What Parents Need to Know About Botflies in Children

Imagine you notice a small bump on your child's skin that seems to be growing bigger each day. It looks red, feels warm, and your child complains it itches or hurts. You might think it is just an insect bite or a simple skin infection. But if you recently traveled to a tropical place, it could be something unusual called a botfly infection.

Botflies are special types of flies found mainly in warm, tropical areas of Central America, South America, and some parts of Africa. The most common type that affects humans is called Dermatobia hominis, also known as the human botfly. These flies have a very interesting but unsettling way of reproducing. They need to lay their babies, called larvae, inside the skin of warm-blooded animals, including humans.

The good news is that botfly infections in children are not common, especially if you live in countries with cooler climates. Most cases happen to children who visit tropical rainforests or rural areas in places like Belize, Brazil, Costa Rica, Panama, or parts of Central Africa during family vacations or visits to relatives.

The way botflies get into your child's skin is quite unusual. The adult female botfly does not directly land on your child and lay eggs. Instead, she catches another flying insect, usually a mosquito or sometimes a tick, and glues her tiny eggs onto the belly of that insect. When the mosquito lands on your child's warm skin to bite, the heat from the body causes the botfly eggs to hatch almost immediately.

Within just a few minutes, a tiny baby botfly larva comes out of the egg and quickly burrows into the skin. It usually enters through the mosquito bite hole or through a hair follicle. This happens so fast and is so small that your child probably will not feel anything at that moment.

Once inside the skin, the tiny larva settles down and starts growing. It feeds on the tissue fluid around it and grows bigger over several weeks. During this time, it breathes through a small hole in the skin. The larva has tiny hooks and spines on its body that help it stay firmly attached inside the skin.

Knowing what to look for can help you identify a botfly infection early. The symptoms usually start to appear about one week after your child has been bitten by the mosquito carrying botfly eggs. Here are the signs parents should watch for:

• A small red bump appears on the skin, usually on exposed areas like arms, legs, face, or scalp
• The bump is slightly raised and may look like a regular mosquito bite at first
• Your child may complain of mild itching at the spot

• The bump gets bigger, growing to about 1 to 3 centimeters in size
• A small opening or hole appears in the center of the bump
• Clear or yellowish fluid may leak from this opening, sometimes mixed with a tiny bit of blood
• The area around the bump becomes red and swollen
• Your child may feel pain, especially sharp or shooting pain when the larva moves inside
• Some children say they can feel something moving under their skin
• The bump may feel warm to touch

Unlike regular skin infections, children with botfly usually do not have fever. Their lymph nodes (the small glands that swell when fighting infection) are usually not swollen. If you gently press around the bump, fluid may come out from the central hole. This central breathing hole is the key sign that helps doctors know it is a botfly and not just a regular boil or infection.

Feature	Botfly Infection	Regular Skin Infection
Central Opening	Yes, always present	Usually not present
Fever	Usually none	Often present
Movement Sensation	Sometimes felt	Never
Fluid Discharge	Clear or blood-tinged	Usually pus (thick, yellow)

If you think your child might have a botfly infection, it is important to see a doctor. A pediatrician, dermatologist (skin doctor), or infectious disease specialist can help diagnose the condition.

The doctor will ask you important questions about your recent travel history. Have you visited any tropical countries in the past few weeks? Did your child spend time outdoors in forests or rural areas? Were there many mosquitoes around? These details give important clues.

The doctor will carefully examine the bump on your child's skin. They will look for the central breathing hole and may gently press around it to see if any fluid comes out. Sometimes, they can actually see the back end of the larva moving in and out of the hole.

In some cases, the doctor might use special tools like dermoscopy (a magnifying device to look at the skin closely) or even ultrasound (the same technology used to see babies before birth) to confirm the larva is there. Once the larva is removed, it can be sent to a laboratory to confirm it is indeed a botfly.

The botfly larva has tiny hooks and spines on its body that anchor it firmly in the skin. If you try to pull it out forcefully, it can break into pieces. Leaving pieces of the larva inside can cause serious bacterial infection. In children, especially if the larva is on the scalp, there is a rare but serious risk that infection could spread to the brain.

Doctors have safe and effective ways to remove botfly larvae from children:

1. Suffocation Method

The doctor may first try to suffocate the larva by blocking its breathing hole. They might apply substances like petroleum jelly, thick ointment, or special tape over the hole. The larva needs to breathe, so when its air supply is cut off for 24 to 48 hours, it becomes weak and the tiny hooks soften. This makes removal much easier and safer.

2. Gentle Extraction

After the larva is weakened, the doctor can carefully squeeze around the bump to push out the larva through the hole. They may use special tweezers or forceps to grab it gently and pull it out in one piece. The whole larva must come out completely.

3. Surgical Removal

Sometimes, especially if the larva is very big or in a difficult location, the doctor may need to do a small surgery. They will numb the area with local anesthesia so your child does not feel pain. Then they make a small cut to widen the opening and carefully remove the larva. This is especially important for larvae near the eyes or on the scalp in young children.

Once the larva is completely removed, the doctor will clean the wound thoroughly. They will prescribe antibiotic ointment to prevent bacterial infection. Your child may also need to take antibiotic pills for a few days. The wound usually heals within one to two weeks.

