Bed bug bites on infants: gentle care and signs to check

Small red or swollen marks may occur on skin uncovered during sleep, but similar spots can come from heat rash, eczema, other insects or infection. A baby's skin reaction cannot prove that bed bugs are responsible. Check the cot and surrounding room while watching the infant's general wellbeing.

An infant may be unsettled, rub the affected area or have scattered marks on the face, arms or legs. Some reactions are barely visible; others become puffy. Marks in a row are possible but are not diagnostic. Look for bugs, pale shed skins or dark specks in cot joints, mattress edges and nearby furnishings.

The bites themselves are not passed between people. Continued new marks can occur if insects remain in the sleeping environment, while marks emerging at different times may reflect a delayed skin response.

Clean the skin with lukewarm water and a mild, fragrance-free cleanser, then use a cool damp cloth for comfort. Keep the baby's nails trimmed and use appropriate clothing to reduce rubbing without overheating. Do not apply an adult itch product, essential oil, insecticide or home remedy to infant skin.

Ask a paediatric clinician or pharmacist before giving an antihistamine or using a corticosteroid, because the baby's age, weight, treatment area and skin condition affect what is appropriate. Move the infant away from a suspected sleeping space, launder suitable fabrics and arrange professional pest-control advice. Never spray a cot or bedding while the baby is present.

Get emergency help if the baby has breathing difficulty, becomes unusually floppy or hard to wake, or develops swelling around the mouth or tongue. Seek prompt clinical assessment for fever, poor feeding, fewer wet nappies, widespread blistering, rapidly increasing swelling, spreading redness, warmth, tenderness, pus or red streaks. A clinician should also review a rash when its cause is unclear or the infant seems persistently distressed.

Tell the clinician when each patch appeared, whether the baby slept somewhere new, what products touched the skin and whether household members have similar marks. Ask whether the appearance fits another infant rash, how to protect scratched areas and which treatment, if any, is suitable for this baby's age. Bring photographs and details of any insects or spotting found near the cot.