June 18, 2024 • 33 mins
In this episode of Pediatrics Now, host Holly Wayment welcomes back Dr. Tess Barton, a pediatric infectious disease expert at University Hospital and The University of Texas Health Science Center at San Antonio, to discuss the common bug bites parents might encounter during the summer. Dr. Barton explains how to distinguish between mosquito and bedbug bites, the signs of a bedbug infestation, and effective treatment options for bug bites.
Dr. Barton shares practical advice on preventing bedbug infestations, including how to inspect hotel rooms and manage infested items. She also covers the dangers of mosquito bites, the effectiveness of various repellents, and the importance of preventing mosquito-borne diseases.
Listeners will learn about other common biting insects, such as fleas, chiggers, and scorpions, and how to identify and treat their bites. Dr. Barton emphasizes the importance of flea control to prevent diseases like murine typhus, which is prevalent in San Antonio.
Tune in for expert insights and tips on keeping your family safe from summer pests.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Music.
(00:05):
Here we are in summer and we're in extreme heat advisories here in San Antonio.
And back on the show is Dr. Tess Barton. She's our pediatric infectious disease expert.
Tess, thank you so much for being back on Pediatrics Now.
Thanks for having me. So, you know, in the summer, the most common bug bites
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that we're going to see are going to be mosquito bites.
And, but I think that when parents come in and they're worried about bug bites,
maybe the thing that they are often worried about are bedbugs.
And so there are a few little clues that you can use to distinguish bedbug bites
from, from mosquito bites.
(00:52):
So the most common findings for mosquito bites is that mosquitoes generally
will bite you where you are exposed, right?
So they're small, they're not strong, they don't have a lot of abilities to
bite you through your clothes.
So if your ankles, your arms, those places are exposed, Those are the places
(01:17):
where you will get bites.
And, you know, mosquito bites can look very different from person to person
because some people are very reactive to them and they will get these really
big welts and some people are not. And they'll just get a little,
you know, little pink bump.
Bedbugs, on the other hand, of course, they don't bite you when you are outside.
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They bite you when you are sleeping peacefully in your bed or on your sofa or
whatever fluffy place that they happen to be living in.
And bedbugs actually like to crawl around under your clothing as well.
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So they don't limit themselves to the places that are exposed.
They also often live at the top of the mattress, underneath the top of the mattress.
And so they will bite you on your face, whereas mosquitoes less likely bite you on your face.
So if you are seeing large red bumps that are also in places that were covered
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by clothing and are scattered kind of all over the body or on the face,
those are warning signs that that actually might be a bed bug infestation.
So in that case, what are we supposed to do?
And if anyone who's listening is having trouble sleeping, just skip this episode for now. Yeah.
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We can talk about all sorts of other bugs, because there's other things and
they each have a pattern.
So you want to know what should they do if they suspect they have bedbugs?
Yes. All right. So bedbugs are an insect that mostly lives in the,
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most commonly lives kind kind of on the underside of your mattress.
And so they come out at night. So you may not ever actually see them crawling
around because they burrow and they hide during the daytime.
So if you feel them and it's the nighttime, you can turn on the lights really
fast and sometimes catch them and see them.
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They vary in size. Most of them are just a few millimeters long.
They look kind of just like a boring little gray bug.
But the hallmark of finding them is that if you pull up the edges of the mattress,
like lift the mattress and look on the underneath side,
you know how like some mattresses have that little strip of piping along the
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edge, you might have to like pull that to the side.
What you may see is you might see the bugs themselves, but more commonly what
you'll see is you'll see their poop.
And because they eat blood, their poop actually looks like dried blood spots.
So if you're finding things that look like dried blood spots clustered on the
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underside of your mattress, that's the telltale sign of bedbugs.
So the first thing is...
Get rid of the mattress? Yeah. I mean, so you probably, you know,
there are many different ways that have been tried for dealing with bedbugs.
Ultimately, getting rid of the mattress is the most effective.
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But you also have to usually treat the home or the room as well,
because they could be hiding in other places, and then they'll just set up shop on your new mattress.
So we recommend any
pillows or beddings or cushions that can be physically washed in the dryer should
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be washed on hot water and dried in high heat to really kill them off.
The other thing that you can do is if it's something too large or bulky to put
in the washer and the dryer, like your sofa or a large pillow,
that you can wrap them up in a black plastic bag and ideally place them in the sun where it's hot.
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But wrap them up in a black plastic bag for a couple of weeks,
because that actually allows,
it traps the bugs, they can't get out, and they will cycle through their life
cycle and any eggs that they have laid will hatch, but they won't have anything
to eat, and then they will die.
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People will often do, you know, like a bug bomb, right, like an insect in the house.
And you can get permethrin sprays and spray, you know, spray your sofa,
spray the undersides of things.
But in general, if it can be if there's toys or cushions or beddings,
you want to wash them, and then be vigilant and keep an eye out for them returning.
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Sometimes bedbugs can be very persistent.
Dr. Barton, do we need to worry about bedbugs or even think about them if we
haven't been traveling recently?
Sure, sure. We have plenty of bedbugs in Texas. So people do pick them up,
you know, often when they are on travels and they stay in a hotel and the bedbugs
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stows away in their luggage and then finds a new home.
But it's also possible for your neighbors to have bedbugs and they come over visiting your house.
Not the neighbors, the bugs. So then they can leave the bugs when they leave?
No, like the neighbors don't bring the bugs. The bugs take a journey.
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They come walking over, seeking out new housing.
Like walking through the grass and everything. Yes.
Speaking of grass, there's also tons of other bugs that you can get in the grass. Yes.
So before we move on, so with the bedbugs, can they be harmful or make us sick or make children sick?
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No, generally they don't make you sick.
I don't know of any diseases that I can think of off the top of my head that
are transmitted by bedbugs.
