Mosquitoes bite infants and children more than any other insect.

Mosquitoes can transmit dangerous blood-borne illnesses including West Nile Virus, malaria, encephalitis and many other diseases.

Only female mosquitoes bite. They need a blood meal to acquire the protein they need to produce eggs.

The irritation from a mosquito bite comes from a reaction to the saliva, which includes digestive enzymes and anticoagulants.

Sensitivity to mosquito bites varies greatly. Some kids become less sensitive to the bite with age; others become increasingly allergic.

Taking a non-sedating antihistamine such as Claritin (loratadine) or Zyrtec can help lessen the effect of a bite if taken beforehand or lessen the severity of the reaction if taken after a bite.

The most effective bug repellant compounds contain DEET, picaridin and oil of lemon eucalyptus. Consumer Reports created a top five list of the most effective insect repellants, which were shown to prevent bites from ticks and at least two types of mosquitoes for at least eight hours.

• Off Deep Woods Sportsmen II (DEET 30%)
• Cutter Backwoods Unscented (DEET 23%)
• Off FamilyCare Smooth and Dry (DEET 15%)
• 3M Ultrathon Insect Repellant 8 (DEET 25%)
• Repel (Plant Based Lemon Eucalyptus)

 
The maximum concentration of DEET recommended for infants and children is 30 percent. DEET products should not be used on children under 2 months of age.

Repellant should be applied over the clothes, and avoid using it on the parts of the hands that might come in contact with your eyes or mouth.

Mosquitoes care what you wear. Avoid bright, floral colors in clothing as well as fragrances in soaps, shampoos and lotions.

Mosquitoes tend to bite between dusk and dawn, and they tend to hang out near water. When it’s hot and humid, expect more pests.

Females lay their eggs in standing water, so be aware of potential breeding areas such as:

• Bird baths
• Outdoor pet dishes
• Flower pot saucers
• Ponds
• Gutters
• Wheelbarrows and buckets
• Wading pools and swimming pools
• Trashcans, recycling bins and trash lids
• Puddles and ditches in your yard or driveway

Five bug repellents scored high marks for preventing bites, and another did pretty well, but four common choices didn’t make the grade in May 2010 testing by Consumer Reports. As a parent and pediatrician, I want a mosquito and tick repellent that is safe, effective, and easy to use. It also helps if it doesn’t smell like bug spray.

Insect and arachnid bites aren’t just annoying; they are also the cause of hundreds of West Nile virus infections, about 1500 cases of malaria, and about 35,000 cases of Lyme disease diagnosed in the US each year – not to mention the million people who die from malaria each year around the world. Even though most mosquito bites are just an itchy nuisance and most tick bites are barely noticed, it’s important to have a reliable way to block bites when needed.

Repellent testing involves daring testers who put their bare arms in mosquito-filled cages and who let ticks crawl on them, while observes record how long it takes the critters to start biting. The top five products prevented bites from ticks and two important species of mosquitoes for at least the full eight hours of the test. In four of these winners, the active ingredient was DEET. The other was a plant-based repellent using oil of lemon eucalyptus:

• Off Deep Woods Sportsmen II (DEET 30%)
• Cutter Backwoods Unscented (DEET 23%)
• Off FamilyCare Smooth and Dry (DEET 15%)
• 3M Ultrathon Insect Repellant 8 (DEET 25%)
• Repel (Plant Based Lemon Eucalyptus)

Another repellant scored almost as well, but the volunteers did start getting mosquito bites after 7 hours:

• Natrapel 8-Hour with Picardin (Picaridin)

All of the above repellents use active ingredients registered with the EPA and included in the CDC recommendations for preventing diseases spread by insect bites.

Other products tested had some benefit, but scored much lower overall:

• Avon Skin-So-Soft Bug Guard Plus IR3535 Expedition SPF 30 (IR3535)
• Bite Blocker Xtreme (Plant Oils)
• Cutter Skinsations Clean Fresh Scent (DEET 7%)
• Burt’s Bees All Natural Herbal (Plant Oils)

These results were similar to what my family found last summer when we tested a number of ‘natural’ insect repellents on a trip to Yosemite.  Repel was the clear winner, preventing all bites.

How safe are the top repellents?

