During the summer, many flying bugs and insects are around and can bite your child. Mosquito and fly bites are generally not serious, just annoying. Use cool compresses, topical Calamine lotion and/or oral Benadryl.

Many bites can be avoided by use of insect repellent. Products with DEET (up to a concentration of 30%) can be used on children ages 2 months old and up. Repellent should be applied to clothing and shoes, as well as exposed skin. Apply carefully near the eyes and mouth. Only apply 1-2 times per day. When your child comes indoors, make sure the repellent is washed off the skin. DEET should not be used in a product that combines the repellent with a sunscreen. Sunscreens are applied repeatedly because they can be washed off. DEET does not wash off as easily with water alone and will last up to 8 hours. Repeated application may increase the potential toxic effects of DEET. Another newer product is picaridin, found in a product called Cutter Advanced Insect Repellent. It is as efficacious against mosquitoes as DEET and has a low potential for toxicity. This product is applied directly to exposed skin.

Bee stings (including honey bee, bumble bee, hornet, wasps and yellow jackets) are more painful and can be more serious. Usually they cause only red and painful bumps with local swelling. However, some people have more severe allergic reactions, such as breathing or swallowing difficulty or hives. Let our office know if your child has these reactions.

As always, prevention is key. Try to keep your child away from areas known to have bees, such as flowering gardens and trash cans in picnic areas.

The treatment for stings is first to remove the stinger, if still present, by scraping it off or using tweezers. Then apply ice or a cool compress to the area. Meat tenderizer or baking soda relieves the pain; mix either with water and rub the mixture on the bite. You can also use acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) for the pain and Benadryl for the swelling and itching.

Call our office if a bite appears infected (red streaks, increasing tenderness, continued increase in swelling).

Meningitis is an infection of the spinal fluid, usually caused by a virus or one of several types of bacteria. Viral meningitis is less severe and resolves without specific treatment. There are three types of bacterial meningitis, for which we have vaccines and antibiotic treatment. Younger children receive vaccines for Hemophilus influenzae type b (HIB) and pneumococcal (Prevnar) meningitis. Meningococcal meningitis is the third type of bacterial meningitis, which is often fatal because of its rapid progression and its high level of contagiousness. Symptoms of meningitis are high fever, headache, stiff neck and also may include nausea, vomiting, extreme light sensitivity, confusion and sleepiness. A rash may also occur with meningococcal meningitis.

Although meningococcal meningitis may occur at any age, certain lifestyle factors may increase the risk of contracting and spreading the disease. These are direct contact with an infected individual, especially through saliva, crowded living conditions and active or passive smoking. Until this year, the vaccine that was available to protect against this disease (Menomune) was given primarily to those adolescents/young adults going off to college, because of the above risk factors. That vaccine had been shown to last for approximately 3-4 years. The American Academy of Pediatrics has just begun recommending the new meningococcal vaccine (Menactra), which lasts longer and may be boosted if it turns out to be necessary as future studies are done. The recommended ages for the vaccine are:

• 11-12 year olds
• adolescents at age 15 or high school entry, whichever comes first
• college freshman living in dormitories
• other groups at high risk (those with underlying medical conditions or those traveling to areas with a high incidence of meningococcal disease).

Once the supply of the vaccine is adequate, in 1-3 years, the vaccine will be recommended for all adolescents, 11 and up. The vaccine may also be approved for 2-10 year olds in the future.

We will be vaccinating those children in the above groups at their physicals. If your child falls into any of these groups and has already had his/her physical this year and you wish them to have the vaccine, please call our office for an appointment.

As your children are outside more in this season, they may be around more animals, both pets and wild animals. Any animal may bite, although wild animals and unvaccinated domestic animals present the highest health risk.

The two risks are infection of the skin from the bite itself and rabies. Dogs and cats can both cause local infection, although cat bites become infected more often. Unfortunately, rabies in wild animals in our area puts unvaccinated pets at risk, making them potential transmitters of this fatal disease. Raccoons, skunks, bats and foxes are potential rabies transmitters in our area. Squirrels and groundhogs generally do not transmit rabies, however it has been reported.

Prevention of exposure to a bite is most important. Children should be taught to stay away from and especially not pick up wild animals (especially sick appearing ones). They should also avoid strange dogs or cats and be taught not to provoke or bother them while eating or sleeping. There should be adult supervision of any child around animals.

If your child is bitten by a domestic animal which has been vaccinated against rabies, clean the wound well with soap and water. If the wound has persistent active bleeding, call our office to see if it needs suturing and check on the tetanus status of your child. If the wound is superficial, watch for signs of infections (pain, swelling, redness, pus formation). The animal should be observed within the owner’s home for 10 days for any sign of illness.

If the bite is from a wild animal, unvaccinated or unknown status animal, wash the wound well with soap and water. Then call our office so that we may examine the wound. Also, rabies prophylaxis with vaccination may be necessary. The police should be called to capture and quarantine the animal--don’t try to do this yourself. Because of the possibility of rabies, all animal bites must be reported by the physician to the local health department.

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