Summertime is time for fun for children but insects can make things miserable, which is why insect bite treatment and prevention are important to know. Not only can insects cause itchy, painful bites, but they can also cause allergic reactions, Lyme disease, impetigo, and infections. It’s important to be prepared for the onslaught of insects in the summer to minimize suffering and prevent complications.
There are many ingredients that are used in insect repellant. These include N,N-diethyl-m-toluamide (DEET), citronella, soybean oil, or permethrin.
When applying an insect repellant, it is important to remember that clothing can rub it off the skin. Evaporation, heat, sweating, or water can decrease its effectiveness, and higher temperatures lessen the time of effectiveness.
The most effective insect repellant is Deet. Deet protects against mosquitoes, flies, gnats, chiggers, and ticks. It does not protect against stinging insects such as bees, wasps, or fire ants. Deet has been associated with side effects but only in very high concentrations such as 10-20% in children with excessively repeated applications. At concentrations of 10% or lower there have been no reported adverse effects. For this reason the concentration used in children should be 10% or less. Also, it should be reapplied infrequently. It should be applied no more than twice in a 6-hour period.
Because of reported side effects, some people like to use the other products.
Citronella is the active ingredient in Avon Skin So Soft. This will work, but only for a very short period of time. And since the safety of repeated applications is unknown, only use this if outdoor activity will be less than 1 hour. Soybean oil is the new product on the market. The makers report excellent study results with 97% protection 3.5 hours after use compared with 86% protection for Deet 6.5% in the same time frame. Since this is a newer product without a long history and multiple studies, the true efficacy and safety is not yet known for sure. Permethrin, which is used in the treatment of scabies and head lice, really should not be used since the safety of repeated application is just not yet known. Thiamine (vitamin B1), which showed promise in some studies, apparently doesn’t work.
Once an insect bites a child, side effects can be anything from a small itching lump to a systemic allergic reaction requiring immediate treatment. For the simple insect bites, an anti-itch cream such as Calamine, Benadryl, Aveeno, or hydrocortisone can be used. Oral Benadryl can also be given if the creams are not helping enough.
For severe reactions including any difficulty breathing, immediate medical treatment is necessary. In these children, epinephrine injections may be needed for future insect bites. If a bee bites a child and the stinger is left in place, scrape off the stinger with a credit card or other flat object. Grabbing and pulling out the stinger will inject more toxins into the body. Apply ice immediately and give a dose of Benadryl. If there is any trouble breathing give a shot of epinephrine if available and call 911. Ticks should be removed with tweezers. In areas of the country with a high prevalence of Lyme disease, a blood test or treatment may be necessary. There is a vaccine for Lyme disease. Check with your physician to see if you or your child would be eligible for this.
Deet is the best and most effective active ingredient with the longest studies proving safety and efficacy. Use this in concentrations of 10% or less for all children and reapply no more than twice in a six-hour period. With good prevention, insect bites can be avoided.
Written by Dr. Michael Bornstein, who has over 28 years of experience as a pediatrician.
Disclaimer: The contents of this article, including text and images, are for informational purposes only and do not constitute a medical service. Always seek the advice of a physician or other qualified health professional for medical advice, diagnosis, and treatment.
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