The EPA rates DEET as Category III (slightly toxic) for acute oral or dermal exposures. DEET is irritating to the eyes and mucus membranes. Skin rashes are the most common side effect and are uncommon. Suspected serious adverse reactions are rare, but include seizures and encephalopathy in children. DEET is considered slightly toxic to birds, fish, and aquatic invertebrates. The EPA says that child safety claims on some DEET products are misleading and not allowed because concentrations lower than 30% are not known to be any safer. Because the risks are well understood, DEET is recommended by the CDC and AAP for use on babies down to 2 months old, but is not considered safe for newborns.

Likewise, the EPA considers picaridin Category III (slightly toxic) for acute oral or dermal exposures. In animal studies it caused slight to minimal liver hypertrophy, individual necrotic liver cells, chronic kidney inflammation, and slight kidney degeneration when ongoing large amounts of picaridin were applied to the skin. They found no evidence that it is an endocrine disruptor or carcinogen. It is nontoxic to birds and moderately toxic to fish.

I prefer the plant-based oil of lemon eucalyptus. No adverse effects have been found, other than eye irritation. The EPA considers it Category IV (practically non-toxic), for acute oral or dermal exposures – indeed for any route except being splashed in the eyes (so use lotion or use spray in the palm to apply to face). They’ve determined that it poses minimal or no risk to wildlife and is not harmful to the environment. The EPA assessment concludes that it is not expected to pose health risks to people, including children, pregnant women, or other sensitive populations. Nevertheless, the official recommendation is not to use it on children younger than 3 because testing has not yet been done on young children.

More infants and children are bitten by mosquitoes than by any other insect. But parents often don’t notice the bites on babies and young children because they don’t look like they do on teens and adults.

When a mosquito stabs her needlelike mouthparts through the skin of her victim, she injects her saliva, which is teeming with digestive enzymes and anticoagulants. The first time a person is bitten, there is no reaction. With subsequent bites, he or she becomes sensitized to the foreign proteins, and small, itchy, red bumps appear about 24 hours later. This is the most common reaction in young children. After many more bites, a pale, swollen hive, or “wheal,” appears, and it’s followed by the red bump 24 hours later. This is a familiar reaction among older children and adolescents.

Preventing mosquito bites is the key to preventing illnesses such as West Nile virus, which has spread throughout the continental U.S. Despite this alarming/troublesome fact, most Americans don’t wear insect repellent or put it on their children. For those who don’t use repellents because they don’t want chemicals on their skin or don’t like the smell or feel of DEET repellents, oil of lemon eucalyptus may be just the ticket.

Oil of lemon eucalyptus, a natural, plant-based repellent was recommended as mosquito protection in 2005 by the Centers for Disease Control and Prevention (CDC). It can be about as effective as DEET, but products containing oil of eucalyptus lemon may need to be applied more often than conventional insect repellents (especially those that contain a high concentration of DEET). Concentrations don’t differ in how much they work, only in how long they work. Oil of lemon eucalyptus usually lasts from two to five hours, but it should be reapplied right away if mosquitoes resume biting. Certified organic formulations are available at health food stores like Whole Foods and Wild Oats.

If your kids are ten or younger, don’t let them apply insect repellent themselves; instead, apply it to your own hands and rub them on your kids’ exposed skin, avoiding the eyes and mouth. Forgo their hands if they are often in their mouth.

Here are some additional tips for avoiding mosquitoes.

• Many species of mosquito prefer biting at dusk, early evening and dawn. It gets worse when the weather is hot or humid. Avoid playing/being outdoors during your area’s peak biting hours.
• Mosquitoes are attracted to things that remind them of mammal flesh and nectar, their two primary food sources. When outdoors, wear clothing that covers most of your body and avoid bright florals. Khaki, beige and olive hold no special allure for mosquitoes.
• However, mosquitoes are attracted to certain body odors, so be aware of the fragrances in your soaps, shampoos and lotions.
• Citronella candles may be useful when your children are playing outside.
• Help reduce the number of mosquitoes in areas where your children play by draining sources of standing water such as flowerpots, birdbaths, swimming-pool covers, buckets, barrels, old tires and clogged rain gutters.

Organic, all natural, bug repellant? Oil of lemon eucalyptus, a natural, plant-based repellant is one of the repellant options newly recommended in 2005 by the CDC for mosquito protection in the United States, based on solid scientific evidence. Oil of lemon eucalyptus has been used elsewhere in the world for years, and is about as effective as DEET, the chemical repellant that has been the standard U.S. recommendation since soon after World War II. Keep in mind that products containing oil of eucalyptus lemon may need to be applied more often than DEET insect repellants – especially more often than those containing high concentration of DEET.

