This week, we picked up a camper. What is it?
What is it called? I don't know. I don't know
what these are called. It's like a tent for your
car. It's a tent that you put on the roof of
your car. And it goes pop! Boom! And then you
can sleep in it. And there's a little ladder.
So the idea is that we are gonna go camping.
The idea. The idea is that me and you and the
dog and the baby, that we're outdoor people and
we're gonna go camping. And that we're all gonna
sleep in the same small little space with a dog
and a baby. The main downfall of this plan is
that the last time I took my dog hiking, I let
him run through all the tall grass, he was chasing
all the bugs, and he, despite being small, loved
the hike. Uh oh. Is there like a part B to this?
I was thinking, look how happy he is! And then
an hour later, I was thinking, why is he covered
in all these tiny little black dots that are
moving? Oh god, I'm just ready. vomit in my mouth.
And then I had to sit with tweezers and remove
over 50 ticks from his tiny little body. I feel
like this is an important lesson about hiking,
but we're going to try car camping anyways, because
the good news is most people are not removing
50 ticks from their children after a hike. But
every summer we see families worried about tick
bites, giant mosquito bites, bee stings, poison
ivy, and all sorts of mysterious rashes. The
tricky part is knowing what's normal and what's
not, and when it's time to seek professional
help. Giant mosquitoes are not normal, but they
are in Alaska. Do you remember how big those
mosquitoes were? They were the size of bears,
honestly. They were small bites, but giant mosquitoes.
But here I think you mean... Big bites. Big bites
from little mosquitoes. Well, welcome back to
this week's episode of the Rolin Forward podcast.
I'm Dr. Stephanie Rolin. I'm Dr. Alicia Rolin
I'm a forensic psychiatrist. And I'm a pediatric
emergency physician. And this podcast, we decided
to do this because as physicians, as sisters,
we know that parents are constantly just inundated
with health information. Some of it's accurate.
A lot of it is confusing. And sometimes just
misleading. And then you're, you know, kind of
sorting through all this trash, trying to find
the truth. Our goal is to cut through the noise
by bringing you practical, evidence -based information
that helps you make informed decisions for your
family without the fear, the hype, or the misinformation.
In this summer, we're doing something a little
different. It's our Summer School, our special
summer series where we share lessons from the
pediatric ER with one goal. We want to help your
family enjoy everything summer has to offer while
avoiding unnecessary trips to the emergency department.
Today's class is Bugs, Bites, and Backyard Adventures.
We'll cover tick bites and Lyme disease, mosquito
bites, skeeter syndromes, bee and wasp stings,
poison ivy, and how to tell what's a normal part
of summer and what deserves a call to your pediatrician's
office. So let's start with the bug that probably
worries parents the most. It certainly worries
me a lot. Ticks. Ticks. Now I'm convinced that
every freckle on my dog is a tick, from now until
forever. Yeah, once you find one, then you just
see them everywhere. The good news is that while
tick bites are common, most tick bites don't
result in diseases like Lyme disease. And knowing
what to do after you find a tick on your body
can make a big difference. So let's start with
the basics. I'm a parent, my child goes to play
outside, they come home, and there's a tick.
Do I burn the house down? The reality would be
that you would scream and call me. I would probably
just send her to you. I'd be like, go see your
Tati. Just like leave. Put her in a bubble. Bring
her house down. No, but really. In this hypothetical
situation, what should a parent do? In this hypothetical
about -to -be -real situation in car camping.
The first step is simple. Remove the tick as
soon as you notice it. Send to me and I'll remove
the tick as soon as you notice it. Either you
or another adult who is nearby should remove
the tick as soon as you notice it. The Center
for Disease Control and Prevention recommends
using a pair of fine tipped tweezers. You grasp
the tick as closely to the skin surface as possible
and pull upwards with a slow and steady pressure.
The goal is not to twist or jerk it because you
don't want it to break off into different pieces
or to leave the mouth part in the skin. Mouthpart
is a word that I did not need to know. Mouthparts?
