Images of Bedbug Bite
Bedbugs are very small insects (Cimex lectularius). Their food source is the blood of humans and other mammals. Bedbugs tend to live in warm, dry places such as mattress, upholstered furniture, and rugs, and they come out at dawn to feed. Their bite is painless, so your baby will likely not wake up when bitten, but the bite produces a very itchy rash. Your baby will wake up with itchy red or pink bumps, usually in lines or clusters. The bite itself is harmless, and bedbugs are not known to spread any blood-borne diseases, but babies and children are prone to scratching at bites, potentially causing secondary skin infections.
Who's at risk?
Anyone of any age can be bitten by bedbugs. Because bedbugs only feed on humans and other warm-blooded animals, they tend to be found in places where there are many people, such as dorms and prisons. They are also common in places where travelers pass through, such as hotels and shelters. Because bedbugs do not feed on trash or dirt, there is no association between poor hygiene and untidiness to bedbug infestations. However, babies who sleep in multiple different environments are probably more prone to bedbugs because they are exposed to multiple potential bedbug habitats. It is probably not possible to look at a couch or mattress and see if it contains bedbugs; a bedbug egg is about the size of a large grain of salt, and an adult bedbug is about the size of a small apple seed. They do not have wings, but can move very quickly.
Signs and Symptoms
You may see a bug bite or notice your child scratching or rubbing their arms or legs against something. What start as small bruise-like areas turn into red bumps on the exposed parts of the body (arms, legs, chest, and sometimes the face). There may be a clustered configuration of 3 bites in a line (commonly known as "breakfast, lunch, and dinner"). Resolution takes about 2 weeks and may leave some darker areas of skin (post-inflammatory hyperpigmentation).
Infants who are prone to eczema may develop a generalized bumpy redness in large areas with severe itching, and they may vigorously scratch the area, which puts infants at risk for bacterial infection if the scratching causes breaks in the skin. Make sure to keep infants' nails trimmed short.
You may see tell-tale signs of bedbug infestation, such as blood stains on the sheets, flecks of bedbug dung on or around the bed, or smell a sweet odor that results from large numbers of bedbugs. You may be able to spot a moving bedbug if you are searching at night.
Management of bedbug bites includes removing the bedbugs themselves and controlling the child's itching.
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 fix any cracks that may be in the furniture; you may need to take the furniture apart to do this well. 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 the adjoining rooms for bedbugs as well, even if the occupants do not complain of itching.
Sometimes, in cases of severe infestation, it may be best to have a licensed pest control agent inspect and eradicate the bedbugs. Remember 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 chemical's risk profile is.
A low-strength topical corticosteroid cream or ointment, such as hydrocortisone, can be purchased over the counter to help with itching. It should not be applied to the face or in skin folds. Make sure to keep children's nails trimmed short to prevent creating breaks in the skin from scratching.
When you travel and stay in hotels, keep your suitcase and clothing away from the bed or other furniture. Upon returning home, wash the clothing you took with you and place your suitcase in an attic, basement, or garage, where there is little chance of the bugs encountering humans for prolonged periods at night.
When to Seek Medical Care
Your baby may need a prescription-strength topical steroid to help intensely itchy bites. Infants have an especially hard time refraining from scratching, especially at night, and will attempt to rub the affected area on anything nearby. Consult with your child's doctor before trying an antihistamine such as Benadryl®. Because scratching can lead to infection, if there is pus, redness, swelling, fever, or if the reaction blisters or is otherwise severe, call your child's doctor. There have been rare cases of severe allergic reaction that affect breathing (anaphylaxis). If this is the case in your child, seek emergency medical care.
Treatments Your Physician May Prescribe
Your child's doctor may give him/her a topical corticosteroid to help reduce the itching and inflammation. These are especially helpful at night, to help prevent infection. In rare cases of blistering skin reaction, oral corticosteroids may be necessary. If your child has a bacterial infection of the skin from scratching, he/she may need oral antibiotics. Rarely, anaphylaxis has occurred and is treated with emergency care.
Ter Poorten, M, et al. The Return of the Common Bedbug. Pediatric Dermatology 22 (3), 183–187, 2005 May.