Swelling in Children: When to Seek Medical Advice

Skin swelling

Hello Dr.
Hsiao, I am a mother of a two-year-old.
About two days ago in the evening, I noticed what appeared to be a mosquito bite near my son's ankle.
Occasionally, I saw him pressing on the affected area with his fingers, so I applied Mentholatum.
The next day, I observed that the area had swollen and developed a hard blister-like formation.
By the evening, the swelling had decreased.
Here is a photo taken this morning: https://imgur.com/RDzeolP.
My son's activity level is the same as usual, and he has no fever, vomiting, or loss of appetite.
His sleep and overall mood are also normal.
He occasionally presses on the affected area (about two or three times a day).
Since my son is currently unable to express whether he feels pain or itchiness, I can only make judgments based on his actions and the appearance of the affected area.
Due to the recent pandemic, I would like to avoid going to hospitals or crowded public places, but I am concerned about the possibility of cellulitis or whether medication is necessary.
Therefore, I am seeking your advice, Dr.
Hsiao.
Thank you.

Rae, 30~39 year old female. Ask Date: 2020/04/22

Dr. Xiao Kaiwen reply Pediatrics

Cellulitis typically presents with redness, swelling, heat, and pain in the affected area.
In contrast, an allergic reaction to insect bites usually results in redness and swelling only.
Therefore, it can be difficult to differentiate between the two based solely on photographs, as both conditions exhibit redness and swelling.
To assess for pain, you can gently press on the area while the child is sleeping and observe for any signs of discomfort, such as facial expressions or withdrawal of the limb.
If the distinction remains unclear, it is advisable to consult a pediatrician for professional evaluation and treatment.

Reply Date: 2020/04/22

More Info

Hello! Thank you for reaching out with your concerns about your two-year-old son’s condition. It’s understandable to feel anxious when you notice swelling or changes in your child’s health, especially in the context of recent insect bites. I’ll provide some insights into when it’s necessary to seek medical advice regarding swelling in children, and I’ll also address your specific situation.

Swelling in children can occur for various reasons, including allergic reactions, insect bites, infections, or even injuries. In your case, it seems that the swelling around your son’s ankle developed after what appeared to be an insect bite. The presence of a hard blister-like formation could indicate a localized reaction, which may be a result of an allergic response or an infection.

When to Seek Medical Attention
1. Persistent or Worsening Symptoms: If the swelling does not improve or continues to worsen over the next few days, it’s advisable to consult a healthcare professional. Persistent swelling could indicate an underlying infection or an allergic reaction that requires treatment.

2. Signs of Infection: Look for additional signs such as increased redness, warmth, or tenderness around the swollen area. If the skin appears to be breaking down or if there is any discharge, these could be signs of an infection like cellulitis or abscess formation.

3. Fever or Systemic Symptoms: If your child develops a fever, shows signs of lethargy, or exhibits changes in appetite or behavior, these could be indicators of a more serious condition that warrants immediate medical evaluation.

4. Difficulty Breathing or Swallowing: If your child experiences any difficulty breathing, swelling of the face or throat, or any signs of anaphylaxis (such as hives, difficulty swallowing, or wheezing), seek emergency medical care immediately.

5. Pain or Discomfort: Since your son is unable to express whether he feels pain or itching, observe his behavior closely. If he seems unusually fussy, avoids using the affected limb, or appears to be in discomfort, it may be worth consulting a doctor.

Your Current Situation
Given that your son’s activity level remains normal, and he does not exhibit fever or other systemic symptoms, it may be reasonable to monitor the situation for a short period. However, it’s essential to keep an eye on the swelling and any changes in the appearance of the affected area. If the swelling persists or worsens, or if you notice any concerning symptoms as mentioned above, it would be wise to seek medical advice.

Home Care Recommendations
- Cold Compress: Applying a cold compress to the swollen area may help reduce swelling and provide some relief.

- Avoid Scratching: Encourage your son not to scratch the area, as this can lead to further irritation or infection.

- Over-the-Counter Antihistamines: If you suspect an allergic reaction, you might consider giving an age-appropriate antihistamine after consulting with a pediatrician.

Conclusion
While it’s understandable to want to avoid crowded places due to the current pandemic, your child’s health and safety should always come first. If you have any doubts or if the situation changes, do not hesitate to reach out to a healthcare provider. They can provide guidance tailored to your child’s specific needs and help ensure that any potential issues are addressed promptly.

I hope this information helps you feel more confident in managing your son’s condition. Please take care, and don’t hesitate to reach out if you have further questions or concerns!

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