Food allergies in children
Reviewed by Professor Brian Lipworth, professor of allergies and respiratory medicine
What is food allergy?
It is a reaction by your immune system to a normal amount of a particular food. This reaction happens every time that food is eaten.
Although food allergies are rare, they are most common in children under the age of four.
The most frequent food allergies are to:
- milk
- eggs
- fish
- nuts
- citrus fruit
- tomatoes.
What are the symptoms?
Children with food allergies often have several different symptoms. These include:
- severe infantile eczema or skin rash
- vomiting and diarrhoea for no apparent reason
- asthmatic bronchitis or asthma
- allergic cold (itchy, streaming eyes and nose).
How do food allergies begin?
A hypersensitive reaction towards food is usually a type 1 allergic reaction to something in the diet.
This means your child's immune system produces a class of antibodies called IgE in response to a particular food. These antibodies cause the allergic symptoms.
Almost one third of the population omit certain foods from their diet or their children's diet because they believe they cause an allergic reaction.
In fact, only about 3 per cent of children suffer allergic reactions towards food, and most will outgrow them before they reach the age of three.
Who's at risk?
Type 1 allergic diseases are to some extent inherited. For this reason you may want to talk to your GP or allergy specialist before you get pregnant if there is a family history of allergy, hay fever, eczema or asthma.
What should I do if I suspect my child has a food
allergy?
- Contact your doctor first.
- Do not put your child on a strange restricted diet that could result in malnutrition.
- A change in your child's bowel movements is not a sign of food allergy.
- It is completely normal for a child's bowel movements to change if their diet is changed.
- Most importantly: relax. Don't assume that your child is suffering from a food allergy until this has been confirmed by an allergy specialist.
How are food allergies treated?
A diet that eliminates the food is the main treatment for this type of allergy.
In rare cases, eating even a small amount of the food can cause anaphylactic shock (severe difficulty breathing and heart malfunction), leading to collapse.
Anaphylactic shock needs immediate treatment with adrenaline, so seek medical help straight away if your child suddenly begins to have difficulty breathing
Asthma and children
What is an asthma attack?
The mucous membranes in the small branches of the airways (bronchi) swell and the circular muscles contract ('spasm' or bronchospasm).
More mucus is produced in the already restricted airways, which makes breathing a struggle. This usually produces a wheezing sound, when breathing out.
What symptoms in children can be due to asthma?
Small children (up to three years):
- a wheezing sound, when breathing out
- coughing, wheezing or breathlessness with exercise
- feeling of a tight chest
- prolonged coughing, not because of a cold, often worse at night
- generally feeling unwell
- recurrent colds from which it takes a long time to recover.
Children from 3 to 15 years:
- a wheezing sound when breathing out
- prolonged coughing, especially at night
- waking up coughing during the night or in the morning
- inactivity or lethargy – no longer wishing to play physical games or take other exercise when they have enjoyed this before.
How common is asthma in children?
- Chronic asthma is the most frequent long-term children's disease.
- About 1 to 2 per cent of all children get chronic asthma during their childhood.
- Approximately 15 to 20 per cent of all children will have symptoms of wheeze, without having chronic asthma.
What causes asthma in children?
In young pre-school children, wheezing is usually brought on by a viral infection – causing a cold, ear or throat infection.
Some people call this 'viral-induced wheeze' or 'wheezy bronchitis', whilst others call it asthma.
Most children will grow out of it, as they get to school age.
In older children, viruses are still the commonest cause of wheezing. But other allergens may also cause an asthma attack like those listed below:
- pollen, eg grass or birch
- animal hair or fur
- food, eg milk or eggs
- house dust mites
- fungus.
What makes a child's asthma worse?
- Exposure to the things that they are allergic.
- Cigarette or pipe smoke.
- Colds.
- Pollution and dust.
- Exertion or exercise: however exercise should be encouraged, with asthma symptoms relieved by medication.
When should a parent visit the doctor?
- If you suspect your child may have asthma.
- When the asthma medication normally used doesn't work, or it's needed more than two or three times per week.
When is it necessary to call the doctor urgently?
