Tag: insect repellents

What is Skeeter Syndrome?

Skeeter syndrome is a large local reaction after a mosquito bite that can mimic an infection.

What’s your first thought if your child has a large swollen area that is hot, red, and either painful or itchy?

A child with Skeeter syndrome - a bite that quickly got red, hot, and swollen.
A child with Skeeter syndrome – a bite that quickly got red, hot, and swollen. Photo by Vincent Iannelli, MD

You’re probably thinking that this bite is infected, right? It was gone without treatment over about 48 hours.

What is Skeeter Syndrome?

While that is certainly a possibility, if the reaction occurs right after a bite or sting, it is much more likely to be an inflammatory reaction – Skeeter syndrome.

The American Academy of Allergy Asthma and Immunology defines Skeeter syndrome as an inflammatory reaction to mosquito bites.
The term Skeeter syndrome was first used in a report by Simons and Peng in 1999.

Although the American Academy of Allergy Asthma and Immunology says that Skeeter syndrome is relatively rare, spend a few minutes with a pediatrician and they will likely tell you that we see it all of the time…

“The large local reactions to mosquito bites that we have designated as skeeter syndrome occur within hours of the bites and are characterized by the cardinal signs of inflammation: swelling (tumor), heat (calor), redness (rubor), and itching/pain (dolor). By inspection and palpation, it is impossible to differentiate between inflammation caused by infection and inflammation caused by an allergic response.”

Skeeter syndrome Case Studies

These reactions can be especially impressive, and scary, for parents if they occur on a child’s eyelid or penis – as loose tissue in these areas can lead to a lot of swelling.

So how can you tell if a child has Skeeter syndrome or cellulitis, an infection that requires antibiotics?

“The reactions were initially misdiagnosed as cellulitis and investigated and treated as such, although by history they developed within hours of a mosquito bite, a time frame in which it would have been highly unlikely for an infection to develop.”

Skeeter syndrome Case Studies

Although cellulitis can mimic or look just like Skeeter syndrome, it is the timing of the reaction, very soon after the bite, that will help you and your pediatrician make an accurate diagnosis. That’s important, because the treatments for Skeeter syndrome and cellulitis are very different.

In general, kids with Skeeter syndrome only require symptomatic care, perhaps an antihistamine and topical steroid cream, while cellulitis is treated with antibiotics.

Are there any other differences between Skeeter syndrome and cellulitis?

While cellulitis will likely continue to worsen, especially if it isn’t treated with antibiotics, you can expect the redness and swelling triggered by Skeeter syndrome to start to get better after two to three days. Keep in mind that many bites and stings do worsen over the first day or two though…

What Causes Skeeter Syndrome?

The large local reaction that occurs with Skeeter syndrome is triggered by antigens in the saliva of the mosquitoes.

While these typically just cause mild local reactions in most of us, others can have severe, delayed reactions, exaggerated local reactions, or very rarely, anaphylactic reactions.

“The children with skeeter syndrome remain healthy, except for recurrent large local inflammatory reactions to mosquito bites.”

Skeeter syndrome Case Studies

So what should you do for your child with Skeeter syndrome?

For one thing, use insect repellents so that they don’t get mosquito bites. And work to control the mosquitoes around your home.

You might also give them an age appropriate dose of a second-generation H1-antihistamine such as cetirizine to prevent or treat the reaction if they do get some bites.

Are mosquitoes the only insects that cause Skeeter syndrome?

By definition, yes.

But we often see these same type of large, local reactions (LLRs) after fire ant bites, bee stings, and other bites and stings.

“There is no clear definition of LLRs. They are generally described as any induration larger than 10cm in diameter around the insect sting. The swelling can occur immediately or 6 to 12 hours after the sting and can gradually increase over 24 to 48 hours. The swelling usually subsides after 3 to 10 days. LLRs represent a late-phase immunoglobulin E (IgE)–associated inflammation.”

Pansare et al on Summer Buzz: All You Need to Know about Insect Sting Allergies

Sweat bees, very small bees, for example, are notorious for “stinging” people around their eyes and causing what looks like periorbital cellulitis, as they like to drink the salt on our sweaty skin.

Is your child’s bite or sting infected?

Just remember, even if the area is hot, red, and swollen, if it got like that within hours of a bite, then it probably isn’t infected.

“The type of clinical reaction determines the risk of allergic reactions to future stings.”

Pansare et al on Summer Buzz: All You Need to Know about Insect Sting Allergies

And also be reassured that children who only have large local reactions are very unlikely to go on to have more severe, anaphylatic type reactions in the future.

