Tag: insect bites

What is Skeeter Syndrome?

Skeeter syndrome is a large local reaction after a mosquito bite that can mimic an infection.

What’s your first thought if your child has a large swollen area that is hot, red, and either painful or itchy?

A child with Skeeter syndrome - a bite that quickly got red, hot, and swollen.
A child with Skeeter syndrome – a bite that quickly got red, hot, and swollen. Photo by Vincent Iannelli, MD

You’re probably thinking that this bite is infected, right? It was gone without treatment over about 48 hours.

What is Skeeter Syndrome?

While that is certainly a possibility, if the reaction occurs right after a bite or sting, it is much more likely to be an inflammatory reaction – Skeeter syndrome.

The American Academy of Allergy Asthma and Immunology defines Skeeter syndrome as an inflammatory reaction to mosquito bites.
The term Skeeter syndrome was first used in a report by Simons and Peng in 1999.

Although the American Academy of Allergy Asthma and Immunology says that Skeeter syndrome is relatively rare, spend a few minutes with a pediatrician and they will likely tell you that we see it all of the time…

“The large local reactions to mosquito bites that we have designated as skeeter syndrome occur within hours of the bites and are characterized by the cardinal signs of inflammation: swelling (tumor), heat (calor), redness (rubor), and itching/pain (dolor). By inspection and palpation, it is impossible to differentiate between inflammation caused by infection and inflammation caused by an allergic response.”

Skeeter syndrome Case Studies

These reactions can be especially impressive, and scary, for parents if they occur on a child’s eyelid or penis – as loose tissue in these areas can lead to a lot of swelling.

So how can you tell if a child has Skeeter syndrome or cellulitis, an infection that requires antibiotics?

“The reactions were initially misdiagnosed as cellulitis and investigated and treated as such, although by history they developed within hours of a mosquito bite, a time frame in which it would have been highly unlikely for an infection to develop.”

Skeeter syndrome Case Studies

Although cellulitis can mimic or look just like Skeeter syndrome, it is the timing of the reaction, very soon after the bite, that will help you and your pediatrician make an accurate diagnosis. That’s important, because the treatments for Skeeter syndrome and cellulitis are very different.

In general, kids with Skeeter syndrome only require symptomatic care, perhaps an antihistamine and topical steroid cream, while cellulitis is treated with antibiotics.

Are there any other differences between Skeeter syndrome and cellulitis?

While cellulitis will likely continue to worsen, especially if it isn’t treated with antibiotics, you can expect the redness and swelling triggered by Skeeter syndrome to start to get better after two to three days. Keep in mind that many bites and stings do worsen over the first day or two though…

What Causes Skeeter Syndrome?

The large local reaction that occurs with Skeeter syndrome is triggered by antigens in the saliva of the mosquitoes.

While these typically just cause mild local reactions in most of us, others can have severe, delayed reactions, exaggerated local reactions, or very rarely, anaphylactic reactions.

“The children with skeeter syndrome remain healthy, except for recurrent large local inflammatory reactions to mosquito bites.”

Skeeter syndrome Case Studies

So what should you do for your child with Skeeter syndrome?

For one thing, use insect repellents so that they don’t get mosquito bites. And work to control the mosquitoes around your home.

You might also give them an age appropriate dose of a second-generation H1-antihistamine such as cetirizine to prevent or treat the reaction if they do get some bites.

Are mosquitoes the only insects that cause Skeeter syndrome?

By definition, yes.

But we often see these same type of large, local reactions (LLRs) after fire ant bites, bee stings, and other bites and stings.

“There is no clear definition of LLRs. They are generally described as any induration larger than 10cm in diameter around the insect sting. The swelling can occur immediately or 6 to 12 hours after the sting and can gradually increase over 24 to 48 hours. The swelling usually subsides after 3 to 10 days. LLRs represent a late-phase immunoglobulin E (IgE)–associated inflammation.”

Pansare et al on Summer Buzz: All You Need to Know about Insect Sting Allergies

Sweat bees, very small bees, for example, are notorious for “stinging” people around their eyes and causing what looks like periorbital cellulitis, as they like to drink the salt on our sweaty skin.

Is your child’s bite or sting infected?

Just remember, even if the area is hot, red, and swollen, if it got like that within hours of a bite, then it probably isn’t infected.

“The type of clinical reaction determines the risk of allergic reactions to future stings.”

Pansare et al on Summer Buzz: All You Need to Know about Insect Sting Allergies

And also be reassured that children who only have large local reactions are very unlikely to go on to have more severe, anaphylatic type reactions in the future.

More on Insect Bites and Stings

What to Do If a Spider Bites Your Child

Have you ever worried that your kids will be bitten by a ‘bad spider,’ like a black widow or a brown recluse spider? Will you know what to do?