- If the child has trouble breathing.
- If the skin changes colour to white or blue, particularly on the lips or around the mouth.
- If the breathing difficulty deteriorates dramatically.
- If the asthma attack is much worse than normal.
- If you're using the ventolin puffer more than every 4 hours.
How does the doctor decide whether a child has asthma or not?
- By listening to the symptoms described by parent and child.
- By examining the child by listening to their chest using a stethoscope.
- By measuring the capacity of your child's lungs with a peak flow monitor – a simple device that measures the maximum speed at which the child can blow out. The reading is reduced if the airways are tight. This can be done at home or in the doctor's surgery.
- By checking whether the treatment recommended by the doctor works.
Why should a child take the medication?
It is often both necessary and helpful to give children medication because it can:
- remove their symptoms allowing them to play and exercise again, like other children
- subdue the allergic reaction of their body and reduce the inflammation in the airways
- remove or lessen damaging effects on your child's lungs so they develop naturally.
Which medication should my child use?
Medicines for asthma are generally thought of in two main groups:
- relievers (bronchodilators): these are quick-acting drugs that relax the muscles of the airways. They relieve the symptoms of wheeze, cough and breathlessness and are the first-line treatment of an acute asthmatic attack.
- preventers (anti-inflammatories): these act over a longer time and work by reducing the inflammation within the airways.
Relievers
There are two groups of these.
The different types of reliever can be combined if necessary.
Beta 2 agonists
These drugs act on molecule-sized receptors on the muscle of the bronchioles. The drug fits the receptor like a key fits a lock and stimulates the muscle to relax. Examples of those that act for a short time (three or four hours following a single dose) are salbutamol (eg Ventolin) and terbutaline (eg Bricanyl).
These drugs (and the other inhaled drugs mentioned below) are inhaled from a variety of delivery devices, the most familiar being the pressurised metered-dose-inhaler (MDI). Special adaptors and types of inhaler are available to make it easier to administer inhaled medication to young children. A doctor or practice nurse can recommend which type will be the most suitable.
Longer-acting beta 2 agonists include salmeterol (eg Serevent). Their action lasts over 12 hours, making them suitable for twice daily dosage. These medications are particularly good for exercise-induced problems and night-time symptoms. They are not suitable for very young children.
Anticholinergics
One of the ways in which the size of the airways is naturally controlled is through nerves that connect to the muscles.
The nerve impulses cause the muscles to contract, thus narrowing the airway. Anticholinergic drugs block this effect, allowing the airway to open.
The size of this effect is fairly small, so it's most noticeable if the airways have already been narrowed by other conditions, such aschronic bronchitis.
These drugs are therefore not commonly used in children, buy ipratropium (eg Atrovent) is available for use in children if required.
Preventers
There are four main groups of these.
Corticosteroids
Corticosteroids (or steroids), such as beclometasone (eg Becotide), budesonide (Pulmicort) and fluticasone (Flixotide), have made an enormous difference to the management of asthma.
They work to reduce the amount of inflammation within the airways, reducing their tendency to contract and have allowed many people with previously troublesome asthma to lead almost symptom-free lives.
They are usually given as inhaled treatment, although sometimes short courses of oral steroid tablets may be required for bad attacks.
Although steroids are powerful drugs, with many potential side-effects, their safety in asthma has been well established.
It's also important to balance the problems that arise from poorly treated asthma against the improvement in health that occurs when the condition is well treated.
Cromones
There are two drugs in this group: sodium cromoglicate (eg Intal)and nedocromil sodium (Tilade).
They also act to reduce airway inflammation. They tend to be best for mild asthma and are more effective in children than adults.
The drugs are given by inhalation and usually well tolerated. This is a good first-line preventative treatment in children, but they may take up to six weeks to have an effect.
Leukotriene receptor antagonists
Leukotrienes are compounds released by inflammatory cells, within the lung, and which have a powerful constricting effect upon the airways.
By blocking this effect with these antagonist drugs, the constriction is reversed.
One of these drugs, montelukast (Singulair paediatric), is presently licensed for children over two years old. Zafirlukast (Accolate) can be used in children over 12 years old.