More on Insect Bites and Stings

Is Acute Flaccid Myelitis Contagious?

Do we really know whether or not acute flaccid myelitis is contagious or not?

Many people were surprised by a comment by Dr. Robert Redfield, the director of the Centers for Disease Control and Prevention, in an interview for “CBS This Morning,” during which he said that acute flaccid myelitis:

“doesn’t appear to be transmissible from human to human.”

Wait, then how do kids get it?

Is Acute Flaccid Myelitis Contagious?

Since we don’t actually know what causes AFM, it is certainly possible, although rather unlikely, that it is caused by something that is not communicable.

But remember, the leading theory is that AFM is caused by an enteroviral infection, either EV-D68 and EV-A71, as most kids develop symptoms shortly after they had viral symptoms, and these two viruses are most commonly identified.

And you are typically contagious when you are sick with an enteroviral infection.

So how can the CDC Director say that AFM “doesn’t appear to be transmissible from human to human?”

It is because even if the virus that causes AFM is communicable, you can’t actually catch AFM from someone.

adult child cooperation daylight
Wash your hands to help avoid viral infections. Photo by Andres Chaparro on Pexels.com

Just like polio.

While the polio virus itself is communicable, paralytic polio isn’t. You can’t catch paralytic polio. Instead, you can catch polio, and then you have the small chance that it develops into paralytic polio.

It may not sound like a big difference, but it is.

Just consider what might happen if AFM itself was contagious, and if most of the kids who were exposed to someone with AFM developed AFM themselves…

We would likely see a lot more cases of AFM, especially in clusters in homes, daycare centers, and schools.

Instead, most cases seem to be isolated.

AFM Clusters

But aren’t there reports of clusters of AFM?

“In September 2016, an acute care hospital in Arizona notified the Maricopa County Department of Public Health (MCDPH) of a suspected case of AFM and subsequent cluster of 11 children who were evaluated with similar neurologic deficits; differential diagnoses included transverse myelitis and AFM.”

Notes from the Field: Cluster of Acute Flaccid Myelitis in Five Pediatric Patients — Maricopa County, Arizona, 2016

Yes, kind of.

But they aren’t clusters of epidemiological linked cases.

In Arizona, for example, only four of the 11 children were confirmed to have AFM and “no epidemiologic links were detected among the four patients.”

“In October 2016, Seattle Children’s Hospital notified the Washington State Department of Health (DOH) and CDC of a cluster of acute onset of limb weakness in children aged ≤14 years.”

Acute Flaccid Myelitis Among Children — Washington, September–November 2016

Similarly, at Seattle Children’s Hospital, the ten cases in their “cluster” had nothing in common, except for having prodromal respiratory or gastrointestinal symptoms about seven days before developing AFM symptoms.

It is likely that you see “clusters” at some hospitals simply because they are referral hospitals for a large region.

But even if we don’t know why some kids with these viral infections develop paralysis and other don’t, if they are the cause, then you wouldn’t develop AFM if you never actually had the virus.

“While we don’t know if it is effective in preventing AFM, washing your hands often with soap and water is one of the best ways to avoid getting sick and spreading germs to other people.”

About Acute Flaccid Myelitis

So handwashing and avoiding others who are sick is still the best strategy to try and avoid getting AFM.

And getting vaccinated against polio and using insect repellents can help you avoid other known causes of AFP – polio and West Nile virus.

More on Preventing AFM

What to Do If a Mosquito Bites Your Child

Mosquito-borne diseases, like dengue, West Nile, and Zika, can certainly be serious, but you likely don’t need to panic your child has gotten one of them every time he or she gets a mosquito bite.

Mosquito bites aren't good, but you don't have to get panicked about them.
Mosquito bites aren’t good, but you usually don’t have to get panicked about them.

Depending on where you live, a mosquito bite can be just a nuisance or it can lead to a life-threatening disease. From Chikungunya virus to Zika, most parents have learned to fear mosquito-borne diseases and because they hear about them so much, fear or even get panicked over mosquito bites.

While it is good to prepared and learn to avoid mosquito bites, you likely shouldn’t be panicked.

But even if your kids aren’t at risk for a mosquito-borne disease, it’s no fun getting bit by mosquitoes. Mosquito bites are itchy, and even when bites don’t get infected, they can leave behind crusted scabs that kids continue to pick at, over and over again.

Still no reason for panic or fear – just good reasons to learn to avoid mosquito bites.

