Yesterday on The PediaBlog, we examined chikungunya — a mosquito-borne viral infection previously endemic to India, Southeast Asia, parts of Africa, and now recently, the islands of the Caribbean. While the disease is seldom deadly, mosquitos are known to transmit other infections throughout the world which are more likely to cause more severe symptoms and death: malaria, dengue, yellow fever, Japanese encephalitis virus, and West Nile virus to just name a few. Some of these can be prevented with vaccines (yellow fever, Japanese encephalitis) and others, like the parasite that causes malaria, can be treated with specific medications. All of them wreak havoc, especially on the poor in developing countries. But as we saw yesterday, chikungunya has arrived on our shores, close on the heels of the appearance of West Nile virus in the United States. Will climate change caused by global warming change the geographic distribution of these infections to places not currently affected? (That’s another topic for another day on The PediaBlog.)

Deadly anaphylactic reactions from bee and wasp stings are very rare in children, but I’m sure most of us would like to avoid the pain and swelling associated with them. Also, let’s not forget other insect-borne illnesses that come from tick bites: Rocky Mountain Spotted Fever (rare in Southwestern Pennsylvania) and Lyme Disease (less rare). If bug-bites can make so many people sick, wherever you are, then it’s time to talk about their prevention.

We’ll start with some general suggestions from the American Academy of Pediatrics:

  • Don’t use scented soaps, perfumes or hair sprays on your child.
  • Avoid areas where insects nest or congregate, such as stagnant pools of water, uncovered foods and gardens where flowers are in bloom.
  • Avoid dressing your child in clothing with bright colors or flowery prints.
  • To remove a visible stinger from skin, gently back it out by scraping it with a credit card or your fingernail.
  • When outside in the evenings or other times when there are a lot of mosquitoes present, cover up with long sleeved shirts, pants and socks to prevent bites.


The use of insect repellents are encouraged for all children and adults older than 2 months old. DEET (N,N-Diethyl-3-methylbenzamide) is probably the safest and most effective insect repellent and is available in many commercial products. The AAP suggests:

  • The effectiveness is similar for 10% to 30% DEET but the duration of effect varies. Ten percent DEET provides protection for about 2 hours, and 30% protects for about 5 hours. Choose the lowest concentration that will provide the required length of coverage.
  • The concentration of DEET varies significantly from product to product, so read the label of any product you purchase. Children should wash off repellents when they return indoors.
  • As an alternative to DEET, picaridin has become available in the U.S. in concentrations of 5% to10%.


Picardin has been shown to be equally effective as DEET. More natural insect repellents which come from essential oils occurring in plants (cedar, citronella, eucalyptus, and soybean) have been shown to be as effective as 10% DEET (ie. about 2 hours of protection). It should be noted that, for both picardin and essential oils, long-term safety studies have not been performed. Allergic reactions and rashes are also more common with essential oils.

Permethrin-containing repellents are most effective for preventing tick bites but should be applied to clothes and NOT skin.

Here are some more tips to prevent insect bites, courtesy of and the AAP:


  • Read the label and follow all directions and precautions.
  • Only apply insect repellents on the outside of your child’s clothing and on exposed skin. Note: Permethrin-containing products should not be applied to skin.
  • Spray repellents in open areas to avoid breathing them in.
  • Use just enough repellent to cover your child’s clothing and exposed skin. Using more doesn’t make the repellent more effective. Avoid reapplying unless needed.
  • Help apply insect repellent on young children. Supervise older children when using these products.
  • 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.


  • Never apply insect repellent to children younger than 2 months.
  • Never spray insect repellent directly onto your child’s face. Instead, spray a little on your hands first and then rub it on your child’s face. Avoid the eyes and mouth.
  • Do not spray insect repellent on cuts, wounds, or irritated skin.
  • 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.

Finally, don’t forget to check your children (and your pets) for ticks. They especially like to hang out in the skin creases of the elbows, knees, underarms, and groin, and on the neck (just under the hairline), scalp, and behind the ears. Removing a tick that is feeding (and getting bigger by engorgement) requires the ability to grasp the head right at the point where the mouth and skin meet with a good pair of forceps (tweezers) and pull it straight out. (This will be painful, since the tick’s mouth will be practically cemented to the skin.) Don’t squeeze on the tick’s body, and make sure all mouth parts are removed before cleaning the area (and your hands) with alcohol or soap and water.

Better yet: don’t get bit!


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