Both. With an S? Worse, worse. Once the tick
is out, wash the bite area and your hands with
soap and water or rubbing alcohol. I remember
growing up, there was all kinds of things people
wanted to do, like burn the tick with a match,
which how do you do that without burning the
skin? Honestly, I don't know. Or just put lots
of petroleum jelly or aquaphor on it, or nail
polish. Those are all things that the CDC specifically
recommends not doing. They don't help remove
the tick, and they actually might increase the
chance that the tick releases more saliva into
the bite before it lets go. Tweezers are really
the safest and most effective method. So once
the tick is removed, do I need to run to the
emergency department? And chop off their arm?
These are the only choices. Essentially never.
Most tick bites can be managed at home. And in
fact, most tick bites never lead to Lyme diseases
or other diseases. Not every tick carries the
bacteria that causes Lyme disease. And even when
an infected tick is involved, the risk of transmission
depends on how long it's been attached. In general,
the bacteria that causes Lyme disease isn't transmitted
immediately. The risk increases when the tick
has been attached for 36 to 48 hours or longer,
and it looks engorged. and you can look up photos
on the internet and have nightmares forever.
I'm just going to call you. I'm not going to
look that up. It sounds like finding a tick doesn't
automatically mean that you need antibiotics.
Exactly. For most children, antibiotics are actually
not recommended after a simple tick bite. There
are very few specific situations where a single
preventative dose of doxycycline may be appropriate,
such as a high -risk bite in an area where Lyme
disease is common. but that's something to discuss
with your pediatrician or another healthcare
professional if you've noticed a tick bite. So
let's say that there's a tick bite, the tick's
removed, you speak to your pediatrician, antibiotics
aren't recommended. Should parents watch for
anything over the next few weeks? The biggest
concern with tick bites is Lyme disease, and
the classic symptom is an expanding rash called
erythema migrans. Despite the pictures that people
see online, it doesn't always look like a perfect
bullseye. It usually starts several days after
the bite, and it gradually gets larger. Parents
should also watch for fever, fatigue, headaches,
muscle aches, facial weakness, and swelling in
a large joint, typically a knee. And if these
symptoms develop ever tick bite, it's time to
call your pediatrician. So, I just don't want
anything to do with ticks, ever. Is there a way
to just avoid any of this in the first place?
Prevention is key. You don't have to avoid hiking
or spending time in wooded grassy areas. But
if you're in spaces where ticks live, You can
use an EPA -registered insect repellent or long
sleeves and long pants when practical and consider
clothing that's been treated with permethrin.
When you come inside or right before you come
inside, do a quick tick check on yourself, your
kids, and your pets. Showering soon after outdoor
activities can help wash away ticks before they
have a chance to attach. Adding permethrin to
my online cart right now. The goal isn't to avoid
being outside, it's to enjoy the outdoors while
making tick checks part of your routine, just
like putting in sunscreen. You put on sunscreen
before you go out, you check for ticks before
you go in. Alright, so moving on from the bug
that scares parents the most to the bug that
simply annoys everyone the most. Mosquitoes.
Why do mosquitoes love kids so much, particularly
my child? The truth is that mosquitoes are attracted
to things like body heat, carbon dioxide, and
certain chemicals on our skin. And children certainly
get bitten a lot, especially because they're
outside a lot, playing in the summer, probably
more than adults. And while most mosquito bites
are just itchy and annoying, some children have
much bigger reactions. I remember I got a mosquito
bite on your face and it made one of your eyes
swell so much. You looked. Terrible. Thank you.