Mosquitoes and Mosquito-Borne Diseases

Diseases that can be spread from the bite of a mosquito can include:

  • Chikungunya – can develop fever and severe and debilitating joint pain 3-7 days after a mosquito bite from Aedes aegypti and Aedes albopictus mosquitoes in countries in Africa, Asia, Europe, and the Indian and Pacific Oceans, Caribbean countries, and most recently, in Florida, Puerto Rico, and the U.S. Virgin Islands.
  • Dengue – can cause severe flu like symptoms, including fever, severe headache, eye pain, joint and muscle pain, rash, and bleeding, after a mosquito bite in one of at least 100 endemic countries, including many popular tourist destinations in Latin America, Southeast Asia and the Pacific islands. While there are cases in the US, it is important to keep in mind that “nearly all dengue cases reported in the 48 continental states were acquired elsewhere by travelers or immigrants.”
  • Eastern Equine encephalitis – a very rare disease, which is fortunate, as it is one of the most deadly of the mosquito-borne diseases. Transmission is in and around swampy areas, with most cases in Florida, Georgia, Massachusetts, and New Jersey.
  • Filariasis – spread by repeated mosquito bites over months to years, this disease is still found in at least 73 countries in parts Asia, Africa, the Western Pacific, and parts of the Caribbean and South America, these parasitic worms can grow and live in our lymph system
  • Japanese encephalitis – you can get a Japanese encephalitis virus infection after being bit by an infected Culex species mosquito in one of 24 countries in South-East Asia and the Western Pacific, especially if you are not vaccinated.
  • La Crosse encephalitis – rare, but can occur in the upper Midwestern and mid-Atlantic and southeastern states and can cause severe disease, including encephalitis, in children.
  • Malaria – although malaria was eliminated in the US in the early 1950s, we still see about 1,700 cases each year in returning travelers. That’s because malaria is a still a big problem around the world, from certain some states in Mexico to most of sub-Saharan Africa and South Asia.
  • St. Louis encephalitis – can occur in eastern and central states, starts with mild symptoms, but can very rarely (between 1 to 12 cases a year) progress to encephalitis (inflammation of the brain).
  • West Nile – has now been found in every state except Alaska and Hawaii, but up to 80% of people don’t develop any symptoms and only 1% develop severe symptoms, with folks over age 60 years most at risk. Although West Nile season peaks in mid-August, cases are usually reported from late summer through early fall.
  • Western Equine encephalitis – rare, but deadly, like Eastern Equine encephalitis, and is found in states west of the Mississippi River
  • Yellow fever – a vaccine-preventable disease, the Yellow fever virus is still found in tropical and subtropical areas in South America and Africa.
  • Zika – is mostly a risk during pregnancy as it can cause serious birth defects, including microcephaly, so there are warnings to avoid high risk areas, which in addition to multiple countries and territories around the world, includes Brownsville, Texas and previously included Miami-Dade County, Florida

Won’t a long list of diseases get parent’s panicked? Only if they skip the part about where the mosquitoes that cause those diseases are active.

What to Do If a Mosquito Bites Your Child

Original Title: DPD_A.freeborni_861sRGB
 Do you know what to do if a mosquito bites your child? Photo by James Gathany

If a mosquito bites your child, don’t panic. There is no reason to run to your pediatrician or the ER and get tested for West Nile or Zika.

That’s not to say a mosquito bite couldn’t send you to the ER, but it would likely only be if your child was severely allergic, with the bite causing an anaphylatic reaction. Fortunately, most bites just leave little red bumps that go away in a few days if you don’t scratch them too much.

So the key treatment after a mosquito bite is classically about relieving the symptoms of itching. As with other itchy rashes, you can do this by:

  • applying an OTC anti-itch cream (hydrocortisone cream or calamine lotion) to the bite
  • taking an oral antihistamine, especially at night
  • applying a prescription steroid cream to help control itching

Also, keep your child’s finger nails short to minimize damage from scratching and wash the areas with soap and water to decrease the risk of secondary infections.

“Where you live, your travel history, and the travel history of your sex partner(s) can affect your chances of getting Zika.”

CDC on Know Your Zika Risk

In general, you should see your pediatrician if you have the symptoms of a mosquito-borne disease and have been in an area with risk of that disease.

Should you worry about dengue, West Nile, or Zika, etc?

  • Does your child live in an area where you can commonly find the mosquitoes that carry any of these diseases?
  • Did your child recently visit an area where you can commonly find the mosquitoes that carry any of these diseases?
  • Is your child a pregnant teen?
  • Is your teen sexually active?
  • Does your child have a chronic medical condition, such as cancer, diabetes, hypertension, or kidney disease?
  • Is your child a first- or second-generation immigrant from a malaria-endemic country who returned to their home country to visit friends and relatives?
  • Was your child at risk for a mosquito-borne disease and skipped taking preventative medications for malaria or skipped getting a Japanese encephalitis vaccine or a Yellow fever vaccine?

