What to Do for Huge Bug Bites
And ACIP thoughts
Does your kid seem to swell up just by looking at a mosquito? One bite, and suddenly there’s a puffy, red welt that has everyone wondering if it’s infected. Don’t panic — most of these bites look worse than they are, and you probably don’t need a prescription. Here’s what actually helps.
Bug Bites: Three Quick Facts
Bug bites* are reactions to bug spit. Bug spit helps to lubricate the bitten area, increase blood flow, limit clotting, suppress local immune responses, and aid bug digestion. It’s the spit that triggers a largely histamine-driven immune response in our skin, creating the familiar redness, pain, swelling, and heat within the first few hours of the bite.
If bites seem worse on vacation, they probably are. When you travel to a new bug neighborhood, you are bit with different spit. You react more dramatically to this new exposure, leading to bigger, more itchy bites.
Kids with a history of eczema are more reactive to bites. Kids with eczema have very sensitive skin that’s ready to react with any small sign of change. When bug spit shows up, the histamine reaction is exceptionally dramatic, causing very large, itching welts.
Pro tip: Lean into the layered prevention methods listed later in this post.
Three Weird Things in Kids with Bug Bites
Kids get “skeeter syndrome.” This happens when huge, painful, itchy hot welts start within a few hours of getting bit, with welts becoming large enough to cause eyes to swell shut and limit movement in arms and legs. Despite the alarming size of these bites, “skeeter syndrome” can be managed at home. Over a few summer seasons, this reaction becomes less dramatic as kids develop a sensitivity to the spit.
Pro Tip: Worried about cellulitis or bacterial infection? It’s all in the timing. Cellulitis and skeeter syndrome can look similar, but cellulitis takes 2-3 days to develop. As long as your kiddo is otherwise fine, start with home management for the first 1-2 days to see if things get better on their own.
Papular urticaria is a thing. This unique condition happens after certain types of bug bites, most commonly mosquitos and bed bugs. As expected, initial bites make red marks and bumps on the skin. But with papular urticaria, once the areas heal, they can be reactivated with scratching. This creates a cycle of itchy, red areas lasting for weeks to months. Although it’s annoying, this rash will go away on its own. And once confirmed by your doc, can be managed with home therapies.
Bug bites can blister. Just like sunburn blisters, the goal is to keep the blisters intact to protect the underlying skin. Using vaseline gauze or medical-grade honey gauze can be helpful — find links in this newsletter.
What to Do if Your Kid Gets Huge Bug Bites
For routine bug bites, skeeter syndrome, and papular urticaria, kids rarely need oral steroids or oral antibiotics. But, they do need mindful care to stay comfortable and protect skin.
Offer a LAAH** before going outside. Taking a LAAH will not prevent bites, but it will limit the histamine reaction, decreasing the itch and swelling.
Oral treatments. As soon as you notice a bite, double up on the LAAH (same dose twice a day) OR add another histamine blocker, like famotidine. (Yes, the stomach medication — it’s a histamine blocker, too!) Your doc will be able to help with dosages and recommendations.
Topical treatments. Using over-the-counter hydrocortisone on the itchy spots is reasonable, but avoid topical antihistamines.
Protect the area with liquid bandaid. This is a great trick for Itties and Littles who can’t keep Band-Aids on. As long as the skin looks otherwise healthy, this barrier will limit the itch and protect from the damage caused by any fingernail scratches. Be sure to keep those nails short! (One example, linked here.)
Watch for signs of infection. Bites with increasing pain, redness, or drainage after 2-3 days, or those with associated symptoms***, need to be seen. In addition, give a call to your doc if you find any ticks that have been attached for longer than 24 hours.
Prevent. Prevent. Prevent.
The best way to avoid the bug bite reactions is to avoid the bites in the first place. Remember that mosquitos, ticks, and fleas carry nasty germs. Preventing the bites is how we prevent infection.
DEET and picaradin are safe for kids as young as 2 months. In our neck of the preverbal neck of the woods, we need these agents to protect our kids. Sunscreen first, then apply insect repellant to the ankles, neck, wrists, and around the diaper area. Avoid the hands and face. (I use Family Care OFF with my kids - low percentage of insect repellant and effective for a few hours.)
Consider layered prevention. Use permethrin-protected clothing, mosquito netting on strollers and carts, limit standing water near your home, and don’t forget your tick checks.
Other Important Notes
Last week’s ACIP meeting gave the public a clear look at the character and quality of its new membership. This advisory group has real power: its decisions directly affect insurance coverage, equitable vaccine access, and public health policy for all U.S. children. If you missed the meeting, here’s a great summary.
A few of my takeaways:
The vote on thimerosal wasn’t about science; it was about optics. Despite two decades of global evidence supporting thimerosal’s safety, the committee voted to remove it from the small number of flu vaccine vials where it’s still used. This won’t change day-to-day pediatric practice (we’ve been using preservative-free vaccines for years), but it risks undermining dementing and international vaccine confidence and may limit manufacturing flexibility in future pandemics.
The impact of flu remains serious. Over 250 U.S. children died from influenza last season, the highest since 2004. Nearly 90% were unvaccinated. The flu vaccine continues to be one of the most effective tools we have to prevent hospitalization and death in children. Undermining that message is a threat to public health.
RSV protection was preserved. The monoclonal antibody for infants, a game-changer in RSV prevention, remains approved. But we’ll need to stay alert. Availability and implementation will continue to vary by region and payer.
COVID-19 vaccine access for kids remains uncertain. There was no ACIP vote. Despite data showing that infants under 6 months have similar hospitalization rates as adults aged 65–74, these babies remain ineligible for direct protection. With no vote and no updated guidelines, I worry the next formulation will be harder to access, especially for our youngest patients.
The bottom line?
In the past, I leaned on the ACIP to offer rigorous, transparent analysis. That trust is fractured. I don’t deny the ACIP’s influence or power, and I share my colleagues concern about the group’s negative global and domestic impact.
Still, I won’t rage. I won’t speculate. Parents come to me for clarity, not chaos.
So I’ll double down on what matters: the kids in front of me. I will stay grounded in what I know — that my job is to keep them safe and healthy, through practical guidance, strong relationships, and science-informed recommendations.
I continue to hold respect for the credible and experienced CDC scientists whose evidence-driven work is still present and under immense pressure. I can only imagine the personal and professional distress they carry. This is another moment in history. And I, like so many of my colleagues, will choose again to be on the right side of it.
To the helpers,