It can often seem like spiders are everywhere, and when you consider that more than 100,000 species of spiders have been identified, they probably are.

A black widow spider is typically easy to identify because of the classic markings on its body.
A black widow spider is typically easy to identify because of the classic markings on its body. Photo by Vincent Iannelli, MD

Even with only 4,000 species of spiders in North America, that’s a lot of spiders.

And believe it or not, that’s a good thing. All of those spiders eat up to 800 million metric tons of insects each year!

Fortunately, very few of these spiders are dangerous.

In the Unites States, just two species of spiders are poisonous enough to cause harm. They include the black widow spider (Latrodectus mactans) and the brown recluse spider (Loxosceles reclusa).

Even in other parts of the world that have more of a variety of venomous spiders, like Australia, that “reputation is bigger than its bite.”

It is important to remember than even venomous black widow and brown recluse spiders aren’t wandering around your house trying to attack your kids. They usually like to live in places where they won’t be disturbed. So unless your child was crawling through boxes in a closet or attic, or some other place where they might have disturbed a spider, it is unlikely that any bites on their skin were caused by a “bad spider.”

And in most cases, any “bite marks” probably weren’t caused by a spider at all, as many experts think that spider bites are over-diagnosed. Many other conditions, including other insect bites and skin infections can mimic spider bites.

Symptoms of a Spider Bite

Surprisingly, most spider bites aren’t that painful. Although it may feel like a pin prick, many bites often go unnoticed, making it hard to know if you have been bitten.

Common spider bite symptoms can include a single bite mark with:

  • swelling
  • redness
  • itching
  • pain

In fact, most spider bites will resemble a bee sting. Your child may also develop hives and other allergy symptoms if they are allergic to the spider bite.

Symptoms of a black widow spider bite cold include severe muscle pain and cramps, which develop within a few hours of the bite. Other symptoms might include weakness, vomiting, trouble breathing, abdominal pain, and high blood pressure.

Brown recluse spider bites can be painful. In addition to pain, these spider bites might cause burning and itching. Another characteristic finding is that the spider bite may look like a bull’s eye, with a red ring around a white center that turns into an ulcer.

Was Your Child Really Bitten By a Spider?

The most obvious way to diagnose a spider bite is to see the spider biting your child.

Keep in mind that since many of us have spiders in and around our homes, simply seeing a spider and then noticing a bite on your child doesn’t necessarily mean that your child has a spider bite.

As hard as it sometimes is to tell if a child even has a spider bite, it can be even harder to determine what type of spider actually bit him. Again, seeing the spider can help, as “bad spiders” have very characteristic features.

The black widow spider is jet black, with a red hourglass marking on the underside of their abdomen. Brown recluse spiders are smaller, are yellowish-tan to dark brown, and have a violin shaped marking on their back.

Should you try to catch a spider to help your doctor identify it? Probably not, as you are more likely to bring your pediatrician a crushed spider that is impossible to identify than anything useful. And you should likely be concentrating on taking care of your child after he has been bitten, instead of chasing after the spider.

What to Do If a Spider Bites Your Child

For most spider bites, you can follow some simple home treatments, including:

  • washing the spider bite with soap and water
  • apply an ice cube to the bite for about 20 minutes
  • giving your child a pain medicine, such as acetaminophen (Tylenol) or ibuprofen (Motrin or Advil)
  • applying a topical antibiotic ointment to the bite two or three times a day
  • applying a topical steroid cream to help control itching and redness a few times a day
  • continuing home treatments for one or two days, the typical time that it takes a spider bite to go away

Of course, you should seek medical attention if you think your child was bitten by a black widow spider or brown recluse spider, or if any spider bite seems like it is getting infected, with increasing redness and pain after a few days.

Don’t overlook the fact that your local poison control center (1-800-222-1222) can be a good resource if you think your child was bitten by a poisonous spider.

What to Know About Spider Bites and Kids

Other things to know about spider bites include that:

  • Even the poisonous black widow spiders and brown recluse spiders rarely cause life-threatening symptoms or death.
  • In addition to seeking medical attention for a black widow spider or brown recluse spider bite, see your pediatrician if a spider bite isn’t getting better in a few days.
  • Kids may need a tetanus shot after a spider bite.
  • Spiders usually bite just once, so if a child has multiple bites, then it likely isn’t from a spider.
  • Although parents often look for the double fang marks in trying to identify a spider bite, they usually aren’t seen, and even when you see “fang marks,” it doesn’t mean that your child was bitten by a spider.
  • Instead of a black widow or brown recluse, it is more likely that you will come across a more harmless spider in or around your home, like a grass spider, wolf spider, orb weaver, or daddy-long-legs.

Most importantly, teach your kids to avoid spiders by shaking out shoes and clothing that are lying on the floor and not storing boxes or other items on the closet floor or underneath your child’s bed. You can help keep spiders out of your child’s crib or bed by making sure any bedding doesn’t touch the floor.

