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With kids spending so much time outdoors this time of year, lots of parents are bringing their children to the clinic with all sorts of bug bites. I'm not always sure if the bite is due to a mosquito, flea, biting fly, or some other culprit, but some of the bites can cause significant reactions.

The immediate reaction to an insect bite usually occurs within 10 to15 minutes after the incident, with local swelling and itching, which may disappear in an hour or less. A delayed reaction may appear in 12 to 24 hours with the development of an itchy red bump, which may persist for days to weeks. This is the reason some people don't always remember being bitten while they're outside, but the following day may show up at the clinic 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 very common in children. For some reason, it seems to me that "baby fat" responds more quickly and severely than the flesh of older kids and adults (no science, just anecdote). Toddlers often have itchy, red, warm swellings within minutes of a bite. Some will go on to develop bruising, and even spontaneous blistering, 2 to 6 hours after being bitten. These bites may persist for days or even weeks, so in theory, those little chubby legs may be affected for most of the summer.

Severe local reactions are called "sweeter syndrome," and occur within hours of a bite. The response may involve swelling of an entire body part, such as the hand, face or an extremity. Such reacations are often misdiagnosed as cellulitis, but with a good history of the symptoms (the rapidity 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 of the swelling and itching. Do not use topical antihistamines. Try to prevent secondary infection (from scratching and picking) by using antibacterial soaps, trimming your child's fingernails and applying an antibiotic cream (polysporin) to open bites.

Due to an exceptionally warm winter throughout the country, the mosquito population seems to be especially prolific this year. The best treatment, of course, is prevention. Before going outside, use a DEET preparation for children over the age of six months, at the lowest concentration that's effective. Mosquito netting may be used for infants in strollers. And remember, do NOT reapply bug spray like you would sunscreen.

(Dr. Sue Hubbard is a nationally known pediatrician and co-host of "The Kid's Doctor" radio show. Submit questions at http://www.kidsdr.com.)