There are diseases that are transmitted by lice and fleas and mosquitoes,
of course, but I don't know that bedbugs actually transmit any diseases. They...
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But they are miserable. Like the bites of bedbugs are extremely, extremely itchy.
And so people who have those bites are pretty miserable for several days.
So what do you recommend for kids? What should the parent do?
If they are bitten? Yes.
I mean, to treat bedbug bites, it's the same kind of grandma medicine that we
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use for other types of bites.
You can use, you know, calamine lotion and antihistamines like, you know, Benadryl.
You can do, you know, oatmeal baths, things that help to dry them up.
Do you recommend Benadryl cream? You can use Benadryl cream,
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but you shouldn't use Benadryl cream and Benadryl by mouth together because
you do absorb some when you put cream on.
So you can also use hydrocortisone cream or other
you know steroid anti-itch creams to to
help with those and just follow what it says on the on the tube yes yes so and
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i know you're a world traveler do you keep your suitcase like not on carpet
when you travel for this reason or is there anything thing you do as a lot of
us are heading on summer vacations?
Yes. So I actually had a bed bug experience when I went to Laos and I had,
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it was, it was sort of the very busy new year's time.
So there were limited hotel rooms. And when we had booked a hotel for a few
days and, and we're peacefully sleeping in the bed when suddenly I felt like.
I felt things crawling on me and I freaked out and flipped the lights on and started looking.
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And I found, I saw the bugs and I immediately packed up my luggage and threw it out of the door.
And it was two o'clock in the morning and we were like, we're not staying here.
And of course, like it was a small town. It wasn't like a big city where things
were open 24 hours and had to like walk around looking for another hotel where
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there was somebody at the desk.
And when we finally found one and we told them like, oh, my gosh,
we were at this other place and there were bugs. Like, you can't bring your things in here.
And they put our things outside and in the morning, right on the street,
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because it was right at the street with a little plaza in front of everybody,
we had to unpack our luggage,
spray everything down with tons of insecticide spray.
We did find one bug in the luggage. oh so
so now after having that experience literally
every time that i go to a hotel or
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an airbnb the first thing
i do you know i walk in i make sure that
it doesn't smell like smoke or whatever and i immediately go to the mattress
and i pull up the mattress and then look at the underside and if there's a cover
i'll unzip the cover and i'll look inside the cover to see if If there's any
signs of those blood spots that are the bed bug poop, because I never,
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ever want to deal with that again.
Wow. So you do that every time that, but that makes sense. And you,
you, what were you saying about smelling smoke, smelling for smoke?
Well, I just don't like smoke in the room, so. If someone had been smoking. Exactly. Yeah.
So that's really smart. And then do you keep your luggage not on carpet for
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24 hours when you get back or do anything like that?
No, I don't usually do that. I just, if I see any evidence of bed bugs,
I just don't stay at the place.
Do you look at all parts of the underside of the mattress or just one corner?
Would they be in all corners or can you tell us about that i usually look at
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the top the two top corners up by the headboard because that's the most common
place where they cluster yeah.
Have you found any yet hopefully not no
yeah okay and did
that ruin your trip to laos it did not it
did not it was we had an amazing trip i was
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actually yeah we were actually in the the process of
moving there when this happened so yeah so
no it was it was fine but it did it you
know it did it did make me very wary of of
of of places of hotels so how long did you live in Laos and what were you doing
(12:33):
there I lived for a year in Laos and I was there's a little children's hospital
that is sponsored by a non-profit organization in a town called Luang Prabang,
which is a UNESCO World Heritage Site.
It's a really lovely town with the sort of highest concentration of Buddhist temples in the world.
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And so I was volunteering at a little hospital doing pediatric work. That sounds amazing.
That's wonderful. Well, thanks for sharing that story with us.
So should we, shall we move on to mosquitoes? When should we worry about mosquitoes?
What do you do to protect yourself against mosquitoes? Do you use any kind of
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spray or is it mostly clothing?
So yeah, we should worry about mosquitoes. Mosquitoes are the most dangerous
animal in the world, right? Yeah.
They kill more people than any other animal. Wow, I did not know.
Because they transmit a variety of diseases. So luckily, you know,
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here in the U.S., we don't have many of those diseases.
You know, we don't have malaria and yellow fever and dengue,
at least not much dengue.
So we don't, you know, we don't have to worry as much about mosquito-related
diseases, although we do have some.
But yeah, mosquitoes are more an annoyance than anything else.
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And but it is a good practice to
try to avoid them so again as i
mentioned they don't they usually don't bite through clothing because they're
not strong enough so long sleeves long pants protective clothing is is a good
all-purpose way to protect yourself from mosquito bites and then yes i i do
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use insect repellent i unfortunately have to use insect repellent like
every day when I go out in my garden to do anything because it's mosquito land.
And so for myself, I prefer to use a DEET-containing repellent,
usually around a 30% DEET.
For children, we recommend that children under two months shouldn't use insect
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repellent. They should use protective clothing.
Children over two months, the AAP does recommend that they can use insect repellents,
but they should have a lower concentration.
So the.
So if it's a DEET-containing repellent, they recommend a 10% DEET product,
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and that will give about an hour and a half of protection against mosquitoes.
So you do have to reapply it if you're going to be outside for longer than that.
Although, when it's a billion degrees outside, I can't imagine why anybody wants
to be outside that long. Right, exactly.
And do you, again, follow the recommendations that's on the container for children?
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I do. I do. But it can be very confusing, right?
Because they also have a list of ingredients and it's hard to know like,
you know, what's the best one.
And a lot of people don't want to use DEET, right?
It's a chemical and we do absorb it into our system a little bit.
About 10% of it we absorb into our system.
And so a lot of parents prefer something that's more natural.