Theophylline
Theophylline and aminophylline are given by mouth, and they are less commonly used in Britain because they're more likely to give side effects than inhaled treatment.
They are still in wide use throughout the world.
What are the long-term prospects?
- Most children outgrow the disease.
- The milder it is, the greater the chance of outgrowing it.
Diabetes in children
Reviewed by Dr Stephen Greene, consultant paediatrician, Professor Ian Campbell, consultant physician and Dr Soon Song, consultant physician
Type 1 diabetes is the most common form of diabetes in children: 90-95 per cent of under 16s with diabetes have this type.
It is caused by the inability of the pancreas to produce insulin.
Type 1 diabetes is classified as an autoimmune disease, meaning a condition in which the body's immune system 'attacks' one of the body's own tissues or organs.
In Type 1 diabetes it's the insulin-producing cells in the pancreas that are destroyed.
How common is it?
Childhood diabetes isn't common, but there are marked variations around the world:
- in England and Wales 17 children per 100,000 develop diabetes each year
- in Scotland the figure is 25 per 100,000
- in Finland it's 43 per 100,000
- in Japan it's 3 per 100,000.
The last 30 years has seen a threefold increase in the number of cases of childhood diabetes.
In Europe and America, Type 2 diabetes has been seen for the first time in young people. This is probably in part caused by the increasing trend towards obesity in our society.
But obesity doesn't explain the increase in the numbers of Type 1 diabetes in children - who make up the majority of new cases.
What causes childhood diabetes?
As with adults, the cause of childhood diabetes is not understood. It probably involves a combination of genes and environmental triggers.
The majority of children who develop Type 1 don't have a family history of diabetes.
What are the symptoms?
The main symptoms are the same as in adults. They tend to come on over a few weeks:
- thirst
- weight loss
- tiredness
- frequent urination.
Symptoms that are more typical for children include:
- tummy pains
- headaches
- behaviour problems.
Sometimes diabetic acidosis occurs before diabetes is diagnosed, although this happens less often in the UK due to better awareness of the symptoms to look out for.
Doctors should consider the possibility of diabetes in any child who has an otherwise unexplained history of illness or tummy pains for a few weeks.
If diabetes is diagnosed, your child should be referred to the regional specialist in childhood diabetes.
How is diabetes treated in children?
The specialised nature of managing childhood diabetes means that most children are cared for by the hospital rather than by their GP.
Most children with diabetes need insulin treatment. If this is the case, your child will need an individual insulin routine, which will be planned with the diabetes team.
- Most now use frequent daily dosage regimes of fast-acting insulin during the day and slow-acting insulin at night.
- Very small children normally don't need an injection at night but will need one as they grow older.
- Increasing numbers of older children use continuous insulin pumps.
Often in the first year after diagnosis, your child may need only a small dose of insulin. This is referred to as 'the honeymoon period.
As well as insulin treatment, good glucose control and avoidance of ‘hypos’ (low blood glucose attacks) is important. This is because many of the complications of diabetes increase with the length of time diabetes has been present.
What can parents do?
Understanding all the different aspects of diabetes and its treatment requires patience, but will benefit your child and family life.Living with diabetes can put families under considerable strain, so access to backup support is crucial. This may be from your GP, the hospital team or social services.
The diabetes team at the hospital can help you with the list below.
- Learn how to administer insulin injections. Insulin is usually injected into the skin over the abdomen or the thighs.
- Know the symptoms of low blood glucoseand diabetic acidosis and what to do about them.
- Make sure glucose is always available.
- Measure blood glucose levels and teach your child how to do this as soon as they are old enough.
- Teach your child how to self-administer insulin injections as soon as they are old enough - around the age of nine is typical.
- See the doctor on a regular basis, and particularly if your child becomes ill for any reason - treatment is likely to need adjusting.
- Inform the school and friends about the symptoms of low blood glucose and what to do about them.
- Contact your local diabetes association for help and support.
Diet
It's important to give your child a healthy balanced diet that is high in fibre and carbohydrates.A trained dietician is usually one of the members of the hospital diabetes team.
