There are Bugs in the House!

Patient Presentation
A 2-year-old female came to clinic for her health supervision visit. The parents were concerned that she had difficulties sleeping at night with late initiation of sleep and multiple awakenings. The social history found a young couple who were living with relatives who also took care of the child while they worked. The household had a large extended family with multiple people coming and going throughout the day and night. The parents noted that the household had many cockroaches and although they themselves had tried to keep their room clean, they often saw cockroaches even during the day. The family said that they did not see nor suspect any bed bugs in their or the patient’s beds. Social services had been working with the parents and felt that they had limited economic means but that the child was not being neglected and that the parents should be commended for everything they had tried to do for the child.

The pertinent physical exam showed a healthy female with normal development and growth parameters in the 50-75%. Her examination was normal. The diagnosis of a healthy female living in a cockroach infested house and poor sleep hygiene was made. The resident physician discussed the importance of good sleep hygiene, particularly consistency. She told the parents that it was difficult given the situation. The parents said that they and one grandparent usually were the night caretakers and they would try to be more consistent with bedtime. She also gave the family some handouts about how to help clean up the household. The parents were doubtful that they would get any help from the relatives but said they would try. The attending physician had thought that cockroaches might be crawling on the child at night contributing to the poor sleep. The resident recommended that netting might be placed over the crib or mattress and tucked in to try to prevent this problem. The family thought that this was something they could do and were going to try.

Pests are just that: Pests. They are bothersome, annoying, and irritating. They can be dangerous or non-dangerous.

Cockroaches are common insects that infest homes. Cockroach body parts and feces can be allergens for certain people. Cockroaches themselves do not directly infect humans with disease through saliva/blood etc., but they carry infectious organisms on their bodies. As cockroaches move in, around, along and through almost anything, they may transmit these organisms to humans through infected food and water, etc. that cockroaches have contacted.

Cockroaches need food, water and shelter. They generally like carbohydrates so anything that is starch-based is roach food including any paper, wallpaper paste, envelope glue, and soap bars (which often contain carbohydrates). Cockroaches are usually active at night, so daytime sightings usually means a high population of insects which have overrun their shelter. During the day, cockroaches may be found hiding clustered together under, around, or even in the walls of appliances, walls, baseboard crevices, cupboards, pantries and especially around sinks. Shelter is in small cracks, crevices and especially in paper items such as boxes, wastepaper etc.. Given that paper items are often stored with garbage, also often near a water supply, its not surprising that kitchens and bathrooms are common cockroach infestation locations.

Learning Point
Cockroach prevention and cleanup includes:

  • Start where the infestation is the highest and work outward from there. Kitchens and bathrooms are often highly infested.
  • Eliminate cracks and crevices with caulk, paint and weatherstripping where possible, especially around pipes, sinks, cupboards, shelving, etc.. Wide cracks are not attractive to roaches, so increasing the width to 1″ in a freestanding cabinet may help eliminate the problem too.
  • Eliminate paper – move boxes, paper and other shelter items to an outside garbage area if possible.
  • Eliminate food – cover and store food in airtight containers. Clean up countertops, sinks, food containers, and garbage areas.
    Clean all countertops and sweep floor and counter tops from crumbs. Clean cupboards of crumbs and frequently wipe out those cupboards with items that may be spilled (bread, cereal) or that have spills (jam jars).

  • Eliminate water – keep plumbing in good working order, eliminate drips and wipe up spills.
  • Separate food, water and shelter sources as much as possible, i.e. frequently remove garbage, move paper items outside the house, wipe up water and other spills quickly.
  • Try using baits or traps before using pesticidal sprays.
    Limit pesticides spray to the infested area and avoid spraying in food preparation or storage areas. Spot spray as much as possible.

Questions for Further Discussion
1. Do bedbugs transmit diseases to humans?
2. How can bedbugs be eliminated?
3. How should pesticides be appropriately used for insect control?

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for these topics: Allergy and Pesticides.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

Environmental Protection Agency. IPM for Cockroaches in Schools. Available from the Internet at (rev. 3/1997, cited 5/13/2011).

Environmental Protection Agency. Cockroaches. Available from the Internet at (rev. 5/26/2010, cited 5/13/2011).

Piper GL, Antonelli AL. Cockroaches Identification, Biology, and Control. Available from the Internet at (cited 5/13/2011).

ACGME Competencies Highlighted by Case

  • Patient Care
    1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
    2. Essential and accurate information about the patients’ is gathered.
    3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
    4. Patient management plans are developed and carried out.
    5. Patients and their families are counseled and educated.
    8. Health care services aimed at preventing health problems or maintaining health are provided.
    9. Patient-focused care is provided by working with health care professionals, including those from other disciplines.

  • Medical Knowledge
    10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
    11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.

  • Practice Based Learning and Improvement
    13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
    16. Learning of students and other health care professionals is facilitated.

  • Interpersonal and Communication Skills
    17. A therapeutic and ethically sound relationship with patients is created and sustained.
    19. The health professional works effectively with others as a member or leader of a health care team or other professional group.

  • Professionalism
    20. Respect, compassion, and integrity; a responsiveness to the needs of patients and society that supercedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development are demonstrated.
    22. Sensitivity and responsiveness to patients’ culture, age, gender, and disabilities are demonstrated.


    Donna M. D’Alessandro, MD
    Professor of Pediatrics, University of Iowa Children’s Hospital