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Daily Dose

Stop Bugs from Biting!

1:30 to read

We are in the throes of mosquito season and with concerns about Zika, West Nile Virus and ckikungunya it is a good time to revisit insect repellents.  The mosquito threat from Aedes mosquitos is especially relevant in the southern and southeastern parts of the United States as these are the mosquitos which carry both Zika and chikngunya. The Culex mosquito species which carries West Nile Virus has been found in all of the continental United States. 

One of the best way to prevent disease is by controlling the mosquito population which means eliminating areas where mosquitoes breed. This means draining standing water!! I find myself outside draining flower pot saucers after watering or an unexpected summer thunderstorm. I am also always changing the dogs water bowl. I am trying to be vigilant about eliminating standing water.

It is also important to try and limit exposure to mosquitos during dusk and dawn which is the prime time for getting bitten, but with that being said, the Aedes mosquitoes seem to be around all day. Wearing protective clothing which is light in color with long sleeves and long pants is  helpful, but is hard to do when it is over 100 degrees everyday and your children want to play outside. 

So, insect repellents are an important part of protecting your children from bites and possible disease exposure ( although children typically do better with these mosquito born viruses than pregnant women, adults and the elderly). There are many products out there to choose from but the insect repellents with DEET have been studied for the longest period of time.

When picking an insect repellent you want to make sure they have been proven to work (efficacy), they should be non-irritating and non toxic and preferably won’t stain your clothes. Cost is also an important consideration.

DEET has been the most widely used ingredient and has been studied and has good safety and efficacy data. DEET works not only against mosquitoes but also ticks, chiggers, fleas, gnats and some biting flies.  Repellents contain anywhere from 5 - 100% DEET, but the AAP recommends that children use products containing up to 30% DEET. There is no evidence that DEET concentrations above 50% provide any greater protection. DEET has also been shown to be safe when used in pregnant women which is particularly important with possible Zika exposure.

Picardin is another repellent that has been widely studied. It comes in concentrations of 5-20% and is odorless, does not damage clothing and has low risk for skin irritation.  The AAP recommends using products for children that contain up to 10% picardin. 

Oil of eucalyptus has been shown to be effective in preventing mosquito bites but it is not approved for use in children under 3 years of age.

Citronella and other oils have shown very little efficacy against mosquito bites and are not recommended.

So, when choosing a product I would start with a lower DEET or picardin concentration depending on your child’s exposure and go up in concentration as needed. Typically, the higher the concentration of DEET or picardin the longer the protection. As you know, some people seem to be bitten more often than others (all sorts of hypothesis about this) so you may use different products on different family members depending on age, frequency of getting bitten and expected exposure ( i.e.. playing in the yard vs a camping trip).

Once again, start reading the labels and then apply the repellent to skin and clothing. Do not use a combination insect repellent and sunscreen, they should be applied separately.  After the kids come in from playing at the end of the day a good bath with soap and water is important  to wash off the repellent.

Daily Dose

Help: Bitten by a Tick

What should you do if you or someone you know has been bitten by a tick? Dear Dr. Sue: my daughter has a tick embedded on her back! EEK! I have removed it but I’m worried about Lyme disease.  Help! Signed: Tina

While many people worry about getting a disease after a tick bite, the actual risk of developing a tick-borne infection is really quite low. It also depends on the type of tick that bit you, the geographic area where you acquired the tick bite, and even how long the tick was attached to the skin.

First off, if you have been camping or in the woods etc., you should always check for ticks at the end of each day, this enables you to know that the tick has not been “feeding” for a lengthy period of time (which is important as longer attachment is required to pass infection). If you find a tick, you need to remove it promptly and properly by using tweezers to grip the tick as close to the skin as possible.  Gently and firmly use steady pressure to pull the tick off. Do not try to squeeze or crush the tick as that may cause the tick to release their fluid which may contain infection causing organisms. If you can identify some of the characteristics of the tick (size, color, flat or engorged) it will help determine if you need to be concerned about Lyme disease, which is not very common, even in endemic areas. After the tick is removed, it is only necessary to wash the area with soap and water and observe for any signs of infection. Remember, illness like Rocky Mountain Spotted fever, Lyme disease, and other tick born diseases are infrequent.  Specifically watch for symptoms over the next days including a rash that begins around the area of the bite, or the development of fever, joint pains, shortness of breath, vomiting, or a diffuse rash all over the body. If any of these symptoms occur after a tick bite, I recommend you seek medical attention immediately. That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Bug Bites

1:30 to read

It is the time of year for bugs and bites and I see a lot of kids with bites coming into my office.  Parents want to know “what kind of bite it is?” and in most of the kids I see, they are having a reaction to a mosquito bite. Parents are extremely concerned that the reaction may be abnormal and lead to breathing issues or that the bite it is infected. For some reason, baby and toddler skin just seems to swell more - that is not science but my observation…maybe because they are “yummier”?  At any rate, the best way to avoid “the mystery bite” is by using insect repellent.

 

The AAP recommends that children be protected from mosquitoes as they may not only cause discomfort and itching, but may cause several viral illnesses including West Nile, Zika and Chikungunya. Insect repellents will also prevent ticks, some of which may transmit Lyme Disease.  

 

Both the AAP and CDC recommend the use of DEET containing repellents for children 2 months of age and older. For young infants it is often easy to protect them from bites by using mosquito netting over their stroller or carseat when they are outdoors.  Once your child is older and hard to “contain” beneath mosquito netting you may use a DEET containing repellent and start with the lowest concentration - you will need to read the labels on each product.  The protection and effectiveness for DEET products of different concentrations is similar, but a higher concentration provides a longer duration of protection. Picardin has also been approved for use in concentrations of 5-10 %. The higher the concentration the longer the duration of protection as well.  So choose accordingly. I often have several products at our house and decide which to use based on the length of time we are enjoying the backyard, age of child or adult and method which I want to use to apply (spray, lotion, wipes).

 

You do not want to choose a product that contains both sunscreen and an insect repellent. Sunscreen should be applied about every 2 hours and bug spray should be applied far less frequently. I recommend applying the insect repellent with my hands rather than trying to spray a young child who is a moving target. I even put the bug spray on those precious bald baby heads (if over 2 months).  It is also important to wash the insect repellent off at the end of the day - bath time for all!

 

It is also important to dress appropriately if you are going outdoors. When possible dress your child in long sleeves, pants and even socks which will prevent bites. Avoid brightly colored and flowery clothes (may be boring), as these too attract insects.

 

It is also especially important to remove standing water around your house and yard. After a rain or watering check any standing water and empty any residual water from buckets, candles, bird baths or empty pots. Standing water is an easy breeding ground for mosquito larvae.  The type of mosquito that carries Zika also prefers to be close to houses…so it is really important drain standing water near your house. 

 

Enjoy the summer and don’t be afraid of bug sprays in children if you use them appropriately, as prevention is always preferable!

 

 

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