollen. This is called a severe local reaction.

Treating a bee sting involves removing the stinger (wasps and others in this family don’t usually leave the stingers in the skin). Then for all these bites, apply a cold compress. Take ibuprofen for pain, and try applying calamine lotion, topical steroids, or a paste made of 1 part meat tenderizer (papain) to 4 parts water. Benedryl may also be helpful.

Rarely, one can have a systemic reaction—one that involves the whole body—called anaphylaxis or bee sting allergy. This is very bad and dangerous. It may show itself by a swollen face, lips and tongue; problems with breathing that sound like croup or wheezing; hives or welts or itching all over; and/or a funny sounding voice. Immediate medical care must be sought—usually Benedryl, Epipens, and 911. After someone has had a severe systemic reaction, he should see his doctor to make a plan to deal with future encounters. Usually, once someone has such an allergy, he will remain allergic to the kind insect that bit him and perhaps its relatives. It is worth considering seeing an allergist to be desensitized.

Caterpillars and moths
Most of these creatures cause us no harm at all, but some carry thousands of tiny hairs or spines which they deposit in our skin when they touch it. These can cause stinging pain and a local reaction. There is a visible “track” where the caterpillar walked across the skin.

The first step in treating this is to use scotch tape to remove the spines. Then for pain and itching, use cold compresses, topical steroids, and antihistamines.

Very rarely, they can cause a systemic reaction. Seek immediate medical attention if your child has trouble breathing, has swollen face, lips, or tongue, or has a funny sounding voice.

Arachnids

This group consists of spider, chiggers, and ticks, among other creatures. Many of us suffer from arachnophobia, but in fact most of these creatures would rather have nothing to do with us, or will only bite us if we contact them.

Spiders
Very few spiders are able to bite us, and most of those that can cannot harm us. No spider will seek us out to bite us. We humans are not their natural prey. So don’t kill spiders indiscriminately. They are an important part of our world.

But…There are 2 species of spiders in our area that can cause severe health consequences: black widows and brown recluses. Though these spiders would MUCH prefer to leave us alone, if provoked they can bite, and sometimes the bites have serious consequences.

If bitten by a black widow, there is usually a self limited reaction. But sometimes about an hour after the bite, a systemic reaction can begin—muscle cramps, abdominal pain, sweating, salivation, high blood pressure, facial swelling. Although there have been no deaths in our country from black widow bites since 1958, these symptoms clearly require emergency medical care.

The brown recluse bite also has the potential to cause a severe reaction, though they usually don’t. When the rare (but well publicized) severe reaction occurs, the victim can have a serious evolving wound which takes weeks to months to heal. Flu-like symptoms with vomiting and sometime a rash can develop 12 to 72 hours after the bite. Even more rarely, hospitalization can be required for the consequences of these bites.

Usually for spider bites, good wound care and observation will produce a good outcome.

Ticks
Tick bites can be serious, but (again) they usually are not.  If your child (or you) is bitten by a tick, you should remove it, clean the area as you would for any minor scratch, and note the date and the size and markings of the tick. The bites themselves look and feel like any other “bug bite”: a pink bump that itches. They can last a long time, and if the child scratches them, they can get the same superficial infections that well scratched mosquito bites can lead to.

In central North Carolina, there are some serious tick borne diseases that are common enough that we have to think about them. The most concerning is Rocky Mountain Spotted Fever (more common in NC than in the Rocky Mountains!). If you have RMSF, you are quite sick. It starts with fever, headache, and muscle aches. After a few days a rash usually appears on the wrists and ankles, and then it spreads up onto the body. Untreated, RMSF can be quite dangerous. If your child (or you) gets sick with a high fever in the summer, see your doctor. There are other tick-borne illnesses that are similar to RMSF but don’t have the rash. These too need treatment.

Lyme Disease, carried by the tiny deer tick, is not very common in our area, but plenty of North Carolinians travel to areas where it is encountered, so we need to keep it in mind.

Chiggers
Chiggers are the nymph form of tiny mites that hang out on briars, bushes, and grasses hoping to find an animal host to attach themselves to. They feed on the host (for example, you) for 4 days and then fall off. While feeding, they, like other stinging pests, inject juices that cause your body to react with a small red welt that is astoundingly itchy. They often bite along the places where clothing is tight, for example, along the waistband or where elastic circles the thighs.

Like mosquitoes, they are more likely to avoid you if you use insect repellent and are well covered. And after picking roadside blackberries, give the pickers a good bath with lots of scrubbing. Since chiggers can survive on clothing for an extended time, be sure to wash all exposed clothing in hot water. And like mosquito bites, they can be treated with hydrocortisone creams and oral benadryl.

So…

Play outside, wear your repellant, have fun, don’t scratch, and be mindful of but not overly worried about the possible health problems,