True or false? Insects prefer biting infants to biting older children/adults.
Answer: No one really knows. Perhaps infants get bitten more because they are “sitting ducks,” unable to shoo insects away. Regardless, infants need protection with the safest /most effective repellants available, for their comfort and their health.
Here is what is known.
1. Choose repellents whose active ingredients are DEET, picaridin or oil of lemon eucalyptus. These three repellents are the best studied, most frequently used, effective against a larger number of species of insects than other substances, and safe for young children when used correctly. The amount of these repellents absorbed through the skin and into the blood of infants/young children is minimal and appears to be harmless.
2. Don’t confuse “natural/organic/chemical free” with “safe/effective.” The fact that a repellent (or other products) is derived from a plant does not necessarily make it safer/more effective than ones made in laboratories. (Numerous plants are deadly.) Most repellents labeled natural/organic/chemical-free have not been evaluated scientifically and, likely, provide inferior protection. Studies show that biting insects are attracted to humans by odors from the skin and carbon dioxide from exhaling. The recommended repellents interfere with this ability.
3. DEET, picaridin and oil of lemon eucalyptus are available in numerous forms. There are pump sprays, aerosols, creams, towelettes, foams, liquids, and wipes. And each product has different concentrations of the active ingredient, causing much confusion. Familiarize yourself with one or two products. Know the concentration of the active ingredient recommended for infants/young children, the lower age cut-off, how often to reapply, and possible side effects. Generally, using concentrations higher than recommended increases protection time while only slightly improving effectiveness, and may cause more skin irritation.
4. Apply repellent to your own hands and then rub it onto children. Avoid spraying in enclosed areas. Apply sparingly; a thin coating suffices. Cover only exposed skin. Avoid eyes, fingers, hands, mouth and cuts. Wash off with soap and water when protection is no longer necessary. Generally, skin and eye irritation is more annoying than alarming. If reactions occur, wash the area, and call a poison control center. Have the product in front of you when calling.
5. Know how often to reapply repellents. There is no telltale sign indicating when repellents lose effectiveness. Follow the information on the label. But this information is calculated from volunteers placing their bare arms into glass cases containing specific types of biting insects and predetermined, constant conditions: temperature, humidity and no wind; no perspiration; and uniform coats applied –conditions rarely duplicated outdoors. Choose repellents that provide protection for the amount of time that you will be outdoors. In areas where insects carry serious diseases reapply somewhat more often than recommended.
6. DEET is the best-studied repellent. It has been in use for 50 years and is approved for infants two months of age. (Use mosquito netting over carriages for younger infants.) Concentrations between 20 and 35% are most often recommended and protect for about five hours. Products with 5% DEET protect for about 90 minutes. A 20-35% DEET, microencapsulated, sustained-release formulation is said to be effective for 8-12 hours and appears to be safe for infants/young children. Only extreme misuse of DEET has caused toxic reactions. DEET has an odor some find unpleasant. It can damage plastics, leather, and clothing made from synthetic fabrics.
7. Picaridin may be safer than DEET. But picaridin has been in use for less time and not nearly as widely, which may account for fewer reports of adverse effects from gross overuse, conditions which provide clues to toxicity. Picaridin is approved for children three years and older. Concentrations of about 20% are recommended for infants/young children. This percentage provides about 8 to 10 hours of protection under ideal conditions. Picaridin may be less irritating to skin, has no odor, and does not damage clothing and plastics.
8. Oil of lemon eucalyptus is the newest approved repellent. This repellent was only approved a few years ago but is becoming increasingly popular, in part because its name sounds “more natural” than the other two approved repellents. Like picaridin, it may be used on children older than three years of age. A 40% formulation provides protection for about six hours under ideal conditions. It may cause eye irritation.
9. The combination of an approved repellent on skin and permethrin on clothing is most effective. Spraying clothing with permethrin – before wearing the clothing – helps prevent insects from biting though the clothing or crawling under clothing. Properly sprayed apparel retains its repellent qualities for weeks, even when repeatedly laundered. Special solutions are available to impregnate tents, bed nets, and curtains, for example, where insects transmit serious illnesses such as malaria. Avoid direct spraying on skin. Permethrin is considered safe for infants. Permethrin is available online and at sporting goods stores.
10. Avoid products that combine insect repellents and sunscreens. Many situations call for both. But ideal intervals between applications and other factors make combination products impractical. Apply sunscreens at least twenty minutes before sun exposure, allowing the product to penetrate the skin. Apply liberally and often. Repellents can be applied (in thin coats) just before exposure. Note that repellents may reduce the effectiveness of the sunscreen, necessitating the use of a stronger sunscreen than called for. In most situations, insect repellent need not be reapplied as frequently as sunscreen. (The latest on sun protection for infants/children will appear in a future posting.)