A healthy diet is the same for everyone, whether or not they have diabetes.
How much your child should eat depends on age and weight. The dietician and parents should determine this together.
Sweets are no longer off limits because the 'diabetic diet' is now a relic of the past.
Once your child gets to know how her body responds to eating and taking insulin, sweets in moderation are possible - accompanied by the appropriate dose of insulin.
Physical activity
Physical activity is important for children with diabetes, who should try to exercise every day.
Physical activity lowers the blood sugar level, so if your child takes insulin, she may need to reduce the dose.
This is because a combination of too much insulin and exercise can lower the blood sugar level and lead to hypos. To counter this, your child should always carry sugar.
Physical activity also affects how much your child can eat. Before your child exercises or plays sport, give extra bread, juice or other carbohydrates.
In the long term
A child who develops diabetes will live with the condition longer than someone who develops diabetes in adulthood.
The longer diabetes is present, the higher the risk of long-term complications such as those affecting the eyes and kidneys.
These can start after puberty, but are usually a concern only in later life.
Regular checkups for late-stage complications begin around the age of nine. From then on, this checkup is done every year.
Nosebleeds in children
Reviewed by Dr Robert Mills, the consultant otolaryngologist
What causes nosebleeds?
A nose starts to bleed when one of the small veins in its lining bursts. This is usually caused by something completely harmless, such as the child picking their nose, blowing it too hard or having their nose knocked while playing.
Another reason could be that the child has pushed something inside their nose.
How should nosebleeds be treated?
A nosebleed can be a very traumatic event for the child. They will often be scared and think something is seriously wrong with them because there is so much blood. So it is important that the parent stays calm. They should cuddle the child and say something reassuring, like, 'It's OK, let's sit down, then you'll be fine. I'm here and I'll make sure you're OK.'
- When the child is sitting down, hold their nostrils with your fingers, a handkerchief or a facecloth.
- Pinch the lower, soft part of the nose between the thumb and forefinger.
- The grip should be firm and the pressure on the nose steady.
- Hold the child's nose for 10 minutes. Look at a watch so you are sure 10 minutes have passed before letting go.
- If the child is old enough, teach them how and where to hold their own nose.
- If in doubt, have the doctor or health visitor show you how to hold the nose.
- It may be a good idea to read a story or watch television while waiting, to divert the child's attention.
- After the nosebleed has stopped, the child should not play any rough games for a couple of hours to prevent the nosebleed starting again.
- Tell the child not to pick, rub or blow their nose for a couple of days.
- If the bleeding continues, try the same procedure once more.
- If the bleeding doesn't stop, call the doctor.
Why does holding the nose help?
Holding the nose presses directly on the bleeding vein. This stops the bleeding and the blood will then coagulate or thicken into a scab.
Why should the child sit down?
Bleeding will stop faster if the child is sitting instead of lying down. It used to be recommended that a person with a nosebleed should lie down, but that makes the blood pressure in the head increase.
When the blood pressure goes up, more blood is pumped through the veins, which will make the nose bleed more and the nosebleed harder to stop.
Also if you lie back, blood will run down your throat. If the child swallows a lot of blood, they will vomit.
Why do some children get nosebleeds more often than others?
Some children have veins that are closer to the mucous membrane of their nose than other children. Because the veins are very close to the skin, they are more likely to burst when the child picks, blows or rubs their nose, or plays rough games.
Some children pick their nose a lot so they too are more likely to get nosebleeds. Cut the child's nails frequently. A little petroleum jelly applied on the inner side of the nose can also soften scabs.
If the child often gets nosebleeds, it may be a good idea to have a doctor examine them.
If the nosebleeds are caused by a vein that is very close to the skin, they can be prevented by cauterising the front of the nose. This is a simple procedure that can be carried out in the GP's surgery or hospital clinic.
How should you remove a foreign body from a child's nose?
If the child has put a foreign body up their nose, let a doctor remove it. Children are capable of putting the most surprising objects up their noses. It is best to have the doctor remove the object to avoid the risk of pushing it up further.
Are nosebleeds dangerous?