The oil usually lasts from 2 to 5 hours, but should be reapplied right away if mosquitoes resume biting. Certified organic formulations of oil of lemon eucalyptus are available. The CDC has also now recommended the use of picaridin (KBR 3023), another chemical effective for mosquito protection. Repellants using this ingredient have been used in Europe, Asia, Latin America and Australia for years. They can be both as effective and as long-lasting as DEET. The main advantage of picaridin products is that they don’t have an objectionable insect-repellant odor.

Preventing mosquito bites is the key to preventing illnesses such as West Nile Virus, now found in 47 of the 48 states in the continental U.S. Most Americans don’t wear insect repellants, even when the mosquitoes are biting. For those who don’t use repellants because they don’t like spreading chemicals on the skin, and for those whose objection is the smell or feel of DEET repellants on the skin, one of the options newly recommended by the CDC may be just the ticket. For those who don’t use repellants because of the effort entailed, the new options won’t make much difference.

Because West Nile virus has made preventing mosquito bites more important in the United States, and because some insecticides are toxic, people have become increasingly concerned with finding gentle and effective solutions at preventing mosquito bites. DEET is the most effective ingredient at preventing mosquito bites. It does not kill mosquitoes, but repels them, discouraging them from biting.

Although DEET is recommended for pregnant and nursing women, we do know that DEET is absorbed through the skin. It crosses the placenta in pregnant women and into the breast milk of those who are nursing. This may be worth the exposure, though, because West Nile virus infections can also cross the placenta, and may pass into breast milk.

Researchers at Chapel Hill Dermatology and the Florida Medical Entomology Laboratory tested 16 different mosquito repellants on 15 volunteers who thrust their arms into cages full of mosquitoes. Four of the products contained DEET, the others were plant-based products. The results were published in the July 4, 2002 New England Journal of Medicine. Bite Blocker for Kids, whose active ingredient is soybean oil, was the most effective of the natural products – working well for an average of 94 minutes in the cage after application. The CDC suggests soybean oil products when looking for a DEET alternative. Herbal Armor (a combination of citronella, peppermint oil, cedar oil, lemongrass oil, and geranium oil) worked well for about 19 minutes. Various Skin-So-Soft products were effective for an average of 3 to 23 minutes in a cage full of mosquitoes. Cage studies, however, may underestimate how well products work in the backyard, where mosquitoes have someplace else to go.

In 2003, 32 states are already reporting West Nile virus activity, compared to only about 20 states at the same time in 2002. The CDC held a press conference on July 15, 2003, where CDC Director Dr. Julie Gerberding warned that we need to be prepared for a worse WNV season than last year, when more than 4000 people in the U.S. were infected, and 284 died. 

Noting that it is still too soon to know with certainty how bad this season will be, she declared, “the signs all indicate that there is reason to anticipate a problem, and the best defense still remains the things that people can do to protect themselves from mosquito bites.” These include using long-sleeve clothing to keep the skin covered when outside (especially in the evening and the morning), using insect repellant containing 10 percent DEET for children when appropriate, and emptying standing water near our homes at least once a week — in flower pots, and tires and anywhere else water collects — because that is where mosquitoes breed.

Most people who get bitten by a mosquito with West Nile virus do not become ill. Those who do get sick typically develop a fever, a very severe headache, and often have significant muscle aches and fatigue out of proportion to common mild viral infections. On July 8, 2003 the FDA approved a new test for West Nile virus. Although West Nile virus appears to be in the U.S. to stay, advances like the new test (and hopefully soon new vaccines and treatments) may help to bring it under control.

Dr. Greene’s Answer:

The West Nile virus (WNV) can be scary, but even in places where it has been appearing for a few years, the number of people who get it is very, very tiny.

Thankfully, the majority of cases of West Nile VirusWNV are asymptomatic, meaning the patient doesn’t even feel sick. About 20% of infected people develop a febrile illness called West Nile Fever. Less than 1% ever develop the most frightening form of WNV, West Nile Neuroinvasive disease.

The symptoms of West Nile Fever are often like the flu: fever, headache, muscle pain, weakness, abdominal symptoms, and sometimes a rash.

The symptoms of West Nile Neuroinvasive disease are like meningitis or encephalitis: bad headache, light sensitivity, stiff neck, and fever. There may be abnormal movements, muscle weakness, and paralysis.