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And there are there are some
alternatives but i think parents need to be aware of
kind of the pros and cons of those different things there are
you know there's all sorts of like citronellas and oil of lemon eucalyptus and
and a variety of like essential oils rosemary oils and things like that that
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are in if you look at like the you know like the skintastic for kids or whatever
It has those kinds of things in them.
And there have been comparative studies looking at how well those work compared
to DEET and other things.
And they are not as effective as DEET.
They also, because they are natural plant-derived oils or plant-derived products,
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sometimes people are actually sensitized to them and they can have like skin
reactions to those products.
So, you know, it doesn't mean that you can't use them.
It just means that you have to anticipate that they may not be as effective
and be on the lookout for the potential for skin reactions.
So, and the pros and cons. So, for you, where you use DEET, it's more important
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to avoid the potential harm a mosquito could cause.
Can you tell us about that? Well, sure.
So, I mean, you know, like I said, here in the U.S., where we don't have as
much of an issue of mosquito transmitted diseases, we do have,
most commonly, we do have West Nile virus.
There are some other viruses that mosquitoes transmit that can cause some serious
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infections, but they're pretty rare, right?
So it's unusual to get a mosquito bite that then leads to some sort of disease
here in the U.S., but it's not unusual elsewhere in the world.
So little travelers, for sure, should be protecting themselves against mosquitoes.
And that's a whole separate issue of bed nets and things like that if you're
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going to be doing international travel.
But here in the U.S., it's really just, you know, doing your best to avoid the
bites so that, you know, you don't scratch it like crazy and get impetigo or something, right?
And to avoid the annoyance and the, you know, the infections that we cause from
our fingernails from messing with our itchy skin. Yeah.
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Dr. Barton, so we were talking about some mosquitoes. Do you think,
A, DEET is okay for kids, or is there anything more you want to say on that?
And B, when should we worry about mosquito bites? We don't usually have to worry
about the health consequences of mosquito bites here in the United States,
but we should worry about them when we're traveling.
As far as is DEET safe for children? Yes, DEET has been shown to be safe for children.
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And we do prefer to give a lower concentration because we know there can be some absorption.
Absorption the there's no reason to
do a hundred there are 100% DEET products
that are available at outdoors stores there
there's really no reason why anybody needs 100%
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DEET other than you want to feel macho about your mosquito but but but that
is too concentrated for children for parents who want a more natural approach
the actual the next best alternative is a product called oil of lemon eucalyptus,
which is a tree with an oily leaf that has a citrusy kind of smell.
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And there was actually a very interesting comparative trial looking at a variety
of different mosquito repelling methods.
And the oil of lemon eucalyptus was around the same effectiveness as DEET.
And so, it is a good alternative for parents who are looking for a more natural,
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less chemical product for an insect or talent.
And with empytygo, is that you scratch it too much and then there's bacteria
under the nail or something? How does that happen? Exactly.
So, empytygo is caused either by staph, a common skin bacteria,
or by group A strep, which is a common throat bacteria.
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And so you basically scratch the skin, you know, as long as bacteria are sitting
on a surface of your skin and not in your skin, they don't really cause you a problem.
But if they get to where they don't belong, that's when they begin to cause an infection.
And so then you can get impetigo. And that can be not only very painful and scarring,
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that can sometimes turn into a bigger infection or have some of the consequences of strep infections.
But yeah, so that's really the main issue with mosquitoes here.
We have not had any human West Nile in Texas this year, although mosquitoes
have tested positive, including mosquitoes in Bexar County.
(21:11):
Wow. But that just means, luckily, it isn't happening. Is it going to happen
this summer, do you think?
I don't know. You know, so the health department does these like sentinel screenings.
So they have mosquito pools, like collections of mosquitoes,
which sounds like the grossest thing ever.
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And they have what are called sentinel chickens that are these like coops of
chickens that they test periodically and horses.
So they test sort of the other animals that can carry this virus.
And so the mosquitoes have tested positive. But typically what
happens when they get a positive test is
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the health department actually will normally do some sort of like regional or
local spraying in the area where those mosquitoes have tested positive so that we don't have,
you know, diseases. And that's been effective.
We have really only a handful of West Nile cases each year. For families,
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you know, there are mosquitoes breed in water and in wet wood.
And so anything where there's a pooling of water that's not regularly flowing
is where you'll find the little mosquito, wiggling mosquito larvae.
So in your potted plants, and if there are tires or other things that are in
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your yard that have gotten rain in them,
and they have a little puddle of water, that's a place where mosquitoes will breed.
And so in your own household, making sure that you've dumped the water out after rains.
And that you don't have standing water that, you know, that if you've got a
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cistern, like a rain cistern or a pool or something, I mean,
pools should be circulating,
but or a fish pond, you know, like those kinds of things should be,
they either need some kind of circulation system so that the water is not stagnant
or they need to be covered. So the mosquitoes don't get in them.
That's great advice. And with the impetigo, if it's swelling,
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it looks like an infection, it's red.
What do you do from there? So yeah, so impetigo will look like,
you know, usually a red, swollen, painful, crusty, oozy little lesion.
It's kind of round and raised.
In Haiti, they call them boutons, which means buttons. So imagine a button on the skin.
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And, yeah, and so usually that can be treated if they're early,
they can really just be treated with a topical antibiotic ointment,
cleaning them, you know, cleaning them well, keeping them dry and treating a
little topical antibiotic is usually enough.
If there's a ton of them or if they have a larger zone of redness around them
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where they're causing kind of a larger skin infection, then that might need
systemic antibiotics, right?
So, antibiotics that you take by mouth. My last question about mosquitoes,
I was reading in the Washington Post that when we breathe out,
it's basically telling the mosquitoes that we're there and we can be like this
giant protein shake for them. That's very attractive. Yeah.
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And but do we build up, you know, like over time, the bites may not show up
on our skin because we're not getting that reaction.