Yes, you did. It was terrible. That's actually
a great example. Children can have what's called
a large local reaction, sometimes referred to
as Skeeter syndrome. It's an allergic reaction
to the protein in the mosquito's saliva. And
the bite can very quickly become swollen, red,
warm, and super, super itchy. It can look incredibly
dramatic, especially if it's on the face. But
that doesn't mean that it's infected. So how
can parents tell the difference between a big
allergic reaction to a disgusting annoying mosquito
bite versus a bacterial skin infection, something
like a cellulitis? That's a great question because
they can look very similar. A large local reaction
usually develops within hours of the bite. It's
usually very itchy and the swelling may continue
to increase over the first day or two before
it gradually improves. A bacterial skin infection,
on the other hand, it tends to become progressively
more painful rather than itchy. The redness continues
to spread, the skin may become tender, and totally
may develop fever or drainage and pus from the
area. If you're ever unsure, it's always reasonable
to check with your pediatrician. So what should
parents do for a typical mosquito bite or even
one of these bigger reactions? I'm itching my
whole body. I know, this episode is making me
itch. Are we all so, so itchy? Are you itchy
listening to this? So itchy. And now you're making
me itch. The goal is to control the itching and
the swelling. A cool compress can help. For children
with bothersome itching, a low -potency topical
corticosteroid, like the over -the -counter hydrocortisone
cream that you can find at any local pharmacy,
might provide some more relief. An oral antihistamine
like Zyrtec can be helpful for itching. And if
it's keeping your child awake, consider using
Benadryl. Which can treat the itch and make people
sleepy. Perfect. Win, win. And as hard as it
is, try to keep kids from scratching. Scratching
breaks the skin and increases the risk of developing
a bacterial infection. All right, so now my favorite
question. Let's just go back to prevention. And
I want to keep mosquitoes from existing in the
first place. Or biting me, at least. I think
that's particularly important. We live in an
area where there is West Nile virus. I'm sorry.
I'm sorry, Dr. Fauci, who canceled his grand
rounds at my hospital because he was actively
sick with West Nile virus. The CDC and American
Academy of Pediatrics recommends using an EPA
-registered insect repellent where you're spending
time outdoors where mosquitoes are active. Products
containing DEET or Picardin? are both safe and
effective while used according to the label.
For children, insect repellent should be applied
by an adult, avoiding the hands, eyes, and mouth,
and it shouldn't be used on infants younger than
two months. Long sleeves and pants can also be
helpful when practical, and one of the easiest
things that families can do around the house
is eliminate standing water. Things like buckets,
flower pots, bird baths, kiddie pools, tires
can become mosquito breeding sites. More words
that I did not need to hear, but it sounds like
overall these giant mosquito bites, whether from
a giant mosquito or a giant bite, can look alarming,
but it's not automatically an infection. It's
not automatically an emergency. Exactly. Most
mosquito bites are more uncomfortable than dangerous.
The biggest challenge is knowing when it's simply
an exaggerated allergic reaction and when it's
something that could deserve a closer look by
your pediatrician. So now we're moving, this
is like a tale of horrors here. We're moving
from mosquitoes to another summer classic, bee
and wasp stings. And I don't know about you,
but I'm always thinking, is this normal or is
my child allergic? That's actually one of the
most common questions I hear. The reassuring
news is that most bee and wasp stings can cause
a normal local reaction. It hurts right away.
and then it looks red and swollen and it's tender,
and the swelling might even increase the first
24 to 48 hours before it starts to improve. So,
speaking of someone who navigated this last week
with one of the children in our home, a swollen
hand after a sting doesn't automatically mean
that something is wrong? It does not mean that
something is wrong. It means that they were stunned
by a bee. A large local reaction can look dramatic,
especially if the sting is on the fingers, foot,
or face. but that doesn't necessarily mean that
your child has a severe allergy. Similar to the
other bug bites, the first step is to wash the
area with soap or water, apply ice or cold -back
to help with pain and swelling, and you can use
age -appropriate medications if needed, things
like NSAIDs, Advil Motrin, things like antihistamines,
Benadryl, and Zyrtec. If your child is stunned
by a honeybee and you can see the stinger, you
want to remove it as soon as possible. How you
remove it doesn't really matter. You just want
to take it out of the body so it stops releasing
venom. So some kids are allergic and when should
parents start worrying about that? The concerns
about allergy is something called anaphylaxis.
Anaphylaxis are when symptoms extend beyond the
sting itself. You should call 911 immediately
if a child develops difficulty breathing, wheezing,
swelling of the lips, tongue or throat, repeated
vomiting, dizziness, fainting, along with widespread
hives along the body. These are all signs of
a severe allergic reaction that require immediate
treatment with an EpiPen. And so that's different
than having a swollen finger or a swollen arm.
