Pesky critters, are they not? Many young children are aflicted every summer with large reactions to ordinary mosquito bites. The bites swell, become reddened and hard ("indurated" in medicalese), perhaps as large as a half dollar or more. The skin around the bite may have the texture of an orange peel. The bite reaction area may weep and ooze a clear yellow fluid. Scratching creates even more irritation, and the traumatized bites sometimes become infected - impetigo.
So what can parents do about this phenomenon? Quite simply, avoidance of the insects and repellents:
- Avoidance means just that. Mosquitoes spend most of their time hanging upside down under leaves, waiting for something warm (a mammal like yourself or your child) to amble by. Then they home in on the warmth and natural odors we give off. I understand that certain perfumes can have an attractive effect, as well. So keep your child indoors during the evening hours when mosquitoes are active.
- We know that the most effective topical insect repellent is a chemical known as DEET. This substance is effective, but unfortunately can be taken up through the thinner skin of young children and might cause brain toxicity. Some slow-release DEET preparations have been approved for use with young children. Because of the risk of toxicity, parents should always follow the application instructions and age guidelines scrupulously when using such a product.
- I sometimes recommend an oral repellent. Ordinary vitamin B1, in a dose of 15 mg per 30 pounds of body weight, is given orally about the same time each day. This apparently makes the individual exude a scent which is quite obnoxious to mosquitoes. If mosquito bite reactions are a major problem, ask your doctor if he or she might do this for you. In our town, patients can get this without a prescription. Your mileage may vary.
- Speculative: It is known that elements of garlic are noxious to mosquitoes - that is natural repellants. I do not know of any controlled studies, but it is possible that one of the oral garlic preparations that claims to be odor free to other humans might deter mosquito biting. This would seem harmless enough to try...
Treatment of the bites:
- Hydrocortisone 1% cream is available over the counter. Use it up to four times a day on any new bites and for several days thereafter.
- Diphenhydramine (Benadryl®) is useful for itching and swelling in a dose of one teaspoon (5 ml) per 25-30 pounds of body weight, given every four to six hours.
- There are topical anti-itching gels and lotions that contain pramoxine and other substances for use after the bites occur. They are safe and fairly effective.
- Of course if you suspect infection, use an antibacterial ointment such as Neosporin® or Bactracin®
Keep in mind that hands and feet tend to swell dramatically in response to any bite or sting. This is because of the natural tourniquet effect of the carpal and tarsal ligaments that encircle the wrist and ankle respectively. Don't be surprised by this; give the Benadryl® as above, and elevate the extremity at night if possible. Don't ask me how to do that with a two year old 8-)