Again, see your pediatrician if your child had a mosquito bite and now has the symptoms of a mosquito-borne disease after being in an area with risk of that disease. This is especially important for anyone who is pregnant or with a chronic medical problem, as they might be at higher risk for severe disease. The elderly are more at risk too.

Preventing Mosquito Bites

Of course, whether you are traveling to the tropics or going for a walk in your neighborhood, your best bet is going to be trying to avoid mosquitoes and mosquito bites in the first place.

  • use insect repellent, which can protect your kids from tick bites too
  • wear long-sleeved shirts and long pants when possible
  • get rid of standing water around your home – places where mosquitoes can breed
  • make sure windows and doors have screens or are kept shut to keep mosquitoes out of your home
  • instead of insect repellent, consider using mosquito netting to cover your infant’s stroller or carrier when outside, and especially when in high risk parts of the world, using insecticide treated bed nets

And review travel advisories before planning a trip to see if you need to take any additional precautions to avoid a mosquito-borne disease.

What to Know About Mosquitoes and Mosquito Bites

Mosquito-borne diseases, like dengue, West Nile, and Zika, can certainly be serious, but you likely don’t need to panic your child has gotten one of them every time he or she gets a mosquito bite.

More About Mosquitoes and Mosquito Bites

What to Do If a Tick Bites Your Child

Don’t panic if a tick bites your child. You have up to 36 hours to remove it, before it is can likely transmit any diseases to your child, like Lyme disease or Rocky mountain spotted fever.

Lyme disease.

That’s usually what comes to mind when people find a tick on their child or if they simply think about tick-borne diseases.

It is important to know that there are many other diseases that can be caused by many different types of ticks though, from anaplasmosis to tularemia. And since these ticks and the diseases they transmit are fairly regional, it is easy to be unfamiliar with them if you don’t live in their specific habitats.

That can especially be a problem if, for example, you are from Hawaii, where tick-borne diseases aren’t a big issue, and you travel for a camping trip to Oklahoma and your child is bitten by a tick. Will you or your doctor know what to do if your child develops symptoms of Rocky Mountain spotted fever?

How To Remove a Tick

Fortunately, if you find a tick on your child, you can decrease their chance of getting sick if you remove it quickly. That makes doing daily full body tick checks important.

 

Use tweezers to remove a tick, grabbing it close to the skin, and pulling it upward with steady, even pressure.
Use tweezers to remove a tick, grabbing it close to the skin, and pulling it upward with steady, even pressure. A special tick-removal spoon can make it even easier!

How quickly?

At least 36 hours.

“Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.”

CDC on Preventing Tick Bites

After removing the tick, wash the bite area and your hands with soap and water and observe your child over the next few weeks for symptoms of a tick-borne disease.

Symptoms of a Tick Bite

Although some of the symptoms of tick-borne diseases are specific to the tick that bit your child, some other symptoms are common to all of them, including:

  • fever
  • headache
  • fatigue
  • muscle aches and joint pains
  • skin rashes
  • chills

Like spider bites, tick bites are usually painless. That often leads to a delay in actually figuring out that a tick has bitten your child, which makes it important to do frequent tick checks if they are doing anything that could expose them to ticks.

Many people are also surprised at how many different diseases can be transmitted by ticks, including:

  • Anaplasmosis – transmitted by the black-legged tick (northeast and upper midwestern United States) and the western black-legged tick (Northern California). May not cause a rash.
  • Babesiosis – transmitted by the black-legged tick (northeast and upper midwestern United States). Can cause severe hemolytic anemia.
  • Colorado Tick Fever – a viral infection that is transmitted by the Rocky Mountain wood tick (western United States, especially Colorado, Utah, Montana, and Wyoming). Can cause meningoencephalitis.
  • Ehrilichiosis – transmitted by the lone star tick in southcentral and eastern US.
  • Lyme disease – transmitted by the blacklegged in the northeastern U.S. and upper midwestern U.S. and the western blacklegged tick along the Pacific coast. Erythema migrans rash or Bull’s eye rash.
  • Powassan disease – a viral infection that is transmitted by the black-legged tick (northeastern United States and the Great Lakes region). Can cause biphasic illness, with children appearing to get better and then the symptoms reappearing again.
  • Rocky Mountain spotted fever – transmitted by the American dog tick, Rocky Mountain wood tick, and the brown dog tick in the U.S. Causing a classic petechial rash on the wrists, forearms, and ankles, which can then spread to the trunk.
  • Rickettsia parkeri Rickettsiosis – transmitted by the Gulf Coast tick in the eastern and southern United States.
  • STARI (Southern Tick-Associated Rash Illness) – “transmitted” by the lone star tick (central Texas and Oklahoma eastward to the the whole Atlantic coast). Children have an expanding “bull’s eye” lesion at the tick bite, like Lyme disease, but the cause is unknown.
  • Tickborne relapsing fever (TBRF) – spread by multiple soft ticks in the western United States which live in rodent infested cabins and can cause relapsing fever – 3 day episodes of fever, in between 7 days stretches in which a child might be fever free, over 3 to 4 weeks.
  • Tularemia – transmitted by dog ticks, wood ticks, and lone star ticks or by handling a sick animal, including wild rabbits, muskrats, prairie dogs, and domestic cats. Can cause an ulcer at the site of infection.
  • 364D Rickettsiosis – transmitted by the Pacific Coast tick in Northern California dn along the Pacific Coast.

