What are bedbugs?

Bedbugs are small insects that feed on human blood by biting through the skin. Bedbugs are most active between 2:00 and 5:00 am and are attracted to heat and exhaled carbon dioxide. Bedbugs can travel 10 to 15 feet to feed and can survive without feeding for up to 6 months. Their bites may look like a small rash and are itchy. Bedbugs are not known to transmit or spread any disease. Bedbugs are not commonly found in early childhood education (ECE) and school settings because the conditions that promote the most activity occur at night when people are sleeping. But they can "hitchhike" on clothing and backpacks from a child's home into the educational setting.

What are the signs or symptoms?

Bites typically occur on exposed skin, such as the face, neck, arms, and hands. Bites are itchy, often occurring in rows, on areas of skin that are exposed during the night.
Bites often present with a raised red bump with a small red dot at the center, marking the site of the bite.
For evidence of bedbugs in the home, look for specks of blood, rust-colored spots from crushed bugs, or pen point?sized dung spots on bedsheets and mattresses or behind loose wallpaper and look for reddish or brown live bugs, about ? of an inch, in crevices or seams of bedding.

What are the incubation and contagious periods?

Bedbugs do not reproduce on humans like scabies or lice. They bite humans at night and then hide in cracks or crevices on mattresses, cushions, or bed frames during the day.
Bedbugs are not considered contagious in the traditional sense because they do not spread directly from person to person.

How are they spread?

Bedbugs spread by hitchhiking on belongings such as clothing, book bags, or outerwear. Children or staff may unknowingly bring bedbugs into ECE or school settings this way.
Bedbugs are not a reflection of poor hygiene or cleanliness, as anyone can be affected.
Bedbugs crawl at a slow pace, similar to that of a ladybug, which limits how quickly they move from one place to another.

How do you control them?

General Approach

Understand the source. Bedbugs in ECE and school settings are almost always "hitchhikers" brought from home and usually do not indicate a problem at the facility.
Educate staff members and families about bedbugs.
Reduce clutter in classrooms and storage areas and minimize items that travel back and forth between homes and the facility.
Separate the backpack and coat of one child from those of another child to avoid cross contamination.
Provide enough space between coat hooks so each child's belongings do not touch those of another child.
Seal cracks and crevices to eliminate hiding places for bedbugs and other pests. Caulk and paint wooden baseboards or molding around ceilings.
Empty and clean cubbies, lockers, and child storage areas at least once every season.
Inspect the nap area regularly (preferably by a trained pest control operator). Use a flashlight to examine nap mats, mattresses (especially seams), bedding, cribs, and other furniture in the area.
Clean up any bedbug debris with detergent and water.

Approach if Bedbugs are Found in the Facility

In the unlikely event that bedbugs are identified in the facility

Avoid overreacting. One bedbug is not an infestation. It is not necessary to send the child home. Do not throw anything away. Nap mats and mattresses can be cleaned.
Contact a licensed pest management professional. Extermination should be done by professionals using methods such as vacuuming, heat treatment (122 ?F [50 ?C] for 90 minutes), freezing infested items, or applying insecticides, if necessary, ideally starting with the least toxic options. Facilities should use integrated pest management, which prioritizes nonchemical strategies (eg, laundering, vacuuming, freezing, and encasing items), and only use chemical treatment when necessary, while avoiding sprays of toxic chemicals that pollute the air, water, and land.
Launder bedding and clothing (hot water and hot drying cycle for 30?60 minutes), vacuum cracks and crevices (in furniture, equipment, walls, and floors), and freeze smaller articles that may have been used as hiding places for bedbugs to help reduce infestation until extermination can be performed. Dispose of the vacuum cleaner filter and bags in a tightly sealed plastic bag.
Use encasements or covers designed for bedbug or allergy control around mattresses, box springs, and pillows to trap bedbugs. These encasements and covers are widely available online by searching for "mattress or pillow encasement."

What are the roles of the educator and the family?

Usually, the educator will not know which children with insect bites have been bitten by bedbugs because they are hard to distinguish from other insect bites.
Children with bedbug bites are not infested and so do not require treatment to prevent spread to others.
Fingernails should be kept short to avoid damaging and infecting the skin because of scratching. Observe for signs of skin infection, such as boils, abscesses, or cellulitis (see Boil/Abscess/Cellulitis Quick Reference Sheet).
Children who are affected may receive steroid skin creams or oral antihistamines to relieve the itch.

Exclude from educational setting?

No.

Bedbug

COURTESY OF NATIONAL PEST MANAGEMENT ASSOCIATION

Close-up of a light-brown bedbug on a finger that shows the bedbug to be about the size of a sunflower seed.

Comment

Good resources for identifying and controlling bedbugs are the US Environmental Protection Agency (www.epa.gov/bedbugs, www.epa.gov/ipm/bed-bugs-and-schools) and the New York City Department of Health and Mental Hygiene (https://www.nyc.gov/site/doh/health/health-topics/bedbugs.page).

Disclaimer

Adapted from Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition.

The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.

Any websites, brand names, products, or manufacturers are mentioned for informational and identification purposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication. The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Bedbugs—Child Care and Schools