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    Protecting Your Family From Bug Bites

    Deaconess Clinic West 06/20/2022

    Summer time means being outside.  And sometimes, that means that insects think that we’re delicious, and begin to bite.
    Fortunately, most bites by mosquitos, flies, fleas and even ticks do NOT cause disease. That being said, the best thing to do for your kids and yourself is to try to prevent the bite in the first place.
    One of the simplest things you can do is to avoid being outside from dusk to dawn (evening through early morning), as that’s when biting insects are most active. The other is to try to wear loose-fitting, long-sleeves and long pants if you must be out during those times. Light-colored clothing is also best, as it’s less attractive to insects, and it’s easier to spot a tick on lighter colors. You can also use bug repellant spray.
    Inspect your kids for ticks when they come in after being outside, and then again later when you give them a bath. Ticks like to hide in “nooks and crannies,” so check those areas carefully. On the scalp, especially behind the ears, is a favorite hiding place.  
    Are bug repellant sprays safe to use on children?
    In general, repellants are all available without prescription, but should be using sparingly on infants and young children. These products aren’t just for repelling mosquitos, but for all biting insects, such as gnats, flies, tickets, fleas, chiggers, etc.
    What are safe bug repellant products to use on children?

    • DEET (as low a concentration as effective).  It comes in ranges of less than 10% up to greater than 30%. Interestingly, DEET peaks in effectiveness at 30%, so buying a product with a higher rating does you no good in preventing bites, but exposes to you to more chemicals. Also, I don’t recommend combo products of sunscreen and DEET, as DEET should only be applied once per day, and sunscreen should be reapplied several times during the day. DEET is approved  by the FDA for children ages 2 months and up, but I and other pediatricians recommend waiting until your child is at least 6 months or older for us
    • Picaridin (KBR 3023) is an alternative to DEET. It’s generally a pleasant-smelling product without the oil residue you get from DEET. It’s available in concentrations of 5-10%. Picaridin is a gentler product, but seems to work quite well. It is also recommended for a single application per day.
    • IR3535 is another product that’s an alternative to DEET. I know it to be safe, but is less available than the other products.
    • Lemon eucalyptus oil is also effective, but is not recommended for children under 3. Oils in general have a higher absorption rate into the skin.
    • Avon’s products, Skin So Soft, have anecdotally been reported to be very effective in some people.  It may be especially good to start an infant with Skin So Soft to see if it works prior to trying a chemical product. Also, it can be reapplied several times without much concern.

    Where on the body should bug repellant be applied?
    It’s recommended that you still try to protect as much skin as you can with clothing barriers, and then to only spray exposed skin, as well as the cuffs/edges of clothing with the repellant. But do not put repellant under clothing, as it increases absorption.
    In infants and toddlers, we never recommend spraying their hands because they put their hands in their mouth. Avoid spraying directly on the face; however, you can spray your own hands and then wipe the baby’s neck and head (avoiding face). Hats are a good plan for protecting the scalp as well.
    Never apply to any open skin, as it can sting, but also increases the body’s absorption of the chemical. Finally, be sure to thoroughly wash off any insect repellant after coming indoors.
    Do the home remedy bug repellents really work?
    I’m told there are a lot of "home remedy repellents" going around on Facebook but I admit that I haven’t seen them. However, I’m familiar with at least a couple of the “old wives tales” and recipes that have been mentioned over the years.
    Oil of eucalyptus, for example, is all-natural, but is not safe for children under the age of 3.
    I’ve heard about the dryer sheets in the nape of the neck or in hats. I don’t know if they work, but trying them is unlikely to hurt anything unless your skin is sensitive to the product.
    Avon’s Skin So Soft is worth trying. I recently learned that “Family OFF” has a product that combines a low concentration of DEET with Skin So Soft, which interested me. Also, those little citronella clip-on fans shouldn’t be used on children, as they could get into them —could really hurt little fingers! 
    Also, the bracelets have gotten some buzz (pardon the pun), but if you’re around young children/toddlers/babies at all, you know how they like to put things in their mouth, and could even do that while you’re wearing the bracelet.
    Overall, nothing is as effective as my earlier tip of using as much of a clothing barrier as possible, and then appropriate use of a repellant.
    Ticks and Lyme Disease
    There are several species of ticks in Indiana, but the most common are the American Dog Tick, the Lone Star Tick (aka Deer Tick) and the Black-Legged Tick. Lyme Disease is caused by a bacteria that is transmitted by the Black-Legged Tick or the Lone Star Tick.
    If the tick has the disease (of which only a small percentage do), then the bacteria can be transmitted via the bite to humans. The tick HAS to be on the body for a minimum of 36-48 hours in order for a Lyme-carrying tick to transmit it. And if a tick is completely flat, then it hasn’t been on very long.

    The nymph stage (baby) is the stage that is most likely to transmit disease. These are really tiny—like 2mm or smaller in size—and hard to see. Symptoms vary, but 90% of infected people will develop a “target” type (also called bull’s eye) rash around the bite within 1 month of infection. It can be flat or raised, but isn’t usually painful. The bull’s eye rash can also be at other sites than the bite, and can multiply in number after the initial bite rash appears. Other symptoms include fever, fatigue, headaches, stiffness in muscles, and/or swollen painful joints.  If your child has any of these symptoms—either after a tick bite, or even the possibility of one—then they should be evaluated.

    Rocky Mountain Spotted Fever
    Rocky Mountain Spotted Fever is caused by a bacteria that can be carried by the American Dog Tick. Symptoms usually begin 2-14 days after the bite of an infected tick. It’s usually a sudden onset of fever and headache, and other symptoms are variable, and a person doesn’t typically have all them, and they include:•Rash 2-5 days after fever—a spotted rash of small flat pink spots that starts on the extremities, then spreads to the trunk.   It’s not itchy, and can turn into red-purple spots.

    • Headache
    • Nausea/vomiting
    • Abdominal pain
    • Muscle pain
    • Red eyes
    • Decreased appetite

    The diagnosis must be made by examination (rather than blood test) and is treated with an antibiotic for all ages.
    Ehrlichiosis is also a bacterial disease that is transmitted by infected Lone Star Ticks.
    Symptoms begin within 1-2 weeks of the bite, and include fever, headache, fatigue, muscle aches, chills, nausea/vomiting, diarrhea, etc.  A rash is present in 60% of kids, but less than 30% of adults. The rash can be variable, but may be flat or raised or pin-point, not itchy, and usually spares the face but does go on palms and soles. Severe symptoms would include difficulty breathing.
    There is a blood test available, but again, it’s often a clinical (exam) diagnosis.  So if this illness is suspect, it’s a good idea to go ahead and treat with antibiotics. It’s a very uncommon illness, but is present in Indiana.
    West Nile Virus
    Not all mosquitos carry West Nile. They get it when they feed on an infected bird, and then can transmit the illness to humans when they bite us. That said, 70-80% of people still don’t become infected even when bitten by an infected mosquito. One in five people will develop fever, body aches, joint pain, vomiting/diarrhea, rash, and a fatigue that can last for a few weeks. The incubation period is usually 2-6 days after the bite before symptoms begin. Less than 1% of those who develop illness will develop serious complications, such as meningitis or encephalitis (headache, neck stiffness, tremors, seizures, paralysis). There is no vaccine, and treatment is mostly supportive of relieving symptoms.
    Overall, please keep in mind that the likelihood of contracting one of these diseases is very small.  And the best protection is avoidance.


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