And although it can be helpful to know about all of the different tick-borne diseases and their symptoms, you should basically just know to seek medical attention if your child gets sick in the few weeks following a tick bite.

What to Know About Ticks and Tick Bites

Of course, it would be even better to reduce your child’s risk of getting a tick-borne disease by avoiding ticks in first place, including limiting his exposure to grassy and wooden areas, wearing protective clothing, using insect repellent, treating your dogs for ticks, taking a shower within two hours of possibly being exposed to ticks, and doing frequent tick checks.

In addition to avoiding ticks, it is important to know that:

  • The Vermont Department of Health advises that the best way to prevent tickborne diseases is to prevent tick bites.
    The Vermont Department of Health advises that the best way to prevent tickborne diseases is to prevent tick bites.

    Tick activity is seasonal, with adult ticks most active in spring and fall, and the smaller nymphal ticks more active in late spring and summer.

  • Tick bites that lead to tick-borne diseases are often not noticed because they are usually painless and are often caused by nymphs, the immature, smaller forms of a tick. So while you might be thinking about a large, adult tick when you are asked about a recent tick bite, a nymph is tiny (about 2mm long) and might even be missed.
  • Testing (on your child), including antibody tests, can be done to confirm a diagnosis of most tick-borne diseases, but keep in mind that testing can be negative early on. You also shouldn’t wait for results before starting treatment in a child with a suspected tick-borne disease. Testing is usually done with either indirect immunofluorescence antibody (IFA) assay or enzyme immunoassay (EIA) tests.
  • It is usually not recommended that you have a tick that has bitten your child be tested for tick-borne diseases. Even if the tick was positive for something, it wouldn’t mean that it transmitted the disease to your child.
  • Experts don’t usually recommend that people be treated for tick-borne diseases after a tick bite unless they show symptoms. The only exception might be if the tick was on for more than 36 hours and you were in an area with a high risk for Lyme disease.
  • Although doxycycline, one of the antibiotics often used to treat tick-borne diseases, is often restricted to children who are at least 8 years old because of the risk of side effects, it should still be used if your younger child has Rocky Mountain spotted fever, ehrlichiosis, or anaplasmosis.

You should also know that most old wives tales about ticks and tick bites really aren’t true. You should not try to burn a tick that is biting your child with a match, paint it with nail polish, or smother it with vaseline, etc. Just remove it with tweezers and throw it away in a sealed bag or by flushing it down the toilet.

What to Do If a Tick Bites Your Child

Don’t panic if a tick bites your child. You have up to 36 hours to remove it, before it is can likely transmit any diseases to your child, like Lyme disease or Rocky mountain spotted fever.

More About Ticks and Tick Bites

Safe and Effective Sun Screens for Kids

Applying a generous amount of a water-resistant sunscreen that provides broad-spectrum SPF 15 to 30 sun protection at least 15 to 30 minutes before your child is going to be in the sun, reapplying every few hours, can help keep your kids safe in the sun.

One of the cardinal rules of summer is that you don’t let your kids get a sunburn.

While a really great rule, it misses that you also shouldn’t let them get a tan either, and the rule doesn’t just apply to summer.

How do they do it in Australia? Slip (on some sleeves) - Slop (on a lot of sunscreen) - Slap (on a hat) - Seek (shade) - and Slide (on your sunglasses).
How do they do it in Australia? Slip (on some sleeves) – Slop (on a lot of sunscreen) – Slap (on a hat) – Seek (shade) – and Slide (on your sunglasses).

That’s were sunscreen comes in. Slop it on.

Sunscreens for Kids

Are sunscreens safe for kids?

