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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.

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