Insect bites and stings in children: Prevention and treatment

Insect bite and sting reactions

Insects bite or sting to defend or feed themselves. When an insect bites or stings a person, it injects its saliva or venom into the skin. The body recognizes these substances as foreign and triggers an immune response. This response causes inflammation, which results in itching and swelling.

Most people experience a skin reaction after an insect bite or sting. Normally, this is nothing worse than a small, itchy red bump that goes away after a day or two. Redness may appear anywhere from a few minutes to a few hours after the bite or sting.

Children often experience more severe swelling than adults. This is because their skin contains more water. What’s more, since children have had fewer bites and stings over their lifetime, they haven’t yet developed a tolerance to them. In children, swelling usually goes away after two to seven days.

Severe reactions

In some cases, insect bites and stings can cause a severe reaction. After a bite or sting, some people may experience the following symptoms:

• Wheezing or trouble breathing
• Dizziness and weakness
• Fainting
• Swelling of the mouth, tongue, face, neck, hands, or feet
• Itchy hives all over their body
• Digestive issues (e.g., nausea, vomiting, diarrhea, stomach pain)

Common insect bites and stings

Different insect bites and stings can cause different reactions.

• Mosquito bites: Mosquito bites are among the most common insect bites. They cause small red bumps that are extremely itchy.
• Blackfly and biting midge (no-see-um) bites: These bites look a lot like mosquito bites. However, they can be more painful, swollen, and itchy. They are also more likely to get infected.
• Horsefly and deer fly bites: These bites are red, raised, and quite painful. They take a long time to heal and are easily infected.
• Bee stings: Bee stings are very painful, and the stinger can remain inside the skin. The skin around the sting turns red and may swell up to 10 cm in diameter. Bee stings can take over a week to heal.
• Wasp stings: Some wasps are attracted to human food, and they may be very aggressive. Wasp stings cause immediate, intense pain. The area around the sting then becomes red and swollen for about one week. Wasps do not leave their stingers in the skin.

• Tick bites: Tick bites can cause small, itchy red itchy bumps or blisters. They aren’t painful. Tick bites may go unnoticed—unless the tick carries Lyme disease.
• Ladybug bites: Some ladybugs, especially the ones with a white spot on their heads, bite. These bites may be painful, but they are harmless.

Prevention

The best way to prevent insect bites and stings is to avoid insects whenever possible. Mosquitoes are often most active at dawn and dusk.

• Avoid areas near stagnant water, such as ponds and marshes, as some insects breed in standing water. Eliminate sources of standing water in your yard. Empty out pots or toys that collect water. Unclog or empty your eavestroughs/gutters and kiddie pools at least once a week.
• When walking in the woods, stay on trails and avoid tall grass.
• Don’t let your child approach an insect nest.
• When eating outside, keep food and drinks covered to avoid attracting insects. Dispose of garbage in a trash can with a lid.
• Teach your child to stay calm around bees and wasps. To stop them from trying to chase these insects, hold both of their hands and lead them away.

If you can’t avoid areas with high insect populations, here are a few ways to prevent bites and stings.

• For babies under 6 months, cover their stroller with mosquito net to protect them from getting bitten.
• Dress your child in a hat, closed-toe shoes, long-sleeved shirt, and long pants to protect their skin. Make sure to tuck shirts into pants and pants into socks.
• Opt for light-coloured clothes, as mosquitoes may be more attracted to dark colours. In addition, light-coloured clothing makes it easier to spot ticks.
• Use insect repellent.
• Avoid using scented products, as they can attract insects.

Insect repellent

Repellents work by making humans smell less appealing to insects. Commercial insect repellents are regulated by the Pest Management Regulatory Agency. The following products are approved for use in Canada.

Icaridin/picaridin

Icaridin, also known as picaridin, is the Public Health Agency of Canada’s first choice for toddlers. It is as effective as DEET. It protects against both mosquito and tick bites.

Icaridin/picaridin is odourless and colourless. It does not irritate the skin and can be used starting at the age of 6 months. It’s recommended to use an insect repellent with no more than 20% icaridin/picaridin, which provides 5 to 7 hours of protection.

DEET

This is the best-known insect repellent and one of the most effective on the market. It protects against bites from flies, mosquitoes, and ticks. The higher the percentage of DEET, the longer the protection will last. In Canada, products with more than 30% DEET are not available.

Although it may cause skin irritation, DEET is safe for children aged 6 months or older. It’s recommended to use insect repellents with no more than 10% DEET. Protection lasts about 2 hours.

For children aged 6 months to 2 years, DEET should not be applied more than once a day. Starting at age 2, it can be applied up to 3 times a day.

Oil of lemon eucalyptus (OLE) or p-Menthane-3,8-diol (PMD)

Products containing these ingredients can protect against blackfly bites for 5 hours and mosquito bites for 2 hours. However, their effectiveness against ticks is unknown. Oil of lemon eucalyptus is not recommended for children under 3. After the age of 3, this product may be applied up to twice a day.

Soybean oil

This is the only product recommended by the Pest Management Regulatory Agency for babies under 6 months of age. However, it is less effective than the products listed above. Soybean oil protects against blackfly bites for 8 hours and mosquito bites for 3.5 hours. Its effectiveness against ticks is unknown.