As with insect repellents, despite all of the warning about chemicals and toxins that you might read on the internet, the answer is of course they are. In fact, most sunscreens can even be used on infants as young as age six months. And it is certainly better than letting your kids get sunburned!

You do have to use them correctly though.

Choosing a Safe and Effective Sunscreen

Which sunscreen should you use?

This Blue Lizard sunscreen includes Titanium Dioxide and Zinc Oxide, providing broad spectrum UVA and UVB protection.
This Blue Lizard sunscreen includes Titanium Dioxide and Zinc Oxide, providing broad spectrum UVA and UVB protection.

Many parents are surprised that there are actually a lot of different ingredients in sunscreens, from Aminobenzoic acid and Octocrylene to Zinc Oxide.

While some are physical sunscreens (Titanium Dioxide and Zinc Oxide), others are chemical sunscreens. Some provide UVA protection, some UVB protection, and some offer both. And not surprisingly, some have become controversial, especially retinyl palmitate (vitamin A) and oxybenzone.

All are thought to be safe though.

Which is best?

When choosing a sunscreen, start with the fact that none should usually be used on infants under six months of age. Otherwise, choose the product (whatever the brand, to be honest, whether it is Banana Boat, Blue Lizard, Coppertone, Hawaiian Tropic, Neutrogena, or Target) best suited to your child’s needs, especially considering that:

  • sun tan lotion and tanning oil should be avoided
  • SPF 8 only blocks 87 percent of UVB rays and should be avoided
  • SPF 15 blocks 93 percent of UVB rays (minimum you should use)
  • SPF 30 blocks 97 percent of UVB rays (good for daily use)
  • SPF 50 blocks 98 percent of UVB rays (good for daily use)
  • SPF 50+ don’t offer much more UVB protection and may encourage folks to stay in the sun longer than they should, putting them at even more risk from UVA rays
  • a broad-spectrum sunscreen provides both UVA and UVB protection
  • even if your kids don’t go in the water, a sunscreen that is water-resistant might stay on better if they are sweating or get sprayed with water

In addition to the active ingredient and it’s SPF, you can now decide if you want a sunscreen that is in a spray, mist, cream, lotion, or stick. You can then pick one that is fragrance free, PABA free (of course), tear free, oil free (important if your kids have acne), for your baby or your kid playing sports, for someone with sensitive skin, or goes on dry.

Using a whipped sunscreen is just one of the newer ways to protect your kids from the sun's harmful rays.
Using a whipped sunscreen is just one of the newer ways to protect your kids in the sun.

Or would you like your child’s sunscreen whipped???

While parents and kids often seem to prefer spray sunscreens, do keep in mind the warnings about inhaling the spray and that some experts are concerned that they make it harder to apply a generous amount on your child. How much of the spray goes off in the wind? How much end up in an oily spot on the floor? If you use a spray sunscreen, follow the directions, rub it in, and don’t spray it in your child’s face. Also, don’t spray sunscreen on your child near an open flame.

Most importantly, you want to choose a sunscreen that will help you get in a good routine of using properly and using all of the time. Personally, I like all of the newer non-greasy lotions for kids and adults that have come out in the last few years. They are easy to apply, even in generous amounts, and work well.

Using Sunscreens on Kids

Now that you have chosen your sunscreen, be sure to use it properly.

“An average-sized adult or child needs at least one ounce of sunscreen (about the amount it takes to fill a shot glass) to evenly cover the body from head to toe.”

FDA

Do your kids still get burned or tanned despite using sunscreen? They aren’t immune to sunscreen. You are probably just making one or more common sunscreen mistakes, like not using enough sunscreen (start using a lot more), waiting until you’re already outside before applying it on your kids (you want to apply sunscreen at least 15 minutes before you go outside so that it has time to get absorbed into their skin), or not reapplying it often enough (sunscreen should be reapplied every few hours or more often if your kids are swimming or sweating a lot).

How long does a 6 or 8 ounce container of sunscreen last you? Remember that if you are applying an ounce before your kids go outside, reapplying it every few hours, and using it on most days (not just in the summer), then it shouldn’t last very long at all.

A layered approach to sun protection can help keep your kids safe in the sun.
A layered approach to sun protection can help keep your kids safe in the sun.

For the best protection and to avoid mistakes, be sure to read the label and follow your sunscreen’s instructions carefully, and also:

  • encourage your kids to seek shade and wear protective clothing (especially hats, sunglasses, and UPF sun-safe clothing), in addition to wearing sun screen for extra sun protection
  • use sunscreen every time they go outside, even when it’s cloudy
  • reduce or limit your child’s sun exposure when UV rays are strongest, which is usually from about 10 a.m. to 2 p.m. (and all of the way to 4 p.m. in most areas), especially on days when the UV index is moderate or high and/or when there is a UV Alert in your area.