We have an immunity to the reaction, but we still would could are we still exposed
to the potential danger or what do you say about that?
Yeah, that's actually a great question. So, you know, there are mosquitoes are
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attracted to a variety of chemicals that we, you know, that we exude.
And some people are kind of more mosquito magnets than others.
And actually, people who eat a lot of garlic naturally repel more mosquitoes than other people.
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Maybe that's a wives' tale. I don't think it's a wives' tale, though.
And that's part of the basis of the vampire myths.
And and so yeah but but but
many people will report the experience of you
know at the beginning of the mosquito season you know
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in the spring after it's been raining a bunch and the mosquitoes have suddenly
been breeding and it's starting to warm up you'll get like one million bites
when you go out and then you know after a month or so you just don't get bitten
anymore and i always joke around that when that's happened to me,
that it's like the mosquitoes can smell that I'm like all used up and they're not fresh anymore.
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They don't want that. But really, it's much more likely that what happens is
our immune systems get reminded about the mosquito saliva.
And while we initially have a little allergic response, which is what makes the little itchy spot,
we get desensitized after repeated exposures so that we're just not as allergic
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to the to their saliva anymore so they may be that they're still biting us but
we are just not not responding to those bites the way that we did initially,
And do we need to not worry about getting one of those rare diseases then, too?
No, I mean, no, not usually. Like, if there's an outbreak, then yeah, right?
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If there's suddenly on the news that, like, oh, several cases of West Nile have
been reported, then yeah, I would be a little bit more robust about mosquito avoidance.
But for the most part, I mean, it is quite rare. So really, it's more for mosquitoes
in the U.S., more of an annoyance than they are truly dangerous.
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Do you recommend once it seems like the mosquitoes are not biting you,
still put the DEET on or can we stop them?
You know, there are mosquito seasons. So actually, when it gets super,
super hot, it's too hot for the mosquitoes.
They don't want to be out either. They want to hide in their nice, cool spaces.
So, I think that you can see sort of how often are you getting swarmed by mosquitoes
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when you go out and decide if you want to use the DEET or not.
Well, we have a lot of biting critters here in Texas.
So biting and burrowing and, you know, blood feasting creatures that like us.
So, you know, there are other common things that are biting or getting on our skin are fleas.
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And there's also chiggers which is a mite that lives in the grass similar to
chiggers is scabies which is another mite that you usually get from contact with another person.
There, of course, are things like spiders. So spiders will absolutely bite you
if you have put yourself in their way.
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The way to figure out what's been biting the child is where is the bite located?
What were they doing when they were bitten? And obviously, did they see the thing?
That's helpful. Yeah, one pediatrician was saying to me, like,
family was saying, well, what bit my child?
And she was saying, well, I can't tell you. I don't know. no, I wasn't there.
(29:03):
She was trying to, you know, can you tell me more information? Right.
And some things are not bites. Some things are also stings, right?
So scorpions and wasps and bees, those are actually stings and not bites,
but they will cause a, you know, a painful lesion, swollen spot.
Is there some of the ones you just listed? Do you want to mention some telltale
(29:23):
signs or is there a website you recommend?
Because it almost seems like it can be overwhelming. Actually,
we'll mention healthychildren.org.
I'm not sure that there's a lot of information about distinguishing different
bites on there, but there's actually good information about repellents and dealing
with bites on that website.
So it's a handy website for parents to have.
(29:47):
So I think that maybe the...
One that I will mention are fleas. So fleas, you know, of course we commonly
associate them being on our household pets.
But fleas are not limited to our household pets.
Fleas live very abundantly on the backyard wildlife.
(30:13):
So the possums and squirrels and even birds and things that are in our yards.
And they will get in our grass. So sometimes there can be flea infestations in your grass.
And I mentioned that because what happens is your dog goes outside to go potty
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and maybe it picks up a flea or something that was on a possum and then it comes
back in and that flea jumps around and it bites you.
You can, one of the ways you can tell if you have a flea infestation in your
graphs is that fleas jump and bite, but they don't jump super far.
So they usually jump all over your ankles and they bite your ankles like crazy, but not the rest of you.
(31:04):
Mm So if you have a bunch of little tiny,
tiny spots, pink itchy spots on your ankles, they can be other things as well,
but sometimes that should prompt a concern for fleas.
And fleas are important in our part of Texas, actually, because fleas do transmit
(31:28):
disease called murine typhus. And we actually have a lot of that in San Antonio.
And that can be pretty serious and pretty dangerous.
And so doing flea control is actually pretty important.
And murine typhus, if you suspect a child has that, what do you do then?
(31:50):
Well, so murine typhus is an illness where the fleas have a bacteria called
Rickettsia typhi, and they transmit that bacteria to you when they bite you.
And that bacteria gets into your bloodstream, and it swims around,
and it causes a lot of inflammation in your blood vessels, and it can cause
(32:12):
inflammation in your brain and in your heart.
So it's actually a pretty serious illness.
Usually it's a fever illness. So people who have a fever that's been going on
for more than a few days, right? So usually if you have a fever, like, oh, it's a virus.
But if it seems like it's going on a little bit longer or if it has a rash,
(32:33):
a fever and a rash with headache or stomach aches, things like that,
those should, you know, raise a little bit of a suspicion for typhus.
We've had a significant increase in typhus cases in the San Antonio area for
the past, you know, 10 years or so.
(32:53):
So it's actually becoming fairly common here, and it is transmitted by fleas.
Can you treat it with antibiotics?
Yes, it is treated with an antibiotic
called doxycycline, which is not the most fun antibiotic to take.
It's got some side effects, but it would be better to avoid getting typhus in the first place.
The adage, prevention is the best medicine. Yes, exactly.
(33:17):
I'm Holly Wainnant. You're listening to Pediatrics Now. Thank you for the honor
of your time. I'll see you next time.