If the child often gets nosebleeds or nosebleeds that are hard to stop, have a doctor examine the child. Children do not come to any serious harm from nosebleeds. Rarely, the bleeding may be due to a problem that prevents the child's blood from clotting properly. This can be confirmed by a blood test.
When should the doctor be called in the case of a nosebleed?
- If there's a chance the child's nose may be broken.
- If the bleeding can't be stopped (how to stop a nosebleed is described above).
- If the child frequently gets nosebleeds that take more than 15 minutes to stop.
- If the child has trouble breathing.
- If the child is bleeding elsewhere, for example from their ears or gums.
- If the child has a foreign body stuck up their nose.
fever in children
Reviewed by Dr Stuart Crisp, consultant paediatrician
Temperature control in the body
The 'core temperature' means the temperature of the deep tissues of the body and in normal circumstances, this is kept at a very even level by a range of automatic adjustments.
When we are too hot, we increase the amount of blood flowing through the skin by opening up the tiny capillary blood vessels. This radiates away excess heat and sweating can further enhance this.
When we are too cold, we shut down skin blood vessels and conserve heat within the internal organs. If necessary we can generate more heat by shivering.
Fever is part of the body's defence mechanism against viruses or bacteria. The body creates extra heat so that the foreign organism cannot survive. Having a temperature helps you fight illness. Fever is a good thing, most of the time.
Actions to reduce fever can help make someone feel more comfortable. But it's not possible, or desirable, to aim to normalise the temperature – while someone is fighting off an infection.
Some children will have a seizure (fit), if their temperature shoots up. But this is uncommon and is not a reason to try to reduce the temperature of a child with a fever.
The part of the human brain that controls body temperature is not fully developed in children. This means that a child’s temperature may rise and fall very quickly, and the child is more sensitive to the temperature of his or her surroundings.
One of the simplest and most effective ways to help a child with a fever feel more comfortable is to take off some of the child's clothes – so heat can escape from their body more easily.
However, if they have goosebumps or start to shiver, the environment is too cold, and they'll not lose heat. Do not put them in a cold shower because their skin will get cold, but their inside temperature will go up.
What is the normal temperature for a child?
If you take the temperature in your child's mouth or from the ear, the normal temperature is 36 to 36.8ºC (97.7 to 99.1ºF).
Thermometers
Traditional mercury thermometers are being phased out, although many are still around.
Mercury is a highly toxic substance if taken into the body – which can be done through skin contact, breathing in the vapour or swallowing it.
All these risks can apply to the fragile glass thermometer if it's broken, for example by a child biting it.
If you have a mercury thermometer, check with your local council how to dispose of it safely.
Modern probe-type digital thermometers are quicker to use, more reliable and are much safer if bitten.
Taking a child's temperature
A body temperature reading can be taken from the mouth, armpit, ear, skin surface or rectum.
Rectal temperature reading is therefore not recommended for home use. Although a rectal temperature reading is the most accurate and is quite often used in hospital, it's not necessary to be so precise when taking temperature readings at home.
Rectal temperatures are the closest to 'core' temperature and are about 0.5ºC (2ºF) higher than readings taken from the mouth or ear.
Temperature readings from the armpit are not very reliable and are about 0.5ºC lower than mouth temperature.
Thermometer strips that are placed on the child's forehead are popular and give a rough guide, only.
Most of the time the exact level of a child’s temperature is not particularly important.
In practical terms, the temperature reading will be enough to give an indication of whether a fever is present.
Fever does not require treating. Only if the child is miserable, should paracetamol or ibuprofen be considered to make the child feel better, by reducing their temperature.
Ear temperature
If you are willing to pay for an ear thermometer, this is a quick method and will give a read-out in seconds. Ear thermometers rely on measuring infrared (heat) radiation from the eardrum.
Other types of thermometer (such as the probe type) are not suitable for taking ear readings and must never be placed within the ear canal.
Some ear thermometers are adjustable, so they can be made suitable for adults or children.
- To get a reliable temperature measurement, the thermometer must be used exactly as directed.
- When you buy the thermometer: ask the salesperson how to use it, and read the instructions carefully before you start.