And remember that spiders eat insects, so might help keep your kids free of other types of bites.

More About Spiders and Spider Bites

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Safe and Effective Insect Repellents for Kids

When used properly, insect repellents are safe and effective and the best way to help your kids avoid getting eaten up by mosquitoes, chiggers, ticks and other things that like to bite kids.

While other measures are important too, insect repellents are typically the best way to protect your kids from biting insects and ticks.
While other measures are important too, insect repellents are typically the best way to protect your kids from biting insects and ticks. Photo by James Gathany.

As we become more and more aware of diseases that can spread from the bites of insects and ticks, it becomes important that we learn to protect our kids. Plus, itchy bites can turn into nasty scabs that your kids pick at over and over, leaving scars that might even get infected.

What should you do?

Insect Repellents for Kids

In addition to simply trying to avoid mosquitoes and ticks, which can be difficult, especially as your kids get older and spend more time outside, you should learn to protect them with insect repellents.

Are insect repellents safe for kids?

Despite all of the warning about chemicals and toxic pesticides that you might read on the internet, the answer is of course they are. In fact, many insect repellents can even be used on infants as young as age two months. And it is certainly better than your kids getting Chikungunya, Dengue, Lyme disease, Rocky Mountain Spotted Fever, West Nile, or Zika. Or MRSA from an infected bite.

You do have to use them correctly though.

Choosing a Safe and Effective Insect Repellent

If they are using the new EPA label, your insect repellent will tell you how long it will protect your kids against mosquitoes and ticks.
If using the new EPA label, your insect repellent will tell you how long it will protect your kids against mosquitoes and ticks.

Which insect repellent should you use?

Although traditionally insect repellents with DEET have long been “considered the best defense against biting insects,” the CDC has now said that some other DEET-free alternative insect repellents may work as well as lower dose DEET, including those with 2-undecanone, Picaridin, IR3535, oil of lemon eucalyptus, and 2% soybean oil.

Of course, that has led to a lot of new insect repellents on store shelves these days. And to a lot of confused parents trying to decide which is the best for their kids.

Don’t be one of them.

When choosing one of these insect repellents, start with the fact that none should be used on infants under two months of age and products containing oil of lemon eucalyptus should not be used on children under age three years. Otherwise, choose the product best suited to your child’s needs, especially considering that:

  • no protection insect repellents should be avoided (garlic, vitamin B1, bug zappers, insect repellent wristbands)
  • shorter protection insect repellents last about two hours (less than 10% DEET, essential oils, 2-undecanone)
  • medium protection insect repellents last about 3 to 4 hours (20% DEET, 7% Picaridin)
  • longer protection insect repellents last about 5 hours or more (24% DEET, 15% Picaridin)

In addition to the active ingredient and it’s strength (how long it lasts), you can now decide if you want an insect repellent that sprays on smooth and dry and isn’t greasy, has a light, tropical scent, or is unscented. Or instead of a spray (pump or aerosol), you can even choose insect repellent wipes or a lotion.

Do keep in mind that the CDC advises that products above 30% DEET reportedly do not provide any extra protection, although it doesn’t keep stores from selling sprays with as much as 100% DEET. For other products, those with higher concentrations of DEET aren’t necessarily stronger, they simply provide longer protection.

So if you are going for a walk around the neighborhood with your preschoolers, some good choices might be:

  • Avon Skin-So-Soft Bug Guard Plus Towelettes (IR3535)
  • BioUD Spray (2-undecanone)
  • Buzz Away Spray (Citronella oil)
  • Cutter All Family Spray (7% DEET)
  • Cutter Lemon Eucalyptus Spray
  • Cutter Natural Spray
  • Cutter Skinsations  (7% DEET)
  • OFF! FamilyCare II (5% Picaridin)
  • OFF! FamilyCare III (5% DEET)
  • OFF! FamilyCare IV (7% DEET)

There are many other brands too, including Sawyer, Repel, and discounted store brands from CVS, Target, and Walgreens, etc.

Using Insect Repellents on Kids

Now that you have chosen your insect repellent, be sure to use it safely.

That means reading the label and following the instructions carefully, being sure to:

  • only apply the proper amount of insect repellent to exposed skin or clothing
  • avoid applying insect repellent near your child’s eyes and mouth, on cuts, irritated skin, or under your child’s clothing
  • wash off the insect repellent when you return indoors
  • avoid spraying insect repellent inside your home or car, directly on your child’s face (apply to your own hands and then rub it on their face) and hands (they might rub their eyes or put their hands in their mouth), or allowing them to spray it on themselves
  • instead of insect repellent, consider using mosquito netting to cover your infant’s stroller or carrier when outside, and especially when in high risk parts of the world, using insecticide treated bed nets

It can also help to mosquito-proof your home and work to control mosquitoes and ticks where your child plays. And of course, have your child cover up and dress to avoid getting bit when possible, with long socks and clothing that covers their arms and legs.