Music.
(00:05):
Here we are in summer and we're in extreme heat advisories here in San Antonio.
And back on the show is Dr. Tess Barton. She's our pediatric infectious disease expert.
Tess, thank you so much for being back on Pediatrics Now.
Thanks for having me. So, you know, in the summer, the most common bug bites
(00:28):
that we're going to see are going to be mosquito bites.
And, but I think that when parents come in and they're worried about bug bites,
maybe the thing that they are often worried about are bedbugs.
And so there are a few little clues that you can use to distinguish bedbug bites
from, from mosquito bites.
(00:52):
So the most common findings for mosquito bites is that mosquitoes generally
will bite you where you are exposed, right?
So they're small, they're not strong, they don't have a lot of abilities to
bite you through your clothes.
So if your ankles, your arms, those places are exposed, Those are the places
(01:17):
where you will get bites.
And, you know, mosquito bites can look very different from person to person
because some people are very reactive to them and they will get these really
big welts and some people are not. And they'll just get a little,
you know, little pink bump.
Bedbugs, on the other hand, of course, they don't bite you when you are outside.
(01:37):
They bite you when you are sleeping peacefully in your bed or on your sofa or
whatever fluffy place that they happen to be living in.
And bedbugs actually like to crawl around under your clothing as well.
(01:58):
So they don't limit themselves to the places that are exposed.
They also often live at the top of the mattress, underneath the top of the mattress.
And so they will bite you on your face, whereas mosquitoes less likely bite you on your face.
So if you are seeing large red bumps that are also in places that were covered
(02:20):
by clothing and are scattered kind of all over the body or on the face,
those are warning signs that that actually might be a bed bug infestation.
So in that case, what are we supposed to do?
And if anyone who's listening is having trouble sleeping, just skip this episode for now. Yeah.
(02:41):
We can talk about all sorts of other bugs, because there's other things and
they each have a pattern.
So you want to know what should they do if they suspect they have bedbugs?
Yes. All right. So bedbugs are an insect that mostly lives in the,
(03:02):
most commonly lives kind kind of on the underside of your mattress.
And so they come out at night. So you may not ever actually see them crawling
around because they burrow and they hide during the daytime.
So if you feel them and it's the nighttime, you can turn on the lights really
fast and sometimes catch them and see them.
(03:24):
They vary in size. Most of them are just a few millimeters long.
They look kind of just like a boring little gray bug.
But the hallmark of finding them is that if you pull up the edges of the mattress,
like lift the mattress and look on the underneath side,
you know how like some mattresses have that little strip of piping along the
(03:48):
edge, you might have to like pull that to the side.
What you may see is you might see the bugs themselves, but more commonly what
you'll see is you'll see their poop.
And because they eat blood, their poop actually looks like dried blood spots.
So if you're finding things that look like dried blood spots clustered on the
(04:09):
underside of your mattress, that's the telltale sign of bedbugs.
So the first thing is...
Get rid of the mattress? Yeah. I mean, so you probably, you know,
there are many different ways that have been tried for dealing with bedbugs.
Ultimately, getting rid of the mattress is the most effective.
(04:30):
But you also have to usually treat the home or the room as well,
because they could be hiding in other places, and then they'll just set up shop on your new mattress.
So we recommend any
pillows or beddings or cushions that can be physically washed in the dryer should
(04:58):
be washed on hot water and dried in high heat to really kill them off.
The other thing that you can do is if it's something too large or bulky to put
in the washer and the dryer, like your sofa or a large pillow,
that you can wrap them up in a black plastic bag and ideally place them in the sun where it's hot.
(05:29):
But wrap them up in a black plastic bag for a couple of weeks,
because that actually allows,
it traps the bugs, they can't get out, and they will cycle through their life
cycle and any eggs that they have laid will hatch, but they won't have anything
to eat, and then they will die.
(05:49):
People will often do, you know, like a bug bomb, right, like an insect in the house.
And you can get permethrin sprays and spray, you know, spray your sofa,
spray the undersides of things.
But in general, if it can be if there's toys or cushions or beddings,
you want to wash them, and then be vigilant and keep an eye out for them returning.
(06:14):
Sometimes bedbugs can be very persistent.
Dr. Barton, do we need to worry about bedbugs or even think about them if we
haven't been traveling recently?
Sure, sure. We have plenty of bedbugs in Texas. So people do pick them up,
you know, often when they are on travels and they stay in a hotel and the bedbugs
(06:35):
stows away in their luggage and then finds a new home.
But it's also possible for your neighbors to have bedbugs and they come over visiting your house.
Not the neighbors, the bugs. So then they can leave the bugs when they leave?
No, like the neighbors don't bring the bugs. The bugs take a journey.
(06:55):
They come walking over, seeking out new housing.
Like walking through the grass and everything. Yes.
Speaking of grass, there's also tons of other bugs that you can get in the grass. Yes.
So before we move on, so with the bedbugs, can they be harmful or make us sick or make children sick?
(07:21):
No, generally they don't make you sick.
I don't know of any diseases that I can think of off the top of my head that
are transmitted by bedbugs.
There are diseases that are transmitted by lice and fleas and mosquitoes,
of course, but I don't know that bedbugs actually transmit any diseases. They...
(07:42):
But they are miserable. Like the bites of bedbugs are extremely, extremely itchy.
And so people who have those bites are pretty miserable for several days.
So what do you recommend for kids? What should the parent do?
If they are bitten? Yes.
I mean, to treat bedbug bites, it's the same kind of grandma medicine that we
(08:10):
use for other types of bites.
You can use, you know, calamine lotion and antihistamines like, you know, Benadryl.
You can do, you know, oatmeal baths, things that help to dry them up.
Do you recommend Benadryl cream? You can use Benadryl cream,
(08:30):
but you shouldn't use Benadryl cream and Benadryl by mouth together because
you do absorb some when you put cream on.