- Especially with small children, ear thermometers require a steady hand to find the right spot.
- The ear canal has a natural curve – so to ensure that the thermometer is pointing towards the eardrum, it may be necessary to pull the top part of your child's ear gently upwards during the reading.
- If your child has been lying with their head on a warm pillow, or has just come inside out of the cold, you will need to wait 10 to 15 minutes before the ear can provide an accurate measurement of body temperature.
Under the armpit
This method is not good for small children, since they will not stay still for long enough.
- With children old enough to co-operate and keep still you need to keep the thermometer under their armpit for at least 5 minutes.
From the mouth
This method is not suitable for young child because they may bite the thermometer and break it.
- The thermometer is placed in the mouth, under the tongue.
- It will take two to three minutes to measure the temperature accurately.
- If your child has just eaten anything hot or cold, you will need to wait 10 minutes before an accurate temperature can be taken.
What can I do if my child has a temperature?
Liquids
A child with a high temperature needs more liquid than usual because the fever will make them sweat a lot.
Make sure your child drinks plenty of liquids – a teaspoonful every few minutes, if necessary. Provided they drink plenty of liquids, it won't matter too much if they eat very little for a couple of days.
Body temperatures
A child with a high temperature also needs rest and sleep.
They do not have to be in bed all day, if they feel like playing. But they must have the opportunity to lie down.
You do not sweat out a fever.
If your child shivers while their temperature is rising, it's okay to cover them with a duvet or a blanket. But as soon as your child's temperature has stabilised and he or she starts sweating, they need to cool down.
Your child only needs to wear underwear or a nappy, which will help the heat escape from the body. Make sure their room is ventilated and cool, but not draughty.
Medicines
If you want to use medication to get the temperature down, ask your doctor or pharmacist. They will be able to tell you what to use and how much. The dosage will depend on both the age and weight of your child.
Paracetamol suspension (eg Calpol) is the usual choice and ibuprofen (egNurofen for children) is an alternative. Aspirin should not be given to children under 16 years of age.
Attention
Sick children are often tired and bad-tempered. They sleep a lot – and when they are awake, they want their parents around all the time. They might whine and act younger than their age.
It's okay to give in and spoil a child a little when they're sick. Read to them, play with them and spend time with them. This is not the time to teach a child good manners.
A child usually recovers and will soon be back to their old self again.
When is a fever critical?
Look at your child and use common sense. Do they look exhausted or ill? Are they behaving differently? If the answer is yes, call the doctor.
You should also call your doctor if:
- you have a young child, less than three months old, who runs any fever
- your child cries and cries, without you being able to comfort them, and doesn't wake up easily
- your child has a temperature over 38ºC (101.3ºF) for more than three days
- your child has just had an operation
- your child doesn't seem to be getting better.
If your child experiences any of the following symptoms with a fever, call your doctor.
- Stiff neck.
- Affected by bright light.
- Hallucinations.
- Red rash or blue or purple dots or patches.
- Trouble breathing.
- Cramps or leg pains.
- Continued vomiting or diarrhoea.
- Continued tonsillitis.
- Pain when urinating, or urinating more than usual.
- Other illnesses.
Stings and insect bites
Reviewed by Dr John Pillinger, GP
Insect bites often cause one or more red bumps that are usually itchy and sometimes painful. Often there's a small hole in the middle of the bite, perhaps with the end of the sting sticking out. Apart from this local irritation, the bite is not usually dangerous provided the victim is not allergic to insect bites.
Bee and wasp stings are more likely to cause allergic reactions than other kinds of insect bites.
What are the sources of insect bites?
The sources of insect bites are recognised to be wide and varied.
Insects, such as fleas can be found on domestic pets, eg dogs and cats; and also on birds.
Bedding and other soft furnishings around the house can also harbour bed bugs and fleas.
About 95 per cent of the fleas on a pet will be in the form of eggs, larvae and pupae (ie in the household) rather than on the animal.
Simply working in your garden can expose you to fleas and other insects.
Travelling can also put you at risk. Depending on your destination – exposure to mosquitoes, ticks and sandflies can occur.