If you forget something, remember slip, slop, slap, seek, and slide.

Facts about Sunscreens and Sun Protection for Kids

Other things to know about sunscreen and sun protection for kids include that:

  • Waiting for improvements to sunscreen labels and new requirements for sunscreens? The FDA made their ‘big changes’ to sunscreens back in 2011. The main things that got left were the SPF cap and the rating system for UVA protection.
  • Tanning beds are not a safe alternative to getting a tan outside in the sun.
  • It is not safe to get a base tan. It won’t protect you from a sunburn and it increases your chance of future melanoma.
  • Still confused about how much sunscreen to use? Another handy rule is that a handful of sunscreen (fill to cover the palm of their cupped hand) should be a generous amount that’s enough to cover your child’s entire body. Since bigger kids have bigger hands, that should help you adjust the amount for different-size kids and as they get older.
  • Avoid combination sunscreen/insect repellent products. Use separate products instead, applying the sunscreen first and reapplying the sunscreen every few hours as necessary. Since you don’t typically reapply insect repellents (unless you are going to be outside for a really long time), if your child starts to get bitten, next time, you will likely need to consider using an insect repellent with a different active ingredient or at least one with a stronger concentration that might last longer.
  • SPF is only a measure of the sunscreen’s level of protection against UVB rays, but does say anything about UVA protection. A sunscreen that is labeled as being broad spectrum should protect against both UVA and UVB radiation.
  • According to the FDA, “SPF is not directly related to time of solar exposure but to amount of solar exposure.” What does that mean? While you can stay in the sun longer when protected with a sunscreen, no matter the SPF, it doesn’t tell you how long. Other factors, including the time of day, weather conditions, and even your location will help determine how quickly your skin will burn.
  • Sunscreens should be stored in a cool place and be thrown away after they expire. While it might be convenient, your car is not a good place to store your sunscreen.

Ready for some fun in the sun now? You sure you won’t come home with a sunburn or a dark tan?

What To Know About Sunscreens for Kids

Applying a generous amount of a water-resistant sunscreen that provides broad-spectrum SPF 15 to 30 sun protection at least 15 to 30 minutes before your child is going to be in the sun, reapplying every few hours, can help keep your kids safe in the sun.

More About Sunscreens for Kids

Safe and Effective Insect Repellents for Kids

When used properly, insect repellents are safe and effective and the best way to help your kids avoid getting eaten up by mosquitoes, chiggers, ticks and other things that like to bite kids.

While other measures are important too, insect repellents are typically the best way to protect your kids from biting insects and ticks.
While other measures are important too, insect repellents are typically the best way to protect your kids from biting insects and ticks. Photo by James Gathany.

As we become more and more aware of diseases that can spread from the bites of insects and ticks, it becomes important that we learn to protect our kids. Plus, itchy bites can turn into nasty scabs that your kids pick at over and over, leaving scars that might even get infected.

What should you do?

Insect Repellents for Kids

In addition to simply trying to avoid mosquitoes and ticks, which can be difficult, especially as your kids get older and spend more time outside, you should learn to protect them with insect repellents.

Are insect repellents safe for kids?

Despite all of the warning about chemicals and toxic pesticides that you might read on the internet, the answer is of course they are. In fact, many insect repellents can even be used on infants as young as age two months. And it is certainly better than your kids getting Chikungunya, Dengue, Lyme disease, Rocky Mountain Spotted Fever, West Nile, or Zika. Or MRSA from an infected bite.

You do have to use them correctly though.

Choosing a Safe and Effective Insect Repellent

If they are using the new EPA label, your insect repellent will tell you how long it will protect your kids against mosquitoes and ticks.
If using the new EPA label, your insect repellent will tell you how long it will protect your kids against mosquitoes and ticks.

Which insect repellent should you use?

Although traditionally insect repellents with DEET have long been “considered the best defense against biting insects,” the CDC has now said that some other DEET-free alternative insect repellents may work as well as lower dose DEET, including those with 2-undecanone, Picaridin, IR3535, oil of lemon eucalyptus, and 2% soybean oil.

Of course, that has led to a lot of new insect repellents on store shelves these days. And to a lot of confused parents trying to decide which is the best for their kids.

Don’t be one of them.