So you can also use hydrocortisone cream or other
you know steroid anti-itch creams to to
help with those and just follow what it says on the on the tube yes yes so and
(08:52):
i know you're a world traveler do you keep your suitcase like not on carpet
when you travel for this reason or is there anything thing you do as a lot of
us are heading on summer vacations?
Yes. So I actually had a bed bug experience when I went to Laos and I had,
(09:14):
it was, it was sort of the very busy new year's time.
So there were limited hotel rooms. And when we had booked a hotel for a few
days and, and we're peacefully sleeping in the bed when suddenly I felt like.
I felt things crawling on me and I freaked out and flipped the lights on and started looking.
(09:40):
And I found, I saw the bugs and I immediately packed up my luggage and threw it out of the door.
And it was two o'clock in the morning and we were like, we're not staying here.
And of course, like it was a small town. It wasn't like a big city where things
were open 24 hours and had to like walk around looking for another hotel where
(10:02):
there was somebody at the desk.
And when we finally found one and we told them like, oh, my gosh,
we were at this other place and there were bugs. Like, you can't bring your things in here.
And they put our things outside and in the morning, right on the street,
(10:23):
because it was right at the street with a little plaza in front of everybody,
we had to unpack our luggage,
spray everything down with tons of insecticide spray.
We did find one bug in the luggage. oh so
so now after having that experience literally
every time that i go to a hotel or
(10:46):
an airbnb the first thing
i do you know i walk in i make sure that
it doesn't smell like smoke or whatever and i immediately go to the mattress
and i pull up the mattress and then look at the underside and if there's a cover
i'll unzip the cover and i'll look inside the cover to see if If there's any
signs of those blood spots that are the bed bug poop, because I never,
(11:09):
ever want to deal with that again.
Wow. So you do that every time that, but that makes sense. And you,
you, what were you saying about smelling smoke, smelling for smoke?
Well, I just don't like smoke in the room, so. If someone had been smoking. Exactly. Yeah.
So that's really smart. And then do you keep your luggage not on carpet for
(11:32):
24 hours when you get back or do anything like that?
No, I don't usually do that. I just, if I see any evidence of bed bugs,
I just don't stay at the place.
Do you look at all parts of the underside of the mattress or just one corner?
Would they be in all corners or can you tell us about that i usually look at
(11:52):
the top the two top corners up by the headboard because that's the most common
place where they cluster yeah.
Have you found any yet hopefully not no
yeah okay and did
that ruin your trip to laos it did not it
did not it was we had an amazing trip i was
(12:12):
actually yeah we were actually in the the process of
moving there when this happened so yeah so
no it was it was fine but it did it you
know it did it did make me very wary of of
of of places of hotels so how long did you live in Laos and what were you doing
(12:33):
there I lived for a year in Laos and I was there's a little children's hospital
that is sponsored by a non-profit organization in a town called Luang Prabang,
which is a UNESCO World Heritage Site.
It's a really lovely town with the sort of highest concentration of Buddhist temples in the world.
(12:54):
And so I was volunteering at a little hospital doing pediatric work. That sounds amazing.
That's wonderful. Well, thanks for sharing that story with us.
So should we, shall we move on to mosquitoes? When should we worry about mosquitoes?
What do you do to protect yourself against mosquitoes? Do you use any kind of
(13:18):
spray or is it mostly clothing?
So yeah, we should worry about mosquitoes. Mosquitoes are the most dangerous
animal in the world, right? Yeah.
They kill more people than any other animal. Wow, I did not know.
Because they transmit a variety of diseases. So luckily, you know,
(13:38):
here in the U.S., we don't have many of those diseases.
You know, we don't have malaria and yellow fever and dengue,
at least not much dengue.
So we don't, you know, we don't have to worry as much about mosquito-related
diseases, although we do have some.
But yeah, mosquitoes are more an annoyance than anything else.
(13:59):
And but it is a good practice to
try to avoid them so again as i
mentioned they don't they usually don't bite through clothing because they're
not strong enough so long sleeves long pants protective clothing is is a good
all-purpose way to protect yourself from mosquito bites and then yes i i do
(14:21):
use insect repellent i unfortunately have to use insect repellent like
every day when I go out in my garden to do anything because it's mosquito land.
And so for myself, I prefer to use a DEET-containing repellent,
usually around a 30% DEET.
For children, we recommend that children under two months shouldn't use insect
(14:46):
repellent. They should use protective clothing.
Children over two months, the AAP does recommend that they can use insect repellents,
but they should have a lower concentration.
So the.
So if it's a DEET-containing repellent, they recommend a 10% DEET product,
(15:06):
and that will give about an hour and a half of protection against mosquitoes.
So you do have to reapply it if you're going to be outside for longer than that.
Although, when it's a billion degrees outside, I can't imagine why anybody wants
to be outside that long. Right, exactly.
And do you, again, follow the recommendations that's on the container for children?
(15:30):
I do. I do. But it can be very confusing, right?
Because they also have a list of ingredients and it's hard to know like,
you know, what's the best one.
And a lot of people don't want to use DEET, right?
It's a chemical and we do absorb it into our system a little bit.
About 10% of it we absorb into our system.
And so a lot of parents prefer something that's more natural.
(15:52):
And there are there are some
alternatives but i think parents need to be aware of
kind of the pros and cons of those different things there are
you know there's all sorts of like citronellas and oil of lemon eucalyptus and
and a variety of like essential oils rosemary oils and things like that that
(16:16):
are in if you look at like the you know like the skintastic for kids or whatever
It has those kinds of things in them.
And there have been comparative studies looking at how well those work compared
to DEET and other things.
And they are not as effective as DEET.