Which insects cause stings or bites?
Stings or bites are caused by midges, gnats, horseflies, bees, wasps, ants, some spiders, fleas, lice, etc.
Wasp stings cause the most allergic reactions in the UK. One or more stings, over a period of time, may be required from a particular insect to sensitise your immune system and cause an allergic reaction.
Twenty per cent of people who have experienced an allergic reaction to an insect sting or bite will have milder or no reaction the next time they are stung or bitten by the same type of insect.
Therefore, it's impossible to predict the outcome of the next sting for any individual. If you're sensitised to wasp venom, it's unlikely that you'll suffer the same response to bee venom.
What does a bite look like?
There will be one or more swollen red bumps on the skin. In the middle, you will often see a small hole, which might have the insect's sting sticking out of it.
If you wake up in the middle of the night having noticed a painful or itchy lump, check to see if other parts of the body are affected. If there is only one bump, or four or five of them close together, you have probably been stung or bitten. Fleas often bite four or five times in the same area so you may find a couple of these clusters on your body.
Some children's diseases can also cause bumps and red, swollen skin. If in doubt, consult your doctor.
What are the symptoms of insect bites?
The skin becomes red, swollen, itchy and can be painful. These are the most common symptoms. Sometimes bites cause an allergic reaction. Bites can become infected by scratching. Look out for a rash or swelling that gets worse instead of better. If this happens, see a doctor.
Call your doctor immediately if you notice any of the following symptoms:
- the person has been stung by many insects at the same time
- a rash or swelling that gets worse instead of better
- if the site is red, tender and swollen
- headache
- dizziness
- nausea (feeling sick)
- pains in the chest
- choking or wheezing
- difficulty breathing.
These may be symptoms of allergy and can be life-threatening if the victim goes into shock. See a doctor immediately or dial 999 for an ambulance.
How to treat an insect bite or sting
Remove the sting. Use tweezers to prise it out or scrape it off with your fingernail, or a credit card. Do not attempt to press out the sting, as this will only help the poison spread under the skin.
Wash the bite with soap and water, then cool off the skin with ice cubes or an ice-pack that has been wrapped in a cloth or thin towel. Rest the affected area and elevate it if possible to prevent excessive swelling. Do this immediately after the victim has been stung.
If necessary, use a painkilling cream or gel or an antihistamine to soothe the itch. If you or a member of your family are allergic to insect bites, talk to your doctor or pharmacist before going on holiday. They may tell you to take an antihistamine with you in tablet form; or Adrenaline or as an EpiPen injection. If so, make sure you ask how to use them correctly.
Anyone who gets a rash or an itch requiring medical treatment, or who may simply feel unwell following a bite or sting should not drive, as there is a risk of passing out. If in doubt, consult your doctor.
Some hospitals provide an immunology or allergy clinic that may be able to confirm which venom an individual is sensitive to. This can be particularly useful if they have previously experienced an allergic reaction following a bite or a significant localised reaction with swelling of over 10cm diameter.
Insect bites and allergies
People who are allergic to insect bites should carry a card, bracelet or necklace that lets other people know about their allergy. If the doctor has prescribed medication for you to be used in case of an allergic reaction, it is important that both you and your family know exactly how to use it.
How to avoid getting stung
- If surrounded by a swarm of bees or wasps, move out of the way slowly. Do not try to wave the insects away. Violent movements will only excite them and make them more aggressive and likely to attack.
- Insect repellents are effective.
- Never aim a blow at a wasps' or bees' nest or attempt to throw them because the insects will immediately attack.
- Stay away from things that attract insects, such as flowers, trees, bushes and piles of wood.
- Be extra careful if you are eating or drinking (especially sweet things) outside.
- Smells and bright colours attract insects. Avoid scented creams and strong perfumes if you are going to spend time outside.
- Long sleeves, long trousers, socks, shoes and gloves help protect you from stings.
- Close the windows in the house and the car to keep the insects out.
- Look out for insects' nests in your home or garden and have them removed immediately.
- Protective gear such as mesh covers for the face can be very effective against the nuisance of the highland midge in summer for example.