Exactly. It's a whole body involvement. It typically
involves multiple systems. So your skin, your
GI tract, your respiratory system, your heart,
and so it's a full body reaction. So it sounds
like the good news is that these severe allergic
reactions are uncommon and most kids can recover
with simple supportive care. But now let's finish
with one of the itchiest parts of summer as people
who are about to go car camping. We haven't talked
ourselves out of it yet. And that is poison ivy.
I feel like every family has a poison ivy story.
Absolutely. Every summer we see kids who have
somehow managed to find one patch of poison ivy
on the entire hiking trail and decided to use
that. as toilet paper, and also rub it all over
their body. I mean, the memories. I don't know
who did that. I think one of the biggest misconceptions
about poison ivy is that it spreads because you
scratch it. The rash itself isn't once contagious,
and so scratching doesn't spread it. Poison ivy
is caused by an oily resin called urushal that's
found on poison ivy, poison oak, and poison sumac
plants. Once the oil is washed off your skin,
you can't spread the rash to someone else. But
what can happen, though, is that the oil stays
on your clothing, your shoes, your backpack,
your gardening tools, or even your pet's fur.
And if someone touches the oil later, they can
develop their own rash. So if your child is coming
from the woods, or perhaps your backyard, and
you think that they have touched or brushed against
poison ivy, what should you do? You want to wash
the exposed skin with soap and water as soon
as possible. It's also super important to wash
clothing, shoes, any gear that might have come
in contact with the plant. And your dog, if it's
been running through the woods, might need a
bath too. Oh, it's a family horror story. Removing
the oil early may reduce how much of a reaction
develops. But what if the rash does appear? Most
cases can be treated at home. Cool compresses
can help with itching, and over -the -counter
topical corticosteroids may be helpful for mild
localized reactions. Try to keep kids from scratching
too much because scratching breaks the skin and
increases the risk of a bacterial infection.
For more extensive rashes, especially those involving
the face, eyes, or genitals, or if the itching
is severe, that's usually when it's time to call
your pediatrician. Some children might need prescription
medications, including oral steroids. So to wrap
up, it sounds like we should go car camping.
We should not avoid the outdoors, but we should
be aware of what poison ivy looks like. We should
wash up after any possible exposure and then
realize that most cases can be managed at home.
Exactly. We want kids outside exploring, hiking,
camping, and playing. But a little preparation
goes a long way towards making sure these adventures
end with great memories and not a week of itching.
So before we wrap up, what is the biggest takeaway
from today's lesson? I'd leave parents with three
things. First, prevention goes a long way. Whether
it's an EPA -registered insect propellant, checking
for ticks after a hike, or learning to recognize
poison ivy, poison oak, poison sumac, a few simple
habits can prevent a lot of summer misery. Noted.
Second, most bites, stings, and rashes are more
uncomfortable than dangerous. They can look dramatic,
but they're often a normal part of spending time
outdoors. Check. And finally, know the warning
signs. Difficulty breathing after a sting, expanding
rash or fever after a tick bite, poison ivy rash
involving the eyes or face, are all good reasons
to call your pediatrician. So let's plan not
to keep kids inside. Let's get outside, let's
explore, hike, catch bugs, maybe even car camp,
make some memories. But let's do it feeling a
little bit more confident that we know what we're
handling when everyone's just got a few extra
bug bites coming home. And that's our episode
for today. Thank you for joining us for another
episode of the Rolin Forward podcast on our
summer school series. And if you enjoyed today's
episode or it just made you itch, we'd love it
if you subscribed. We usually don't talk about
bugs. It's usually not an itchy podcast. You
can leave us a five -star review and then share
it with someone else in your life. You can find
us on social media, send us an email at rolinforwardshow
.com. And then we'll see you next week for another
lesson from the pediatric emergency department.
Until then, stay safe, itch free, and enjoy the
summer.