Summer time is a wonderful opportunity for children and families to enjoy the outdoors. More physical activity and fresh air are not only good for our physical health, but also for our mental wellness. It is important for children and their caregivers to take necessary safety precautions to enjoy their outside time. I often get a lot of questions about insects, not only as to what can be used to repel, but also how to treat bites.
Taking precautions from biting insects is important. These include mosquitos, flies, chiggers, and ticks most commonly. With the concern that Zika virus may become a legitimate concern in the US based on the opportunity for the same mosquitos of the Aides family found here in North America as well as South/Central America, there is more cause for vigilance and prevention from exposures to and bites from these insects in particular with insect repellants. Stinging insects, including bees, wasps, and hornets are also worrisome, but avoidance and wearing less brightly colored clothes is the mainstay for stings and repellents are not useful. Not only are biting insects a nuisance, but also children are more likely to have a more pronounced local reaction. A local reaction can include swelling between joints, but not crossing a joint and anything short of full circumferential swelling. Some children have nothing more than the commonly seen “red bump”, but others are much more dramatic in their body’s normal reaction to bites with redness, swelling and warmth. Even some clear, pustules at the central site of the bite can be seen in the first few days. These eventually scab and heal over in the natural healing process. Cool compresses and over the counter hydrocortisone can be helpful in alleviating itch and discomfort. Avoiding topical Benadryl is recommended for children younger than school aged, as these can be absorbed in uncertain amounts and dosing of the antihistamine more inconsistent when applied to the skin. If children have more extensive or multiple bites, considering oral antihistamine may be an option, but consulting with a physician for guidance would be best.
When families look for options, the most effective topical deterrents involve products containing DEET. These may be found in many forms, including aerosols, sprays, liquids, creams, and sticks. There are also other options that employ natural ingredients. These may include Picardin and oil of lemon eucalyptus or 2% soybean oil which were recommended by the Center for Disease Control and Prevention as alternatives to DEET and work as well, lasting 3-8 hours depending on the concentration. DEET concentrations may range from less than 10% in products such as Off Family Skintastic to more than 30% concentration, lasting up to 5 hours for these higher concentrations.
The AAP recommends that repellants used on children not contain more than the 30% DEET concentration and no DEET is recommended on the skin of children younger than 2 months. It is important to read the label on any of these products including any precautions. Only applying the repellents on the outside of the child’s clothing and on exposed skin in limited amounts. Note that the permethrin containing products should not be applied to the skin. I always recommend that if applied to the child, even if just the clothing, to be sure to wash the clothing and child’s skin with soap and water to remove any residual prior to their retiring for the evening or wearing the clothes again. Be sure that you always have good ventilation when spraying any aerosols and do not apply to the face, but rather to strollers, mosquito netting, blankets that they will be close to, etc. Products with essential oils can be briefly effective, but better studies need to be completed to identify true benefits. Wristbands soaked in chemical repellants, garlic or vitamin B1 taken by mouth, ultrasonic devices that give off sound waves or backyard bug zappers are NOT proven effective repellants.
While these measures can help to repel insects, it is not going to prevent all bites, so wearing more protective long sleeves and pants when going through insect-prone areas is still very important. Avoiding scented soaps and lotions also helps to avoid attracting both biting and stinging insects as well wearing less brightly colored clothing.
Performing tick checks at the end of a day outside is a good summertime routine for children living in areas with high concentrations of the critters. If you suspect a reaction to a repellant manifest with a rash, immediately stop using the product and wash off your child. If they should ingest a product or have a more severe reaction, call Poison Control at 1-800-222-1222 or contact your child’s physician to seek help.
Other summertime protection includes keeping sunscreen applied to avoid harmful UV rays on the skin and wearing protective eyewear to avoid similar damage to the eyes including cataracts and macular degeneration. Because children tend to spend more time outside and have higher body surface areas than adults, they are more susceptible to UV damage than adults. Keeping well hydrated with prolonged sun exposure is also important for children spending longer days at soccer tournaments or outdoor camps through the summer months.
Enjoying time with your family, friends and neighbors in a restful and safe environment is paramount. Sharing your knowledge with others will keep all of our children have an enjoyable and productive summer!
Dr. Tuohy attended the University of Notre Dame for her undergraduate degree. She received her medical degree from the Medical College of Georgia and completed her pediatric residency from the University of Utah Department of Pediatrics. She brings over 14 years of pediatric experience, having practiced in both Minnesota and Georgia. Dr. Tuohy is board certified by the American Academy of Pediatrics. She practices at Lee Davis Pediatrics.