They also, because they are natural plant-derived oils or plant-derived products,
(16:41):
sometimes people are actually sensitized to them and they can have like skin
reactions to those products.
So, you know, it doesn't mean that you can't use them.
It just means that you have to anticipate that they may not be as effective
and be on the lookout for the potential for skin reactions.
So, and the pros and cons. So, for you, where you use DEET, it's more important
(17:07):
to avoid the potential harm a mosquito could cause.
Can you tell us about that? Well, sure.
So, I mean, you know, like I said, here in the U.S., where we don't have as
much of an issue of mosquito transmitted diseases, we do have,
most commonly, we do have West Nile virus.
There are some other viruses that mosquitoes transmit that can cause some serious
(17:34):
infections, but they're pretty rare, right?
So it's unusual to get a mosquito bite that then leads to some sort of disease
here in the U.S., but it's not unusual elsewhere in the world.
So little travelers, for sure, should be protecting themselves against mosquitoes.
And that's a whole separate issue of bed nets and things like that if you're
(17:58):
going to be doing international travel.
But here in the U.S., it's really just, you know, doing your best to avoid the
bites so that, you know, you don't scratch it like crazy and get impetigo or something, right?
And to avoid the annoyance and the, you know, the infections that we cause from
our fingernails from messing with our itchy skin. Yeah.
(18:22):
Dr. Barton, so we were talking about some mosquitoes. Do you think,
A, DEET is okay for kids, or is there anything more you want to say on that?
And B, when should we worry about mosquito bites? We don't usually have to worry
about the health consequences of mosquito bites here in the United States,
but we should worry about them when we're traveling.
As far as is DEET safe for children? Yes, DEET has been shown to be safe for children.
(18:49):
And we do prefer to give a lower concentration because we know there can be some absorption.
Absorption the there's no reason to
do a hundred there are 100% DEET products
that are available at outdoors stores there
there's really no reason why anybody needs 100%
(19:10):
DEET other than you want to feel macho about your mosquito but but but that
is too concentrated for children for parents who want a more natural approach
the actual the next best alternative is a product called oil of lemon eucalyptus,
which is a tree with an oily leaf that has a citrusy kind of smell.
(19:36):
And there was actually a very interesting comparative trial looking at a variety
of different mosquito repelling methods.
And the oil of lemon eucalyptus was around the same effectiveness as DEET.
And so, it is a good alternative for parents who are looking for a more natural,
(20:01):
less chemical product for an insect or talent.
And with empytygo, is that you scratch it too much and then there's bacteria
under the nail or something? How does that happen? Exactly.
So, empytygo is caused either by staph, a common skin bacteria,
or by group A strep, which is a common throat bacteria.
(20:24):
And so you basically scratch the skin, you know, as long as bacteria are sitting
on a surface of your skin and not in your skin, they don't really cause you a problem.
But if they get to where they don't belong, that's when they begin to cause an infection.
And so then you can get impetigo. And that can be not only very painful and scarring,
(20:48):
that can sometimes turn into a bigger infection or have some of the consequences of strep infections.
But yeah, so that's really the main issue with mosquitoes here.
We have not had any human West Nile in Texas this year, although mosquitoes
have tested positive, including mosquitoes in Bexar County.
(21:11):
Wow. But that just means, luckily, it isn't happening. Is it going to happen
this summer, do you think?
I don't know. You know, so the health department does these like sentinel screenings.
So they have mosquito pools, like collections of mosquitoes,
which sounds like the grossest thing ever.
(21:32):
And they have what are called sentinel chickens that are these like coops of
chickens that they test periodically and horses.
So they test sort of the other animals that can carry this virus.
And so the mosquitoes have tested positive. But typically what
happens when they get a positive test is
(21:56):
the health department actually will normally do some sort of like regional or
local spraying in the area where those mosquitoes have tested positive so that we don't have,
you know, diseases. And that's been effective.
We have really only a handful of West Nile cases each year. For families,
(22:22):
you know, there are mosquitoes breed in water and in wet wood.
And so anything where there's a pooling of water that's not regularly flowing
is where you'll find the little mosquito, wiggling mosquito larvae.
So in your potted plants, and if there are tires or other things that are in
(22:47):
your yard that have gotten rain in them,
and they have a little puddle of water, that's a place where mosquitoes will breed.
And so in your own household, making sure that you've dumped the water out after rains.
And that you don't have standing water that, you know, that if you've got a
(23:10):
cistern, like a rain cistern or a pool or something, I mean,
pools should be circulating,
but or a fish pond, you know, like those kinds of things should be,
they either need some kind of circulation system so that the water is not stagnant
or they need to be covered. So the mosquitoes don't get in them.
That's great advice. And with the impetigo, if it's swelling,
(23:32):
it looks like an infection, it's red.
What do you do from there? So yeah, so impetigo will look like,
you know, usually a red, swollen, painful, crusty, oozy little lesion.
It's kind of round and raised.
In Haiti, they call them boutons, which means buttons. So imagine a button on the skin.
(23:57):
And, yeah, and so usually that can be treated if they're early,
they can really just be treated with a topical antibiotic ointment,
cleaning them, you know, cleaning them well, keeping them dry and treating a
little topical antibiotic is usually enough.
If there's a ton of them or if they have a larger zone of redness around them
(24:21):
where they're causing kind of a larger skin infection, then that might need
systemic antibiotics, right?
So, antibiotics that you take by mouth. My last question about mosquitoes,
I was reading in the Washington Post that when we breathe out,
it's basically telling the mosquitoes that we're there and we can be like this
giant protein shake for them. That's very attractive. Yeah.
(24:47):
And but do we build up, you know, like over time, the bites may not show up
on our skin because we're not getting that reaction.
We have an immunity to the reaction, but we still would could are we still exposed
to the potential danger or what do you say about that?