Facts About Insect Repellents for Kids

Other things to know about insect repellents for kids include that:

  • Protect times can be different for protection against mosquitoes vs ticks.
  • IR3535, also known as Insect Repellent 3535, is a synthetic biopesticide (ethyl butylacetylaminopropionate). It was once only found in Avon Skin So Soft products, but can now be found in other brands too.
  • It is the chemical in oil of lemon eucalyptus, PMD or para-menthane-3,8-diol, that gives it pesticidal properties.
  • Avoid combination sunscreen/insect repellent products. Use separate products instead, applying the sunscreen first and reapplying the sunscreen every few hours as necessary. Since you don’t typically reapply insect repellents (unless you are going to be outside for a really long time), if your child starts  to get bitten, next time, you will likely need to consider using an insect repellent with a different active ingredient or at least one with a stronger concentration that might last longer.
  • Although available, insect repellent lotions are often harder to find in stores.
  • In addition more standard insect repellents, permethrin treated clothing is available.
  • Don’t be fooled by natural insect repellents that ‘smell amazing’ and say that they aren’t “full of chemicals.” They likely contain para-menthane-3,8-diol, ethyl butylacetylaminopropionate, or other chemicals. While they are DEET-free and some may be natural, they aren’t free of chemicals. And keep in mind that many natural insect repellents are non-EPA registered.
  • Call poison control (1-800-222-1222) if your child gets the insect repellent in their mouth or eyes or has a reaction.

Although they are the best protection, since insect repellents aren’t perfect, you should also learn how to remove ticks and the symptoms of mosquito and tickborne diseases.

Yet more protection options include the Dengue vaccine (not available in the US yet though) and preventative medications for malaria.

What to Know About Insect Repellents for Kids

When used properly, insect repellents are safe and effective and the best way to help your kids avoid getting eaten up by mosquitoes, chiggers, ticks and other things that like to bite kids.

More About Insect Repellents for Kids

Fire Ant Bites

Learn how to treat and avoid fire ant bites and stings.

A classic fire ant mound popping out of a nice green lawn.
A classic fire ant mound popping out of a nice green lawn. Photo by Bart Drees.

Are you worried about your kids getting bit by fire ants?

If not, then you don’t live in Alabama, Florida, Georgia, Louisiana, Mississippi, or Texas, where they have been around for a while.

Fire Ants

Fire ants are thought to have been imported on ships into Mobile, Alabama from South America. They have continued to spread ever since, lately making it as far as eastern New Mexico, the southern half of Oklahoma, and parts of California.

Like imported killer bees, fire ants are more aggressive than native ants.

Many of us get annoyed when we see large fire ant mounds pop up in our yards after it rains, but it can be really concerning one or more fire ants bite or sting your child.

Symptoms of Fire Ant Bites

While many insects bite, it is the classic behavior of fire ants that can make their bites so much worse.

When disturbed, fire ants emerge aggressively, crawling up vertical surfaces, biting and stinging “all at once”.

Texas Imported Fire Ant Research and Management Project

In a typical situation, a toddler or preschooler steps on a fire ant mound in the yard, and before you know it, dozens of fire ants are covering their feet and legs. Or they fall onto the mound, with the fire ants all over their hands and arms.

As you scramble to move your child and get the ants off (quickly rub them off with a cloth or your own hand), they will likely all start stinging.

Multiple fire ant bites on a child's hand.
Multiple fire ant bites on a child’s hand. Photo by the Texas Department of Agriculture.

Fortunately, very few people are allergic to fire ant stings, which might trigger a whole body reaction, with dizziness, shortness of breath, and hives, etc.. The redness, swelling, and white-yellow pustule at the site of the bite are usually the normal symptoms of a local reaction to the fire ant venom.

The pustules go away over a few days to weeks. There is no need to pop or try to drain them. In fact, popping them might lead to their getting infected. It’s better to leave them alone.

After you are bit, it is going to hurt or burn for a few minutes too – that’s why they are called fire ants.

How do you treat fire ant bites?

After you remove the ants, basic first aid and treatment for fire ant bites might include washing the area with soap and then using a cool compress, oral antihistamines, and topical steroids to treat itching.

And of course, seek immediate medical attention if your child is having an allergic reaction to the bites or if it appears that the bites are later getting infected, with increased pain and swelling when you would think that they should be improving.

What To Know About Fire Ant Bites

Although fire ant bites are rarely dangerous or life-threatening, your best bet in protecting your kids is to get rid of any fire ants in your yard and in other places that they play. You might also encourage your kids to wear shoes (not sandals or Crocs) and socks when walking or playing outside.

For More Information on Fire Ant Bites

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