Bug-busting
Written by Rosalind Ryan, a health journalist
Nearly one in ten primary school children in the UK suffers from head lice at any time. It makes sense to prepare yourself and your children for any potential future invasions. Luckily there are more ways to stay bug-free than simply dousing yourself in chemicals or locking yourself indoors.
Head-to-head problems
'This is why young children are often infected, because they play with their heads close together,' says GP, Dr Rob Hicks. 'When they come home and cuddle their parents, lice can spread throughout the family,' he says.'Lice are spread by head-to-head contact,' says Christine Brown, a nurse consultant and advisor to primary care trusts on head lice policy.
Lice only need 30 seconds to move from one head to another, but it’s a myth that they prefer dirty hair.
'A louse doesn’t mind if your hair is clean or dirty, long or short. It makes no difference, as long as it can get to your scalp,' says Brown.
'But it's easier to pass them on if you have short hair because they don’t have far to travel,' she says.
A growing issue
But it's possible that the lice could have multiplied from two to two hundred in that time frame.It can take about three months before you show any symptoms because the scalp may not be itchy before then.
'Live lice are between 1mm and 3mm long,' says Brown. 'Many people mistakenly call them 'nits', but nits are the empty eggs or eggs that never hatched.'
Nits are pale in colour and stick firmly to your hair.
Just because you have nits, doesn't mean you have lice because the eggs may never have hatched. But if you do find live lice, you must treat them as soon as possible to prevent them from spreading.
Chemical measures
They work by altering the louse's nervous system.A popular way to treat lice is with chemical, or insecticide, remedies.
But many experts warn that lice in the UK are becoming resistant. 'This may be because the lice are developing resistance or because we're using the treatments incorrectly,' warns Dr Hicks.
'Many people use insecticides as a preventive, which doesn't work and just fuels resistance,' he says.
You should only use chemical cures on live lice, not on nits, or as a precaution for your family.
One of the most effective is malathion – known as Derbac-M and Prioderm.
Full Marks Solution works in a similar way. You need to apply all medical treatments twice, about a week apart, to catch any newly hatched lice.
But check with your school or GP that there's no resistance in your area.
A new remedy is a silicon solution called dimethicone, sold as Hedrin.
'It's probably the best I've found,' says Brown. 'It works by coating the lice, so they cannot process water properly. The lice swell up and eventually explode inside their bodies.'
Studies have found Hedrin can be 97 per cent effective and is less likely to cause resistance in communities.
What's the alternative?
Dr Hicks says: 'Wet your child's hair – use conditioner – and go through it with the comb. The teeth are exactly the right size and distance apart to catch lice, even the smallest ones.''Bug-busting' means using a very fine-toothed plastic comb to remove lice and nits from your child's hair.
You need to do this roughly every four days for two weeks to catch any un-hatched lice. But bug busting is not ideal for everyone.
'You need a very co-operative child to sit still for that long,' warns Brown. 'It may be best if they only have one or two lice.'
To make bug-busting more effective, add tea tree oil to your conditioner.
A study by the University of Queensland recently discovered tea tree oil was more than 90 per cent effective at killing head lice, compared with 82 per cent for some chemical treatments.
'Neem oil is also good,' says Dr Hicks. 'It comes from the neem tree and works by confusing the louse's hormones – so they don't breed or feed properly.'
Check your child's skin for sensitivity before using essential oils.
The good news about head lice is that they are basically harmless and do not carry other diseases.
The bad news: everyone will eventually get them.
But if you check your family's hair regularly, you can find them, treat them and beat them.
- The most effective prevention is to regularly check your family's hair. 'We tell parents 'once a week, take a peek', especially if they have young children,' says Brown. Visit www.onceaweektakeapeek.com for more.
- Don't ignore head lice. They will not clear up on their own. You must treat them as soon as you spot any live lice.
- Tell your child's school and friends if they have head lice. If you don't, they'll risk spreading them and catching them back again.
- 'You can't really take precautions against head lice, but you can treat them to prevent them spreading,' says Dr Hicks. 'Remember there's no shame in getting them; it's a normal part of growing up.'
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