Dermatology • Jul 11, 2013

Bug bites – How to protect your kids

One morning last summer I looked down at my young son and thought “holy clown ear batman!”
His small ear was at least twice its normal size. I worried it was some weird infection, but realized that my well-appearing child with a suddenly itchy, but not painful ear was simply the victim of a tiny yet vicious mosquito.  We got a lot of weird looks around town that day.

So what can you do about these tiny enemies?

MosquitoPREVENTION: Kids are bug magnets and they can have very strong reactions to all types of bites. Prevention is also the best medicine. There are many options on the market.

1) The Best Protection: a combination of Permethrin-treated clothing and 30% DEET applied to exposed skin. This combination gives the best studied, most effective and longest-lasting protection from mosquitoes and ticks with the least absorption of chemicals into the skin.

  1. Treated cloth will not rub or sweat or be licked off
  2. DEET (max of 30%) should only be applied once a day to children
  3. No repellants should be used on babies less than 2 months old
  4. Apply in a well ventilated area or outside
  5. Like sunscreen, do not spray onto face. Apply to hands and rub onto key areas.
  6. Wash hands after application
  7. More is not better.
  8. The most common side effect of too much DEET is skin irritation or rash.

2) Alternatives:

  1. Long pants and sleeves will provide some protection but do not actually kill or repel insects/arthropods.
  2. A thorough skin check to remove any ticks at least once a day will help prevent transmission of serious infections.
  3. Picaridin is effective against mosquitos and ticks. It is generally well tolerated. It does not last as long as DEET.
  4. Lemon Eucalyptus  (P-methane-3,8-diol) may sound natural but it is not as well-tested and NOT recommended for use in young children. It is not listed by the EPA as effective against ticks.
  5. BioUD has a very low toxicity rating and can be effective against mosquitoes. Effectiveness against ticks in commercially available concentrations is unknown.
  6. IR 3535 is a synthetic repellant found in some Avon products. This newer product is not as well studied. Initial studies show a lower but potentially long acting protection.

TREATMENT: no repellents are 100% effective….

1) Topical: applied to the skin

  1.  1% hydrocortisone ointments are available without a prescription and will help take the itch, redness and swelling away. Apply only to the bite. If you have an infant with a lot of bites or you are concerned about infection, call your doctor first
  2. Benadryl type ointments can help but can also cause irritation. Antihistamines are better taken by mouth. See below.
  3. Calamine lotion is safe though messy and can be mildly effective
  4. Ice or a cold compress will temporarily decrease itching. Warm water or just being hot will increase itching

2) Oral: take by mouth

  1. Antihistamines: Benadryl (diphenhydramine), Zyrtec, Allegra, or Claritin type medications are all helpful to decrease itching and reactions. Benadryl type medications are the most effective but can make children sleepy or sometimes even hyper. Use as directed or call your nurse or doctor for further instruction.
  2. Antibiotics: These are sometimes needed if the bite becomes infected or if a tick transmits certain infections after a long period of attachment. Call your doctor if your child develops fever, rashes, or other symptoms related to an insect encounter.

Outdoor time is really great for kids’ development and health. Make it easier on them and on yourself by being prepared.