Bedbug Bite
Bedbugs are small (apple seed-sized) insects that feed on the blood of humans and other warm-blooded mammals. They live in dark, dry places such as mattresses, rugs, and upholstered furniture, and they come out during the night to feed by making small bites in their food source. The bite itself is painless, so children rarely wake up at the time of the bedbug bite, but the resulting bite leaves behind a substance in the skin that causes a very itchy rash in most people. The child will often awaken with a rash of scattered pink or red papules (small, solid bumps) or a welt. The bites themselves are not dangerous, but children can get skin infections if they scratch and break the skin.
Who's At Risk?
Bedbugs do not discriminate; anyone can be affected. Children who sleep in multiple environments (at friends’ houses, for example) are more prone to bedbugs because they are exposed to more potential bedbug habitats. Bedbugs do not feed on trash or dirt, so untidiness and poor hygiene do not contribute to bedbug infestations. Bedbugs are most commonly found in highly populated areas.
Bedbugs can survive for months without feeding, and they can be passed on in old furniture, mattresses, used clothing or bedding, and suitcases and bags used during travel.
Signs & Symptoms
Your child may complain of itching, although there may not be a visible bug bite. You will likely see papules (small, solid bumps) on the exposed parts of the body (arms, legs, chest, and sometimes the face). The papules may be red in lighter skin colors or deep red, purple, or dark brown in darker skin colors. There may be a clustered configuration of 3 bites in a line (“breakfast, lunch, and dinner”). Resolution of individual lesions takes about 2 weeks and sometimes leaves darkening of the skin (postinflammatory hyperpigmentation).
Children who are prone to eczema may develop large, bumpy areas with severe itching that are either red or darker than the child’s surrounding skin. Children are often tempted to vigorously scratch the affected areas, but scratching should be avoided, as it increases the risk for bacterial infection caused by breaks in the skin.
There may be signs of bedbug infestation such as blood stains on the sheets or flecks of bedbug dung on or around the bed, or you may smell a sweet odor that results from large numbers of bedbugs. You may be able to spot bedbugs by searching cracks and crevices, such as along the seam of the mattress.
Self-Care Guidelines
The goal of management of bedbug bites includes removing the bedbugs and controlling the itching.
To help remove the bedbug infestation, wash all linens in hot water and dry them in a hot dryer. You may also need to wash the curtains. Scrub furniture to remove eggs, and fill any cracks in the furniture. Vacuum the room, including the mattress (concentrating on the seams) and any surrounding crevices. You may want to fill and seal any cracks around the room and paste down any rolling wallpaper seams. Check adjoining rooms for bedbugs as well.
It is best to have a licensed pest control agent inspect and eradicate the bedbugs. Note that some insect repellants can be toxic to children, so make sure to find out exactly what chemicals the agent will be using and what the potential risks are.
Diphenhydramine (eg, Benadryl) can be used to control the itching, especially at nighttime. A low-strength topical corticosteroid cream or ointment, such as hydrocortisone, can be purchased over the counter to help with itching as well. Make sure to keep your child’s nails trimmed short to help prevent breaks in the skin from scratching.
Treatments
Your child’s medical provider may prescribe an antihistamine, such as hydroxyzine (eg, Vistaril), and/or stronger topical corticosteroids to help reduce the itching and inflammation and reduce the possibility of infection caused by scratching. These might be especially helpful at night, to reduce the chances of the child inadvertently scratching without realizing it. In rare cases of a blistering skin reaction, oral corticosteroids may be necessary. If your child has a bacterial infection of the skin from scratching, they may need oral antibiotics. Rarely, anaphylaxis has occurred and is treated with emergency care.
Bedbug bites are difficult to visually diagnose. If your child is continuing to get lesions, their medical provider may need to take a small sample of skin (biopsy) to determine if they have some other skin condition.
Visit Urgency
Your child may need a prescription-strength topical steroid to help relieve intensely itchy bites. Children have an especially hard time refraining from scratching, especially at night. Because scratching may cause infection, look for signs of infection, such as pus, redness, swelling, or fever. If you see any of these signs or if there is blistering or an otherwise severe reaction, call your child’s medical provider. There have been rare cases of severe allergic reactions that have affected breathing (anaphylaxis); if this is the case in your child, it necessitates immediate emergency medical care.
References
Bolognia J, Schaffer JV, Cerroni L. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018.
James WD, Elston D, Treat JR, Rosenbach MA. Andrew’s Diseases of the Skin. 13th ed. Philadelphia, PA: Elsevier; 2019.
Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology. 9th ed. New York, NY: McGraw-Hill Education; 2019.
Paller A, Mancini A. Paller and Mancini: Hurwitz Clinical Pediatric Dermatology. 6th ed. St. Louis, MO: Elsevier; 2022.
Last modified on May 30th, 2023 at 3:06 pm
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