Choosing the right mosquito repellent for your kid

 

“Protection is better than cure”.

Choosing the right insect repellent for your kids is a big job. There are lots of ingredients and lots of misinformation on which is the right product. The market comes up, every season (April to November roughly) with ever new and varied versions of the options of mosquito repellents: wipe, apply, plug in, coil; choice lies with the consumers.

But what to choose?? Of lately, everybody is suddenly into organic/natural/ herbal products because the new age mantra is ” Natural is better” and  they are presumed to be safe. But are they really effective or is it the companies just cashing in on the fear in the parents mind!!

We all know that even a single bite from an infected arthropod (for e.g. mosquito) can result in transmission of diseases, some which are dangerous like dengue, malaria and chikungunya especially in a country like India. So it is important to know which repellent products can be relied on to provide predictable and prolonged protection to your child from bites. Unfortunately just as with other products, we don’t have a regulatory agency in India ( vis-a-vis other countries) to advice on which product should be used and which should not be. 

Insect repellents prevent bites from biting insects but not stinging insects. Biting insects include mosquitoes, ticks, fleas, chiggers, and biting flies. Stinging insects include bees, hornets, and wasps.

Commercially available insect repellents can be divided into two categories:  synthetic chemicals and plant-derived essential oils. They come in many forms, including aerosols, sprays, liquids,creams, and sticks (roll-ons).

Here I will be only discussing about application type and not vaporizers/plug-ins type.

The 4 currently recommended repellents all over the world by CDC/WHO and which are registered with the Environmental Protection Agency, USA (EPA) are:

(These products have been tested and proven to be both effective and safe for humans and the environment, when used as directed, but remember no repellent is 100% effective)

1. DEET [N,N-diethyl-m-toluamide]:  Many repellents contain DEET as the active ingredient. The concentration of DEET varies considerably among products. The duration of protection varies with the DEET concentration; higher concentrations protect longer.The amount of DEET may range from < 10% to > 30% (DEET greater than 30% doesn’t offer any additional protection and is generally not recommended).  Questions often arise about use of DEET on children. There is no restriction on the percentage of DEET in the product for use on children. There also are no data showing incidents that would lead us to believe there is a need to restrict the use of DEET. However AAP recommends not using it in children less than 6 months. While unwarranted fear continues to persist regarding DEET, it has the longest track record (over 6 decades) of safety and effectiveness in human studies when used as directed, and is regarded as the most effective insect repellent against mosquitoes.

Note: DEET can be safely applied to cotton, wool and nylon, but may damage spandex, rayon, acetate and pigmented leather. DEET may react with some synthetic fabrics and plastics and hence can dissolve them (e.g. sunglasses frames or watch bands).

2. Picaridin (KB3023): Picaridin is a newer insect repellent ingredient and is odourless and less sticky when compared to DEET. It may be more pleasant to use and does not dissolve plastic. Studies have found picaridin to be as effective as DEET; however, it is not as long-lasting and will need to be reapplied more often. Products containing 10 per cent picaridin will prevent mosquito bites in most situations. A 5-10% conc. can protect against ticks and mosquitoes for 5 to 8 hrs.  These products should not be used on infants younger than 6 months old.
3. Oil of lemon eucalyptus (OLE) with enhanced PMD (paramenthane-3,8-diol): 30% conc. can provide protection for upto 6 hrs. It is a good choice for people who want botanically based repellent. However, it should not be used on children aged < 3 years due to age-related safety issues ( can be a lung irritant or allergenic). Synthetic PMD is also available, however is used in lesser conc. (10%). Note: “Pure” oil of lemon eucalyptus, as an essential oil, is not recommended for use as an insect repellent.

4. IR3535: A 20% conc can provide protection for upto 8 hrs. Relatively safer to use. Like DEET it also melts some plastics and may damage fabrics.
5. 2-undecanone (derived from the wild tomato plant) is a natural insect repellent that has been recently added to the CDC’s list of recommended insect repellents and is EPA-registered. 7.5 % conc. offers protection for 4 hrs. Being a recent introduction, very limited options are available as of now.

OTHERS ( NOT RECOMMENDED, BUT USED WIDELY)

6. Botanical repellents: No guidelines or data exist for their use. Citronella oil, catnip oil, soybean oil, geranium oil, peppermint oil etc. though effective, provide very limited protection due to quick evaporation after application and might cause allergic reactions due to high level of impurities. They may be good for a quick trip to the market or garden but not for long outdoor stays.  It is therefore recommended that consumers who are in high risk areas for mosquito borne diseases or who need long lasting effective protection should avoid botanically based repellents aside from OLE described above.

Note: Permethrin, an active ingredient in treating head lice, is an insecticide and repellent. It can be effectively used to repel mosquitoes and other insects when sprayed on clothes, sleeping bags, or tents. IT SHOULD NOT BE DIRECTLY APPLIED TO SKIN!

Use of DEET-containing products in conjunction with a permethrin-product may be the most effective means of repelling insects.

