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As always happens at this time of year, lots of parents are bringing their children in for treatment of a wide range of insect bites. Whether the work of a mosquito, flea, biting fly or some other pest, some bites can trigger significant reactions.

The immediate reaction to a bite usually occurs within 10 to 15 minutes after the incident, with local swelling and itching, though both may disappear in an hour or less. A delayed reaction may appear 12 to 24 hours later with the development of an itchy red bump that may persist for days to weeks.

This is the reason some people don’t remember being bitten while they were outside, but the following day may show up in my office with bites all over their arms, legs or chest, depending on what part of the body was exposed.

Large local reactions to mosquito bites are common in children. For some reason, areas of “baby fat” seem to be subject to larger reactions than the same parts of the body on older kids and adults (no science, just anecdote). Toddlers often develop itchy, red, warm swellings within minutes of insect bites.

Some of these will go on to develop bruising and even spontaneous blistering 2 to 6 hours after being bitten. These bites may persist for days to weeks, so in theory, those little chubby legs may be affected for most of the summer.

Severe local reactions to mosquito bites are called “skeeter syndrome” and occur within hours of someone being bitten, and may involve swelling of an entire body part, such as a hand, the face or an extremity. Such swelling is often misdiagnosed as cellulitis, but with a good history of the symptoms – the speed with which the area developed redness, swelling, warmth to touch and tenderness – you can distinguish large local reactions from infection.

Systemic reactions to mosquito bites, including generalized hives, swelling of the lips and mouth, nausea, vomiting and wheezing, have been reported due to a true allergy to the mosquito salivary proteins, but are extremely rare.

The treatment of local reactions to bites involves the use of topical anti-itching preparations like Calamine lotion, Sarna lotion and Dommeboro soaks. This may be supplemented by topical steroid creams – either over-the-counter or prescription – to help with itching and discomfort.

An oral antihistamine (Benadryl) may also reduce some swelling and itching. Do not use topical antihistamines. Try to prevent secondary infection – from scratching and picking – by using antibacterial soaps, trimming fingernails and applying an antibiotic cream (polysporin) to open bites.

The best treatment is prevention! Before going outside, use a DEET preparation on children over the age of six months. Pick the lowest concentration that’s effective. Mosquito netting may be used for infants in strollers.

A final warning: Do not re-apply bug spray like you would sunscreen. This could be harmful.

Dr. Sue Hubbard is a pediatrician, medical editor and media host. Submit questions at kidsdr.com.