When choosing one of these insect repellents, start with the fact that none should be used on infants under two months of age and products containing oil of lemon eucalyptus should not be used on children under age three years. Otherwise, choose the product best suited to your child’s needs, especially considering that:

  • no protection insect repellents should be avoided (garlic, vitamin B1, bug zappers, insect repellent wristbands)
  • shorter protection insect repellents last about two hours (less than 10% DEET, essential oils, 2-undecanone)
  • medium protection insect repellents last about 3 to 4 hours (20% DEET, 7% Picaridin)
  • longer protection insect repellents last about 5 hours or more (24% DEET, 15% Picaridin)

In addition to the active ingredient and it’s strength (how long it lasts), you can now decide if you want an insect repellent that sprays on smooth and dry and isn’t greasy, has a light, tropical scent, or is unscented. Or instead of a spray (pump or aerosol), you can even choose insect repellent wipes or a lotion.

Do keep in mind that the CDC advises that products above 30% DEET reportedly do not provide any extra protection, although it doesn’t keep stores from selling sprays with as much as 100% DEET. For other products, those with higher concentrations of DEET aren’t necessarily stronger, they simply provide longer protection.

So if you are going for a walk around the neighborhood with your preschoolers, some good choices might be:

  • Avon Skin-So-Soft Bug Guard Plus Towelettes (IR3535)
  • BioUD Spray (2-undecanone)
  • Buzz Away Spray (Citronella oil)
  • Cutter All Family Spray (7% DEET)
  • Cutter Lemon Eucalyptus Spray
  • Cutter Natural Spray
  • Cutter Skinsations  (7% DEET)
  • OFF! FamilyCare II (5% Picaridin)
  • OFF! FamilyCare III (5% DEET)
  • OFF! FamilyCare IV (7% DEET)

There are many other brands too, including Sawyer, Repel, and discounted store brands from CVS, Target, and Walgreens, etc.

Using Insect Repellents on Kids

Now that you have chosen your insect repellent, be sure to use it safely.

That means reading the label and following the instructions carefully, being sure to:

  • only apply the proper amount of insect repellent to exposed skin or clothing
  • avoid applying insect repellent near your child’s eyes and mouth, on cuts, irritated skin, or under your child’s clothing
  • wash off the insect repellent when you return indoors
  • avoid spraying insect repellent inside your home or car, directly on your child’s face (apply to your own hands and then rub it on their face) and hands (they might rub their eyes or put their hands in their mouth), or allowing them to spray it on themselves
  • instead of insect repellent, consider using mosquito netting to cover your infant’s stroller or carrier when outside, and especially when in high risk parts of the world, using insecticide treated bed nets

It can also help to mosquito-proof your home and work to control mosquitoes and ticks where your child plays. And of course, have your child cover up and dress to avoid getting bit when possible, with long socks and clothing that covers their arms and legs.

Facts About Insect Repellents for Kids

Other things to know about insect repellents for kids include that:

  • Protect times can be different for protection against mosquitoes vs ticks.
  • IR3535, also known as Insect Repellent 3535, is a synthetic biopesticide (ethyl butylacetylaminopropionate). It was once only found in Avon Skin So Soft products, but can now be found in other brands too.
  • It is the chemical in oil of lemon eucalyptus, PMD or para-menthane-3,8-diol, that gives it pesticidal properties.
  • Avoid combination sunscreen/insect repellent products. Use separate products instead, applying the sunscreen first and reapplying the sunscreen every few hours as necessary. Since you don’t typically reapply insect repellents (unless you are going to be outside for a really long time), if your child starts  to get bitten, next time, you will likely need to consider using an insect repellent with a different active ingredient or at least one with a stronger concentration that might last longer.
  • Although available, insect repellent lotions are often harder to find in stores.
  • In addition more standard insect repellents, permethrin treated clothing is available.
  • Don’t be fooled by natural insect repellents that ‘smell amazing’ and say that they aren’t “full of chemicals.” They likely contain para-menthane-3,8-diol, ethyl butylacetylaminopropionate, or other chemicals. While they are DEET-free and some may be natural, they aren’t free of chemicals. And keep in mind that many natural insect repellents are non-EPA registered.
  • Call poison control (1-800-222-1222) if your child gets the insect repellent in their mouth or eyes or has a reaction.

Although they are the best protection, since insect repellents aren’t perfect, you should also learn how to remove ticks and the symptoms of mosquito and tickborne diseases.

Yet more protection options include the Dengue vaccine (not available in the US yet though) and preventative medications for malaria.

What to Know About Insect Repellents for Kids

When used properly, insect repellents are safe and effective and the best way to help your kids avoid getting eaten up by mosquitoes, chiggers, ticks and other things that like to bite kids.

More About Insect Repellents for Kids

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