The minimum required concentration of each four of these agents to be effective for 3 hours against most arthropods is 20% (in cream, roll-on or spray vehicle). In general, products with a 20% – 30% concentration provide a longer duration of protection if planning to be outdoors for more than 2-3 hours. Remember that strength of a repellent ( as measured by concentration) determines the duration of protection provided and not how many mosquito bites are prevented.

Described side effects of these agents are mild, being limited to local irritative dermatitis and allergy. There is no age restriction except for OLE.

The current recommendations about frequency of applications are (not to be used for > 1 month on daily basis):

• Use of topical repellent in infants above 6 months, once daily
• Only in exceptional circumstances of severe arthropod exposure risk, their brief use in nursing infants as young as 2 months is acceptable, however with never more than 1 application daily.
• From ages 1 to 12 years, 2 applications daily may be safely used;
• 3 applications daily after 12 years old through adulthood   

Mosquito coils although effective, should not be used as they generate significant indoor air pollution ( data suggests burning of 1 coil is equivalent to smoking 100 cigarettes).

Ensuring Safety: Remember these important points to use repellents safely:

Applying the Product: Young children should not be allowed to handle the product. When using repellent on a child, an adult should apply it to his or her own hands and then rub them on the child with the following consideration:

Dos:

1. Read the label and follow all directions and precautions
2. Only apply just enough repellents on the outside of your child’s clothing (and not under the clothing) and on exposed skin. Using more doesn’t make the repellent more effective. Avoid reapplying unless needed. Note: Permethrin-containing products should not be applied to skin.
3. Apply or spray repellents (on skin) in open areas to avoid breathing them in. ( But take care to not use repellents like a perfume and spray it all around your kid and over his clothings; its of no use). 
4. Help apply insect repellent on young children. Supervise older children when using these products.
5. Wash your children’s skin with soap and water to remove any repellent when they return indoors, and wash their clothing before they wear it again. This is particularly important when repellents are used repeatedly in a day or on consecutive days.
6. Keep it out of reach of children.

Dont’s:

1. Never apply insect repellent to children younger than 2 months.
2. Never spray insect repellent directly onto your child’s face ( i.e. near mouth and eyes). Instead, spray a little on your hands first and then rub it on your child’s face. Avoid the eyes and mouth. Apply sparingly around ears. If you’ve accidentally sprayed repellent in your eyes, rinse them immediately with water
3. Do not apply repellent to children’s hands, since children tend to put their hands in their mouths
4. Do not spray insect repellent on cu​ts, wounds, or irritated skin.
5. Do not use products that combine DEET with sunscreen. The DEET may make the sun protection factor (SPF) less effective. These products can overexpose your child to DEET because the sunscreen needs to be reapplied often. In general, apply sunscreen first and then repellent.
6. Do not spray in enclosed areas (e.g tents) or near food.
7. Roll-on preparations are preferable to sprays.

NOTE: The following types of products are not effective repellents:

• Wristbands, neckbands and ankle bands, mosquito repellent patches
• Garlic or vitamin B1 taken by mouth
• Electronic or Ultrasonic devices that give off sound waves designed to keep insects away ( some smartphone apps are also available)
• Bird or bat houses
• Bug zappers (Insects may actually be attracted to your yard).
• Odour-baited mosquito traps
• Pure essential oils
• Clip-on repellents, Insecticide fans, repellent candles
• Skin moisturizer or sunscreen combined with insect repellent  ​

Reactions to Insect Repellents

If you suspect that your child is having a reaction, such as a rash, to an insect repellent, stop using the product and wash your child’s skin with soap and water. If you go to your child’s doctor’s office, take the repellent container with you.. 

Other Ways to Protect Your Child from Insect Bites.

While you can’t prevent all insect bites, you can reduce the number your child receives by following these guidelines:

1. Tell your child to avoid areas that attract flying insects, such as garbage cans, stagnant pools of water, and flowerbeds or orchards.
2. Dress your child in long pants, a lightweight long-sleeved shirt, socks, and closed shoes when you know your child will be exposed to insects. A broad-brimmed hat can help to keep insects away from the face. Mosquito netting may be used over baby carriers or strollers in areas whe​re your baby may be exposed to insects.
3. Avoid dressing your child in clothing with bright colors or flowery prints because they seem to attract insects.
4. Don’t use scented soaps, perfumes, or hair sprays on your child because they may attract insects.
5. Keep door and window screens in good repair.

 

In the end, remember that no repellent works every place against every pest. If you are hesitant to try a new bug repellent, start using it in your backyard, neighborhood and places you go regularly. If one product fails to deter biting bugs as you had hoped, next time try a different formulation with a higher percentage of the repellent chemical, or a product with another active ingredient. But remember to read the ingredients and instructions for its application carefully.

Read the label..! ..Keep your kids safe !!

Dr. Garima| themoppetsclinic 🙂

For more information: please read

1. EWG’s 2018 Guide to Bug Repellents : What to Look for in Bug Repellent
2. Rodriguez et al; Journal of Insect science; 2017, 17(1); 1-6
3. Editorial, American family physician; Jan 2015