When taking your baby outside, keep in mind that you need to protect her from biting insects (mosquitoes, ticks, fleas, chiggers, biting flies) and stinging insects (bees, hornets, wasps). Mosquitoes can spread West Nile virus and Zika, and in other parts of the world, malaria. Ticks can give your child Lyme disease, Rocky Mountain spotted fever, or other diseases. And of course, any bug bite can cause your child to scratch so much she gets infected with a superficial staph or strep infection in the skin. So what’s the best and safest way to protect your child from these summertime pests?
Do Your Best to Avoid the Bugs
The first rule is to cover up as much as possible. Wear shirts with short or, if tolerable, long sleeves, not tank tops. Wear shoes and socks instead of sandals and flip-flops. Put on a wide-brimmed hat. Longer shorts or pants are better than short shorts. Cover strollers with netting, if possible.
Don’t dress in clothes with bright colors or flower prints as these may attract insects. Avoid using scented soaps, perfumes, hair sprays, and body lotions as they may also attract insects.1
When possible, keep children away from areas that attract flying insects: stagnant pools of water, flowerbeds, orchards, and garbage cans.
Make sure your window and door screens are intact.
Use Insect Repellent
There are several natural and chemical insect repellents that are safe for children. However, the American Academy of Pediatrics (AAP) does not recommend using any insect repellent on children younger than 2 months old.1
The most well-known repellent is DEET (N,N-diethyl-3-methylbenzamide, also known as diethyltoluamide). It is the most effective insect repellent, and lasts about 2-5 hours after application, depending on the concentration. As discussed previously on The Pulse and in other studies, it is also safe to use when pregnant.2
Products can contain a range of DEET concentrations from less than 10% to more than 30%, but products with more than 30% DEET don’t offer any extra protection. The AAP recommends using products with no more than 30% DEET on children.1
Historically, there has been a lot of concern about using DEET in children due to reports of seizures. However, there have been only 10 case reports of seizures in children associated with DEET applied to the skin, and none since 1992. And in these cases, other causes of seizures were not ruled out, such as encephalitis that could have been caused by a mosquito.2
In addition, a large-scale study on over 20,000 cases of accidental DEET exposure showed that children experienced less of the severe side effects and adults more of the worse side effects from DEET exposure.2
Still, it’s best to use caution when applying a DEET-containing product.
- Apply the repellent only on the outside of clothing and on exposed skin
- Use only enough to cover the clothing and skin. Using more doesn’t make it more effective. Do not reapply unless necessary.
- Wash the skin with soap and water after returning indoors. Wash clothes before wearing them again.
- Don’t apply the repellent to a child’s hands or around her mouth.
Alternatives to DEET
There are many alternatives to DEET, but most are lacking in sufficient safety studies on children.
One alternative is picaridin. In concentrations between 10-20%, it protects as well as DEET against mosquitoes and is better than DEET at repelling some ticks. Picaridin lasts from 3-8 hours, depending on concentration. Because of the lack of data, it is not recommended for children younger than 2 years old.1,3,4
Permethrin is a potent repellent for all kinds of biting insects and kills ticks on contact. However, it should not be applied to the skin as it can be irritating. It is often sprayed on clothes and outdoor equipment (tents, sleeping bags). Permethrin is designed to last on clothes even after several washings.1,3
IR3535 (ethyl butylacetylaminoproprionate) is an effective repellent against biting insects, including ticks, and is the active ingredient in Avon Skin So Soft. It lasts about 2-3 hours after application. There is no data on its safety in children or pregnant women.3
All of the above are chemical repellents. A popular plant-based repellent is oil of lemon eucalyptus, also known as PMD (p-menthane-3, 8-diol). It’s effectiveness and duration is similar to DEET, but offers better protection against ticks than DEET. It is usually found in pump sprays in concentrations of 10-40%. PMD is not recommended in children younger than 3 years old.
Citronella (3,7-dimethyloct-6-en-1-al) is another plant-based repellent. It is used as a lotion or oil on the skin and is commonly used in candles. It has a short duration of action, lasting only 30 minutes to 2 hours.2-4
Products That DON’T Work
The market is flooded with many products advertised as insect repellents, but these are not effective. For example, some essential oils do repel insects, but need to be reapplied every 30 minutes, making them impractical. The list of products to avoid includes:1,4
- Essential oils
- Wristbands with chemical repellents
- Garlic or Vitamin B1 taken orally
- Bug zappers (these may actually attract insects to the backyard)
- Ultrasonic devices using sound waves to repel insects
- Choosing Insect Repellent for Your Child. 2017. (Accessed May 11, 2018, at https://www.healthychildren.org/English/safety-prevention/at-play/Pages/Insect-Repellents.aspx.)
- Koren G, Matsui D, Bailey B. DEET-based insect repellents: safety implications for children and pregnant and lactating women. CMAJ. 2003 Aug 5;169 (3):209-12.
- Diaz JH. Chemical and Plant-Based Insect Repellents: Efficacy, Safety, and Toxicity. Wilderness Environ Med. 2016 Mar;27 (1):153-63.
- Webb CE, Hess IM. A review of recommendations on the safe and effective use of topical mosquito repellents. Public Health Res Pract. 2016 Dec 14;26 (5).