As of yet, there is not a specific treatment, just support until people get over it. Of the 19 people in the United States who got the West Nile virus in the year 2000, the average hospital stay was 7 days. Five were sick enough to be in an ICU and two were sick enough to be on a ventilator. Two died. But this is out of many millions of people in the area, and one-third of those who got sick were older than age 75. The two who died were both over age 80.

The average age of people in the New York “epidemic” was 63. Kids can get it, but it’s much less common. West Nile is rough on birds, though. Avoiding mosquitoes and birds is the best way to prevent it.

The best way to avoid bee stings is prevention. Effective prevention means not attracting bees and not frightening them if they are present. Prevention techniques are especially important in the fall, when most stings occur. It takes 2 million visits to flowers to make one pound of honey. In the autumn, as flowers disappear, bees search more widely for food and take more risks.

To avoid attracting bees, try the following:

1. Avoid fragrances, including hair spray, scented soaps, lotions, and oils. Bees usually approach children with a sweet scent. Avon’s Skin-So-Soft may make bees less apt to explore, and it is safe even on young children.
2. Don’t wear brightly colored clothing, particularly floral patterns, i.e. don’t look like a flower patch. Bees also see in the ultraviolet range. If the pattern lights up under black light, it is particularly interesting to bees.
3. Be very careful with food. Cans of soda are notorious: Bees climb in unobserved, and are frightened into stinging when the child drinks. Something as small as a forgotten raspberry jam stain on a sweater can be a problem.

If a bee does land, take steps to avoid frightening it:

1. Hold still. Tell kids to pretend they’re statues. Rapid movement startles the bee and encourages stinging.
2. Try blowing gently on the bee. This can encourage it to move on while not startling it.
3. Wear shoes. Bees will of course be frightened if you step on or near them. Shoes don’t make them less frightened, but they do protect feet from frightened bees.
4. Wear long pants when you know you are going to be in an area that is likely to have bees in it, such as a field.
5. Wear a hat. Furry animals steal honey from bees. Bees are in a heightened state of readiness when they are close to hair or fur. They have been proven to have a lower threshold for stinging people with hats.

Dr. Greene’s Answer:

Bee venom contains at least nine different components that work together to cause reactions in those stung. When a bee injects its venom under the skin, the child may have immediate reactions (those symptoms beginning within 4 hours), delayed reactions (symptoms that don’t appear until more than four hours after the sting), or both. Classifying the reactions is important both for immediate management and for predicting future problems (Allergy Principles and Practice, Mosby 2003).

Some immediate reactions are classified as local (a two – or three-inch area of swelling, redness and pain that lasts less than 24 hours). Others qualify as large local reactions (those that are larger — often an entire limb — or that last longer, but all symptoms are adjacent to stings). Systemic reactions are allergic responses distant from the sting and include symptoms such as hives, generalized itching, generalized swelling, low blood pressure, difficulty breathing, or anaphylactic shock — a severe reaction involving most or all of these symptoms.

A sting on the forehead with swelling of the eyelids is a large local reaction, while a sting on the foot with swelling of the eyelids is a systemic reaction. Large local reactions are rarely serious and rarely portend future severe allergies. Systemic allergic reactions, though, are present and future warning signs.

A fourth type of immediate reaction is the toxic reaction, which can follow multiple stings. This is a direct result of bee venom, and not an allergic reaction. Symptoms can include fever, weakness, nausea, vomiting, and pain. Toxic reactions are rarely serious, but do sometimes sensitize the child and herald future allergic reactions.

Delayed reactions result when the body’s immune system prepares for future stings, but some of the exuberant defense measures inadvertently turn against the body itself. These symptoms begin more than four hours after the initial sting. Delayed reactions include serum sickness (fever, weakness, rash, swelling, and/or intense itching which begin a week after the sting), nephrotic syndrome (inflammation of the kidney), neuritis (inflammation of the nerves), or inflammation of other parts of the body.

New York City officials have confirmed that two crows infected with the West Nile virus were found on Staten Island, New York City. 23 other infected crows have been found in outlying areas. The virus was also present in 32 mosquitoes collected in Westchester and Suffolk Counties.

While the numbers are small (out of the thousands of mosquitoes and birds tested) they show that the West Nile virus — never seen in North America before 1999 — has survived the winter and is again spreading.

In 1999, it caused the deaths of seven people in the New York area.