Creepy crawlers, flying stingers and things that go bite in the night.

It happens so often after a trip. Your child is scratching, fidgeting and you see a bump on his or her skin.

Your child may not remember what caused the spot or may be too young to tell you. Here is a little primer on what to look for and when to see the pediatrician.

Mosquito bites- The familiar raised wealts, on exposed areas are frequently mosquito bites. Although usually no more than a nuisance in the northern United States, these insects cause numerous diseases in the tropics. West Nile virus is one exception and may be a serious infection over a wide geographic area, including the northeastern United States. Experienced travellers to tropical countries know that Malaria, Dengue, Yellow fever and Chickungunya are all spread by mosquitos. 30% DEET is relatively safe for kids and should prevent most of the mosquito bites. Permethrin may be applied to clothing ahead of time and dried on the fabric. The protection will last through several washings. Bed netting (frequently soaked in permethrin) is appropriate if there is a chance that mosquitoes may get into the sleeping area. A head net may be necessary during peak biting times. Clothing should include long sleeves, long pants and a hat. After bite is a rollon ammonia preparation for cooling bites and stings. It should not be used on the face, but may be helpful for pain control in certain circumstances.

Spider bites- Physicians may talk about the "breakfast, lunch and dinner rash" of spiders. These bites frequently come in a linear pattern of 3 bites, commonly about 4-8 inches apart. They may be small red bumps about the size of a pencil eraser, or may be larger, even may have a central small blister. (Any blistering rashes of unknown cause should be reported to your doctor.)

Chiggers- The small numerous bites of these tiny critters are frequently seen on the back of the thighs, after a camper sits on a fallen log.

Adirondack black fly- Ok if you're not from upstate New York these may be unfamiliar pests. Lucky you. These flying insects bite around the hairline and the forehead, leaving a bleeding site in a nearly perfect circle. They tend to found be near mountain streams in June. Local hikers wear head netting and DEET if they venture out in early summer.

Head lice - OK not likely on a trail, but occasionally found in campers returing from sleepover camp. We used petroleum jelly on the hair overnight for a while but the parents got upset that the petroleum jelly didn't wash out and the kids looked like "greasers" on an old 1950s movie. We use hair gel now, applied overnight under a shower cap and washed away in the morning. Clothing, combs brushes, hats and scarves must be washed in hot water or isolated in plastic for a couple of weeks. Anything that has been exposed and cannot be cleaned in hot soapy water should be wrapped in plastic for 14 days. Frequent combing with a head lice comb may prevent a repeat performance as long as exposure is still likely.

Ticks- My region of the country is the epicenter of Lyme disease. DEET may helpt to prevent tick bites. A stainless steel fine toothed (head lice) comb may help to search the hair for ticks after a hike in the woods. Part the hair and look in sections. Removal of an embedded tick is done with a blunt tweezer- gently pull the tick without squeezing it, holding the tick as close to the skin as possible . Pull very slowly and hope that the tick gets tired and lets go. Some ticks take 4-6 minutes of gently pulling to remove from the skin. Clean with alcohol. Report to your doctor if any rash occurs, especially if it is circular or bullseye in pattern. Report any joint pain, neck stiffness, extremely severe headache or any facial muscle weakness.

Bed bugs- Yuck. I include these here in case your cabin or cot is infested when you camp. (You could get them from a five star hotel in any city of the world, but we aren't talking about hotels right now.) Bed bugs are the size shape and color of apple seeds. They come out at night and bite a number of times in nearly the same place, frequently on the wrist or neck. Most bites are in areas that were exposed overnight while sleeping. The bite is not painful and may not even be visible at first but may begin to itch and swell over the next few days. Some people are allergic to bedbugs and get large wealts and some people are not allergic and may not notice the bites at all. Bedbugs hide in woodwork and on mattress seams. They may be killed in a few days by diatomaceous earth ( left in clean cat food cans and placed under the bed legs) but the bed bugs may be quite difficult to eradicate and professional exterminators may be required for an established infestation. Trained dogs may be able to locate a colony of the bugs. Remember to wash all clothes in hot water and dry on a hot cycle when you get home from a trip and store the luggage away from the bedroom, preferably sealed in plastic. If you notice bed bugs while on a trip, permethrin on your clothes or a bit of deet on skin may help to prevent further bites. Try not to use DEET any more than necessary and wash it off when it is no longer needed.

Hives- frequently caused by an allergic reaction to food, drug or environmental antigens, hives are not always easy to tell from mosquito, spider, flea or bedbug bites. One clue to tell them apart is that the wealts from hives often change in shape over several hours time and will move around the body.( Bug and insect bites do not move or disappear over several hours observation time. ) Hives may respond to antihistamines but may come back later in different places. Severe hives or hives associated with wheezing, trouble breating, trouble talking or swallowing, or with dizziness are a more severe allergic reaction and require immediate medical care ( an epipen may be available if the person has a history of severe allergy in the past.)

Poison Ivy- Poison ivy causes a "linear wealt". Frequently a puffy red itchy line will occur gradually over 24-72 hours after exposure. Round or oval patches of poison ivy may be on the legs or buttocks if the child was sitting on the plant.

Burning poison ivy , as in a bonfire, may cause extensive puffy red skin around the face arms or other exposed areas. The face is red and itchy, with sparing around the eyes, nose and mouth if someone was near a bonfire where the weed was burning. Poison ivy resin will splatter like butter when it burns or may be aerosolized into small particles and carried longer distances on the wind. Blistering may be noted at the center of linear wealts and patches. Heavy exposure by direct contact may cause black spot poison ivy. This condition is so named because the resin may turn black when exposed to the skin and may be shiny, appearing much like lacquer finish on furniture. Medical care may be required for extensive poison ivy or may be needed when the diagnosis is unsure.

Bee and wasp stings- the familiar wealts hurt immediately and so are more easy to identify. An ice cube may be applied immediately. If the sting is not near the face, meat tenderizer is sometimes applied to the sting, mixed with a bit of water. Any allergic reactions occuring after a beesting should be taken seriously and treatment ( antihistamine, epipen) should not be delayed, when it is necessary.

Skin infection- I list this here because some skin infections start from bee stings or may look like bug bites at first. Any large or enlarging red, swollen or painful areas or any streaking or draining wounds shoud be reported immediately to your doctor.

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