Other products

A number of products on the market claim to be able to repel mosquitoes. These include citronella candles and ultrasonic devices. However, tests carried out on these products have shown that they are not very effective.

Tips for applying insect repellent

It’s important to take certain precautions when using insect repellent on your child.

• Apply the smallest possible amount of insect repellent to your child’s skin. Always follow the instructions on the label.
• Avoid applying mosquito repellent on your child’s face or hands, so they don’t get any in their mouth.
• To apply mosquito repellent around the face, spray it into your hands first, then pat it onto, for example, your child’s neck.
• Do not apply insect repellent on sunburns or wounds, or on irritated skin.
• Do not apply insect repellent to skin covered by clothing. However, you can spray it directly onto clothing in a well-ventilated area.
• Reapply insect repellent after swimming. Do not exceed the maximum number of applications indicated on the label.
• Wash your hands after applying insect repellent on your child.
• Bathe your child when they finish playing outside to remove the insect repellent from their skin as quickly as possible.
• Do not spray insect repellent indoors or around food. Otherwise, the spray could be inhaled or ingested.

How to treat bites and stings

Most insect bites and stings can be treated at home. Here’s how:

• Wash the affected area with soap and water.
• Wrap some ice in a damp cloth and hold it against the bite or sting to relieve pain, no longer than 15 minutes. The cold will reduce the inflammation and itching.
• Elevate the bitten or stung limb to reduce swelling, if necessary.
• If small blisters appear, avoid piercing them, as this may increase the risk of infection.
• You can give your child acetaminophen (Tylenol® or Tempra®) if the bite or sting hurts.

What to do if your child gets stung by a bee

• Remove the stinger promptly. This prevents the venom from spreading in the skin.
• To remove the stinger, scrape the skin with your fingernail or a card, such as your medicare card.
• Avoid using tweezers to remove the stinger, as they can cause it to break, increasing the amount of venom released.

What to do if your child gets bitten by a tick

• Use tweezers or bent needle nose pliers to remove the tick completely. Position the tweezers/pliers as close to the skin as possible. Slowly and steadily pull the tick upwards out of the skin, without twisting. If a small part of the tick remains in the skin, try to remove it with the tweezers/pliers.

• Put the tick in a rigid container, such as an empty pill bottle, seal it, and put it in the fridge (in case you or your doctor want to order a laboratory analysis). Label the container, noting the body part bitten, the date the tick was removed, and where your child was when they were bitten.
• Wash the skin with soap and water and wash your hands.
• Call Info-Santé 811. In regions where there is a higher risk of Lyme disease, a preventive dose of antibiotics may be recommended under specific circumstances.
• Monitor the bite for the next 30 days. If a red bullseye-shaped rash appears, consult a doctor.

Do insects spread disease? In Canada, most insects do not carry disease. However, blacklegged ticks can transmit Lyme disease and anaplasmosis. That’s why it’s important to remove ticks promptly and to watch closely for the following symptoms: fever, chills, headaches, sore muscles, stomach issues, and a bullseye-shaped rash around the bite. For more information, see our fact sheet on Lyme disease (French only). Some mosquitoes carry the West Nile virus. However, their numbers are still relatively low in Canada. The disease causes cold-like symptoms and is generally mild.

How to reduce itching and swelling

If the bite or sting doesn’t seem to be bothering your child, just keep an eye on it. In most cases, the swelling will go down on its own by the next day. If the itching and swelling do bother your child, there are many products that can help.

• Reactine® or Claritin® antihistamine syrup: These medications can relieve itching for up to 24 hours. If your child has a large rash, or if they can’t stop scratching even after taking one of these medications, ask a pharmacist about trying another type of antihistamine.
• Cortisone cream: Cortisone cream can be applied twice a day for 5 to 10 days if the bite or sting is very swollen and uncomfortable.
• Calamine: Unlike the options above, calamine can relieve itching, but not swelling.
• A paste of baking soda and water: Apply the paste to the bite or sting to relieve itching. Pharmacies also sell itch-relief sticks made with baking soda (e.g., After Bite®). Before buying one, ask a pharmacist about which product would be best for your child. These products often contain a variety of added ingredients that differ from one brand to the next.
• Baking soda in bath water: If your child is itchy all over, add 1 cup of baking soda to their bath water while filling up the tub.

When should you consult a doctor?

• Your child’s symptoms do not improve after two or three days
• There is redness and swelling more than 10 cm in diameter around the bite or sting
• Your child’s pain, itching, or redness get worse
• There is fluid with greenish pus coming out of the bite or sting
• Your child has a fever or seems unhealthy in general
• A bullseye-shaped rash appears around a tick bite

• Has a severe allergic reaction (French only)
• Is wheezing and having trouble breathing
• Has a rapid heart rate
• Feels dizzy or weak
• Loses consciousness
• Is nauseous or vomiting
• Was stung or bitten in the mouth, in the throat, or near the eyes
• Has a swollen face, mouth, tongue, neck, hands, or feet
• Has trouble swallowing
• Has itchy hives all over their body
• Has received an epinephrine (adrenaline) injection

Scientific review: Dr. Anne-Claude Bernard-Bonnin, pediatrician Research and writing:The Naître et grandir team Updated: May 2023

Photos: GettyImages/dorioconnell and ArtBoyMB, CDC/James Gathany