You will need to keep the area clean and dry. Change the bandage as instructed by your doctor. Watch for any signs of infection like increased redness, swelling, warmth, or pus coming from the wound.

Prevention is always better than treatment. If you are planning to travel with your children to tropical areas where botflies are found, taking simple precautions can greatly reduce the risk of infection.

• Learn about the areas you will visit. Know if botflies are common there
• Pack appropriate protective clothing and insect repellent
• Teach your children about insects and why it is important to avoid mosquito bites
• Find out where the nearest medical facilities are located at your destination

• Dress your children in long-sleeved shirts and long pants, especially during outdoor activities
• Choose light-colored clothing as it is easier to spot insects on light colors
• Tuck pants into socks when walking in forests or grassy areas
• Have children wear hats to protect the scalp
• Use closed shoes instead of sandals when exploring nature

Using insect repellent is one of the most effective ways to prevent mosquito bites and therefore botfly infections:

• Use child-safe insect repellents containing DEET, picaridin, or oil of lemon eucalyptus
• For children under 2 years, use lower concentrations of DEET (10 to 30 percent)
• Apply repellent to all exposed skin, but avoid hands, eyes, and mouth
• Reapply as directed on the product label, especially after swimming or sweating
• Wash off repellent when coming indoors

• Use mosquito nets when children sleep, especially in areas without air conditioning or screens
• Keep windows and doors closed or screened to prevent insects from entering
• Stay indoors during dawn and dusk when mosquitoes are most active
• Avoid areas near standing water where mosquitoes breed
• If possible, choose accommodations with air conditioning, as mosquitoes are less active in cool environments

• Check your child's skin carefully after spending time outdoors
• Look for any unusual bumps, bites, or redness
• Bathe children and wash their hair thoroughly
• Change into fresh clothes that were stored indoors

Botfly infections require extra attention when they occur in babies and very young children:

• Young children cannot explain their symptoms well, so parents must be extra observant
• Babies may cry more, refuse to eat, or seem unusually fussy if they have pain from a botfly
• Check your child's entire body, including the scalp, behind ears, and between toes regularly
• Young children are more likely to scratch or pick at bumps, which can cause secondary infection
• Keep fingernails short and clean to prevent scratching injuries

Botfly infections are not contagious, so your child cannot spread it to other children. However, it is best to keep your child home until the larva is removed and the wound begins healing to prevent secondary infections and to keep your child comfortable.

Yes, if left alone, the larva will mature over 6 to 12 weeks and then exit the skin on its own to continue its life cycle in the soil. However, waiting this long means your child will have pain and discomfort for many weeks. It is much better to have it removed medically as soon as it is discovered.

Botfly infections are rarely fatal. The main risks are secondary bacterial infection if the wound is not properly cared for, and the rare complication of brain infection if a scalp larva in a very young child is not treated promptly. With proper medical care, complete recovery is expected.

Yes, having a botfly infection once does not provide immunity. If your child is exposed to mosquitoes carrying botfly eggs again, another infection is possible. This is why prevention is so important, especially when traveling to tropical areas.

The wound should gradually become less red, swollen, and painful over several days. Normal healing includes some mild redness and slight clear drainage for the first few days. See your doctor if you notice increased pain, spreading redness, thick yellow or green pus, fever, or red streaks extending from the wound.

If you notice an unusual bump on your child's skin after traveling to a tropical area, follow these steps:

1. Stay calm. Remember that botfly infections are treatable and usually not dangerous
2. Do not squeeze, pick, or try to remove anything from the bump
3. Take clear photos of the bump to show the doctor
4. Note when you first noticed the bump and if it has changed
5. Write down all the places you traveled recently and when
6. Schedule an appointment with your pediatrician or a dermatologist as soon as possible
7. Keep the area clean and covered with a light bandage to prevent your child from scratching
8. Monitor your child for fever, increased pain, or spreading redness

While it is not pleasant to think about, understanding what happens during a botfly infection can help reduce fear and anxiety:

The larva spends about 6 to 10 weeks growing inside the skin. During this time, it creates a small pocket or cavity in the tissue. It breathes through the small hole in the skin and releases waste through the same opening, which is why you might see fluid coming out.

The larva grows through three stages, getting bigger each time. In the final stage, it can grow up to 2 centimeters long. When fully grown, if left untreated, it would naturally wiggle out of the skin, fall to the ground, burrow into soil, and transform into an adult fly.

Interestingly, the botfly larva produces special substances that help prevent complete bacterial infection of the wound. This is nature's way of keeping the larva's home safe. However, this does not mean infections cannot happen, which is why medical care is still important.

Having a botfly can be scary and upsetting for children. Here are ways to help your child cope:

• Explain what is happening in simple, age-appropriate terms without scary details
• Reassure your child that the doctor can help and that they will feel better soon
• Let them know that many children get similar problems when traveling and that it is not their fault
• Distract them with favorite activities, games, or stories while waiting for treatment
• Stay calm yourself, as children pick up on parental anxiety
• Praise your child for being brave during examination and treatment
• If your child is old enough, you can show them educational pictures to help them understand what is happening