Stop the Summertime Bites
By Anne Marie Tuohy, MD
Summer time is a wonderful opportunity for children and families to enjoy the great 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 get a lot of questions about insects, not only what can be used to repel, but also how to treat bites.
Taking precautions to protect against 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 U.S. 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 interactions with these insects, particularly 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. Repellents are not useful.
Not only are biting insects a nuisance, but children are also more likely to have a 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 have more dramatic effects. Their body’s normal reaction to bites could include redness, swelling, and warmth. In some cases, reactions include clear pustules at the central site of the bite that 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 is more inconsistent when applied to the skin. If children have more extensive or multiple bites, consider an oral antihistamine, but consult with a physician for guidance.
When families look for repellent options, the most effective topical deterrents include products containing DEET. These may be found in many forms, including aerosols, sprays, liquids, creams, and sticks. There are other options that utilize natural ingredients. These may include picaridin, oil of lemon eucalyptus, or 2% soybean oil. These natural alternatives are recommended by the Center for Disease Control and Prevention as substitutes to DEET and work as well, lasting 3-8 hours depending on the concentration.
DEET concentrations may range from less than 10% to more than 30% concentration, lasting up to 5 hours with the higher concentrations. The American Academy of Pediatrics recommends that repellents used on children not contain more than 30% DEET concentration and no DEET is recommended on the skin of children younger than two months. It is important to read the label on any product for precautions. Applying the repellents on the outside of the child’s clothing and on exposed skin in limited amounts are options.
Note: Permethrin containing products should not be applied to the skin.
I recommend that if applied to the child, even if it’s limited to just the clothing, be sure to wash the clothing and the child’s skin with soap and water to remove any residual repellent 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. Applying to strollers, mosquito netting and blankets that they will be close to are all options. Products with essential oils can be briefly effective, but better studies are needed to identify the true benefits.
Wristbands soaked in chemical repellents, garlic or vitamin B1 taken by mouth, ultrasonic devices that give off sound waves, or backyard bug zappers are NOT proven, effective repellants.
While precautionary measures can help repel insects, it is not going to prevent all bites. Wearing more protective long sleeves and pants when going through insect-prone areas is still very important. Avoiding scented soaps and lotions can help you avoid attracting both biting and stinging insects, as well wearing less brightly colored clothing.
Performing tick checks at the end of a day spent outside is a good summertime routine for children living in areas with higher concentrations.
If a reaction to a repellent manifests with a rash, stop using the product and wash off your child immediately. 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 precautionary measures include 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 the great outdoors this summer with your family, friends and neighbors in a restful and safe environment is paramount. Sharing your knowledge with others will help keep all of our children protected. Have an enjoyable and productive summer!
 A Parent’s Guide to Insect Repellents (Copyright 2009 American Academy of Pediatrics, Updated 6/12.
Dr. Marie 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.