Yeah, that's actually a great question. So, you know, there are mosquitoes are
(25:08):
attracted to a variety of chemicals that we, you know, that we exude.
And some people are kind of more mosquito magnets than others.
And actually, people who eat a lot of garlic naturally repel more mosquitoes than other people.
(25:29):
Maybe that's a wives' tale. I don't think it's a wives' tale, though.
And that's part of the basis of the vampire myths.
And and so yeah but but but
many people will report the experience of you
know at the beginning of the mosquito season you know
(25:49):
in the spring after it's been raining a bunch and the mosquitoes have suddenly
been breeding and it's starting to warm up you'll get like one million bites
when you go out and then you know after a month or so you just don't get bitten
anymore and i always joke around that when that's happened to me,
that it's like the mosquitoes can smell that I'm like all used up and they're not fresh anymore.
(26:11):
They don't want that. But really, it's much more likely that what happens is
our immune systems get reminded about the mosquito saliva.
And while we initially have a little allergic response, which is what makes the little itchy spot,
we get desensitized after repeated exposures so that we're just not as allergic
(26:35):
to the to their saliva anymore so they may be that they're still biting us but
we are just not not responding to those bites the way that we did initially,
And do we need to not worry about getting one of those rare diseases then, too?
No, I mean, no, not usually. Like, if there's an outbreak, then yeah, right?
(26:59):
If there's suddenly on the news that, like, oh, several cases of West Nile have
been reported, then yeah, I would be a little bit more robust about mosquito avoidance.
But for the most part, I mean, it is quite rare. So really, it's more for mosquitoes
in the U.S., more of an annoyance than they are truly dangerous.
(27:24):
Do you recommend once it seems like the mosquitoes are not biting you,
still put the DEET on or can we stop them?
You know, there are mosquito seasons. So actually, when it gets super,
super hot, it's too hot for the mosquitoes.
They don't want to be out either. They want to hide in their nice, cool spaces.
So, I think that you can see sort of how often are you getting swarmed by mosquitoes
(27:49):
when you go out and decide if you want to use the DEET or not.
Well, we have a lot of biting critters here in Texas.
So biting and burrowing and, you know, blood feasting creatures that like us.
So, you know, there are other common things that are biting or getting on our skin are fleas.
(28:20):
And there's also chiggers which is a mite that lives in the grass similar to
chiggers is scabies which is another mite that you usually get from contact with another person.
There, of course, are things like spiders. So spiders will absolutely bite you
if you have put yourself in their way.
(28:41):
The way to figure out what's been biting the child is where is the bite located?
What were they doing when they were bitten? And obviously, did they see the thing?
That's helpful. Yeah, one pediatrician was saying to me, like,
family was saying, well, what bit my child?
And she was saying, well, I can't tell you. I don't know. no, I wasn't there.
(29:03):
She was trying to, you know, can you tell me more information? Right.
And some things are not bites. Some things are also stings, right?
So scorpions and wasps and bees, those are actually stings and not bites,
but they will cause a, you know, a painful lesion, swollen spot.
Is there some of the ones you just listed? Do you want to mention some telltale
(29:23):
signs or is there a website you recommend?
Because it almost seems like it can be overwhelming. Actually,
we'll mention healthychildren.org.
I'm not sure that there's a lot of information about distinguishing different
bites on there, but there's actually good information about repellents and dealing
with bites on that website.
So it's a handy website for parents to have.
(29:47):
So I think that maybe the...
One that I will mention are fleas. So fleas, you know, of course we commonly
associate them being on our household pets.
But fleas are not limited to our household pets.
Fleas live very abundantly on the backyard wildlife.
(30:13):
So the possums and squirrels and even birds and things that are in our yards.
And they will get in our grass. So sometimes there can be flea infestations in your grass.
And I mentioned that because what happens is your dog goes outside to go potty
(30:38):
and maybe it picks up a flea or something that was on a possum and then it comes
back in and that flea jumps around and it bites you.
You can, one of the ways you can tell if you have a flea infestation in your
graphs is that fleas jump and bite, but they don't jump super far.
So they usually jump all over your ankles and they bite your ankles like crazy, but not the rest of you.
(31:04):
Mm So if you have a bunch of little tiny,
tiny spots, pink itchy spots on your ankles, they can be other things as well,
but sometimes that should prompt a concern for fleas.
And fleas are important in our part of Texas, actually, because fleas do transmit
(31:28):
disease called murine typhus. And we actually have a lot of that in San Antonio.
And that can be pretty serious and pretty dangerous.
And so doing flea control is actually pretty important.
And murine typhus, if you suspect a child has that, what do you do then?
(31:50):
Well, so murine typhus is an illness where the fleas have a bacteria called
Rickettsia typhi, and they transmit that bacteria to you when they bite you.
And that bacteria gets into your bloodstream, and it swims around,
and it causes a lot of inflammation in your blood vessels, and it can cause
(32:12):
inflammation in your brain and in your heart.
So it's actually a pretty serious illness.
Usually it's a fever illness. So people who have a fever that's been going on
for more than a few days, right? So usually if you have a fever, like, oh, it's a virus.
But if it seems like it's going on a little bit longer or if it has a rash,
(32:33):
a fever and a rash with headache or stomach aches, things like that,
those should, you know, raise a little bit of a suspicion for typhus.
We've had a significant increase in typhus cases in the San Antonio area for
the past, you know, 10 years or so.
(32:53):
So it's actually becoming fairly common here, and it is transmitted by fleas.
Can you treat it with antibiotics?
Yes, it is treated with an antibiotic
called doxycycline, which is not the most fun antibiotic to take.
It's got some side effects, but it would be better to avoid getting typhus in the first place.
The adage, prevention is the best medicine. Yes, exactly.
(33:17):
I'm Holly Wainnant. You're listening to Pediatrics Now. Thank you for the honor
of your time. I'll see you next time.
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