By: Sophie J. Balk MD, FAAP
Warmer weather means more chances for kids to get outside to play, hike and enjoy the fresh air with family and friends. Warmer weather also means preventing insect bites.
Biting insects such as mosquitoes and biting flies can make children miserable. More worrisome is that bites from some insects can cause serious illnesses.
Beyond the itch: illnesses carried by insects
Insect-transmitted illnesses include Lyme Disease, West Nile Disease, Zika, and others from mosquito and tick bites. And according to the U.S. Centers for Disease Control and Prevention (CDC), insect-borne illnesses are on the rise.
One way to protect your child from biting insects is to use insect repellents. When there's a possibility of getting a serious illness, such as Lyme disease, transmitted by an insect bite, make sure you choose repellent that is effective – meaning that it works well. It's also important to know how to use repellants correctly and safely.
Insect repellents approved as safe and effective
The U.S. Environmental Protection Agency (EPA) regulates and approves insect repellents for their safety and effectiveness. DEET is approved as a safe and effective insect repellent.
The concentration of DEET in a product indicates how long the product will be effective–a higher concentration works for a longer time. For example, 10% DEET provides protection for about 2 hours, and 30% DEET protects for about 5 hours. Concentrations of more than 50% DEET provide no added protection. You can choose the lowest concentration to provide protection for the among of time spent outside. For example, if you plan to be outside for one hour, you can choose 10% DEET.
When used on children, insect repellents should contain no more than 30% DEET. Insect repellents are not recommended for children younger than 2 months of age.
DEET-containing repellents should not be harmful if parents follow directions on the label to use the product safely. DEET products can cause skin rashes especially when high concentrations are used, but these reactions are rare.
Picaridin and other repellents
In addition to DEET, picaridin and other products are considered safe and effective by the EPA. You can find information about these by using the
EPA search tool.
Tips for choosing and applying insect repellent on your child
Choose products in the form of sticks, lotions or unpressurized sprays.
Read the label and follow all directions and precautions.
Only apply insect repellents on the outside of your child's clothing and on exposed skin – not under clothing.
Use just enough repellent to cover your child's clothing and exposed skin. Using more doesn't make the repellent more effective. Repellents such as DEET should only be applied once a day.
Use spray repellents in open areas to avoid breathing them in.
Help apply insect repellent on young children. Supervise older children when using these products.
Wash your children's skin with soap and water to remove any repellent when they return indoors and wash their clothing before they wear it again.
Keep repellents out of young children's reach to reduce the risk of unintentional swallowing.
Avoid sprays in pressurized containers to avoid inhaling the product or getting it into eyes.
Never apply insect repellent to children younger than 2 months of age. Instead, use mosquito netting over baby carriers or strollers in areas where your baby may be exposed to insects.
Never spray insect repellent directly onto your child's face. Instead, spray a little on your hands first and then rub it on your child's face. Avoid the eyes and mouth.
Do not spray insect repellent on cuts, wounds, or irritated skin.
Do not use products that combine DEET with sunscreen. These products can overexpose your child to DEET because the
sunscreen needs to be reapplied often – every 2 hours while in the sun, and after swimming or sweating.
Natural insect repellents
"Natural" insect-repellent ingredients including citronella, geranium, peppermint and soybean oil. These are deemed safe but have not been approved for effectiveness by the EPA. Most of these keep insects away for only a short time. In addition, some natural repellents can cause skin irritation.
There are other products marketed to families that are not proven to be effective against mosquitoes. These include wristbands soaked in chemical repellents, for example, as well as backyard bug zappers and ultrasonic devices that give off sound waves meant to keep insects away.
Natural and other alternative repellents may be good if there is no concern about getting a serious insect-borne illness. If there is a health concern–such as for Lyme disease in an area known to have ticks–DEET, picaridin or another product that's proven effective is a better option.
Other ways to protect your child from insect bites
While you can't prevent all insect bites, these steps can help reduce them:
Tell your child to avoid areas that attract flying insects, such as garbage cans, stagnant pools of water, and flowerbeds or orchards.
Dress your child in long pants, a lightweight long-sleeved shirt, socks, and closed shoes when you know your child will be exposed to insects. A broad-brimmed hat can help to keep insects away from the face.
Keep door and window screens in good repair. Remove any outside places with standing water where mosquitoes may breed.
Don't use scented soaps, perfumes, or hair sprays on your child because they may attract insects.
Use mosquito nets and fans in outdoor eating areas.
Avoid dressing your child in clothing with bright colors or flowery prints because they may attract insects.
- Check your child's skin at the end of the day if you live in an area where ticks are present and your child has been playing outdoors. Remove ticks safely.
Remember that the most effective product for ticks is permethrin. It should not be applied to skin but on your child's clothing. Permethrin also may be applied to outdoor equipment such as sleeping bags or tents.
What if my child has a reaction to an insect repellent?
If you suspect that your child is having a reaction to an insect repellent, such as a rash:
Stop using the product and wash your child's skin with soap and water.
Poison Help at 1-800-222-1222 or your child's doctor for help.
If you go to your child's doctor's office, take the repellent container with you.
Insect repellents don't kill insects but work by keeping insects away from the person using them. Keep in mind that they repel insects that bite but not insects that sting. Biting insects include mosquitoes, ticks, fleas, chiggers, and biting flies. Stinging insects include bees, hornets, and wasps.
Talk with your child's pediatrician if you have any questions about protecting your child from insect bites.
About Dr. Balk
Sophie J. Balk MD, FAAP, is an Attending Pediatrician at Children's Hospital at Montefiore and a Professor of Pediatrics at Albert Einstein College of Medicine. She is an Executive Committee member of the American Academy of Pediatrics Council on Environmental Health and Climate Change. Dr. Balk has served as Associate Editor of the four editions of Pediatric Environmental Health. In clinical practice and research, her focus includes pediatric environmental health, pediatric tobacco issues, and skin cancer prevention.