Mosquito prevention and treatment: A quick guide for families

The Pediatric Insider

© 2017 Roy Benaroch, MD

 

Mosquitoes are more than an itchy nuisance. Though uncommon, serious diseases such as West Nile Encephalitis and dengue fever can be spread by mosquito bites in the USA. Our newest worry, Zika virus, is especially dangerous to pregnant women and their unborn babies — and there will almost certainly be US cases this summer.  Itchy mosquito bites can be scratched open by children, leading to scabbing, scarring, and the skin infection impetigo. Prevention is the best strategy.

Try to keep your local mosquito population under control by making it more difficult for the insects to breed. Empty any containers of standing water, including tires, empty flowerpots, or birdbaths. Avoid allowing gutters or drainage pipes to hold water. Mosquitoes are “home-bodies”—they don’t typically wander far from their place of birth. So reducing the mosquito population in your own yard can really help.

Most biting mosquitoes are active at dusk, so that’s the most important time to be vigilant with your prevention techniques. Light colored clothing is less attractive to mosquitoes. Though kids won’t want to wear long pants in the summer, keep in mind that skin covered with clothing is protected from biting insects like mosquitoes and ticks. A T-shirt is better than a tank top, and a tank top is better than no shirt at all!

Use a good mosquito repellent. The best-studied and most commonly available active ingredient is DEET. This chemical has been used for decades as an insect repellant and is very safe. Though rare allergies are always possible with any product applied to the skin, almost all children do fine with DEET. Use a concentration of about 10%, which provides effective protection for about two hours. It should be reapplied after swimming. Children who have used DEET (or any other insect repellant) should take a bath or shower at the end of the day.

Other agents that are effective insect repellants are picaridin, oil of lemon eucalyptus, and IR3535 (also known as ethyl butylactylaminopropionate. Tasty!) These are probably not more effective than DEET, but some families prefer them because of their more pleasant smell and feel. Other products, including a variety of botanical ingredients, work for only a very short duration, or not at all. The CDC has extensive info on these products here.

There are also yard sprayers or misters, devices that widely spray repellants or pesticides. I couldn’t find much in the way to independent assessments of these products, but there’s no reason to think they wouldn’t work. Still, I’m leery about the idea of spraying chemicals all over the place, when we know that DEET sprayed on your child is effective and safe for both child and environment.

About “Organic” or “Natural” insecticides or repellants – those are just  marketing words. Organic compounds are no more or less likely to be dangerous to people or the environment than non-organic compounds; likewise, “natural” in no way implies that something is safe or effective (or even “natural” in the sense that most people mean that term.) These words are tossed around as part of the typical salad of meaningless marketing-speak on labels. Ignore them.

There are also devices that act as traps, using chemicals or gas to attract the mosquitoes from your yard. Although I don’t have much independent confirmation that these work, they are probably environmentally friendly and safe.

Some children do seem more attractive to others to mosquitoes, and some children seem to have more exaggerated local reactions with big itchy warm welts. To minimize the reaction to a mosquito bites, follow these steps:

1. Give an oral antihistamine like Zyrtec or Claritin, or old-school oral Benadryl (do NOT use topical Benadryl. It doesn’t work, and can lead to sensitization and bigger reactions.)
2. Apply a topical steroid, like OTC hydrocortisone 1%. Your doctor can prescribe a stronger steroid if necessary.
3. Apply ice or a cool wet washcloth.
4. Reapply insect repellent so he doesn’t get bitten again.
5. Have a Popsicle.
6. Repeat all summer!

Updated and adapted from previous posts. Reduce reuse recycle!

Protect yourself from mosquitoes and Zika

The Pediatric Insider

© 2016 Roy Benaroch, MD

I remember a trip to the Florida Everglades in about 1978. Surrounded by mosquitoes, alligators, and miles of swamp, our teachers told us that every creature was a vital part of the food chain, and essential to the ecosystem.

I hate those bloodsuckers. The mosquitoes, I mean. Not the teachers.

Mosquitoes are more than an itchy nuisance. Though uncommon, serious diseases such as West Nile Encephalitis and dengue fever can be spread by mosquito bites in the USA. Our newest worry, Zika virus, is especially dangerous to pregnant women and their unborn babies. Though it’s not yet been spread by mosquitoes in the continental USA, Zika will be here soon. Itchy mosquito bites can be scratched open by children, leading to scabbing, scarring, and the skin infection impetigo. Prevention is the best strategy.

Try to keep your local mosquito population under control by making it more difficult for the insects to breed. Empty any containers of standing water, including tires, empty flowerpots, or birdbaths. Avoid allowing gutters or drainage pipes to hold water. Mosquitoes are “home-bodies”—they don’t typically wander far from their place of birth. So reducing the mosquito population in your own yard can really help.

Biting mosquitoes are most active at dusk, so that’s the most important time to be vigilant with your prevention techniques. Light colored clothing is less attractive to mosquitoes. Though kids won’t want to wear long pants in the summer, keep in mind that skin covered with clothing is protected from biting insects like mosquitoes and ticks. A T-shirt is better than a tank top, and a tank top is better than no shirt at all!

Use a good mosquito repellent. The best-studied and most commonly available active ingredient is DEET. This chemical has been used for decades as an insect repellant and is very safe. Though rare allergies are always possible with any product applied to the skin, almost all children do fine with DEET. Use a concentration of about 10%, which provides effective protection for about two hours. It should be reapplied after swimming. Children who have used DEET (or any other insect repellant) should take a bath or shower at the end of the day.

Other agents that are effective insect repellants are picaridin, oil of lemon eucalyptus, and IR3535 (also known as ethyl butylactylaminopropionate. Tasty!) These are probably not more effective than DEET, but some families prefer them because of their more pleasant smell and feel. Other products, including a variety of botanical ingredients, work for only a very short duration, or not at all. The CDC has extensive info on these products here.

There are also yard sprayers or misters, devices that widely spray repellants or pesticides. I couldn’t find much in the way to independent assessments of these products, but there’s no reason to think they wouldn’t work. Still, I’m leery about the idea of spraying chemicals all over the place, when we know that DEET sprayed on your child is effective and safe for both kid and environment.

About “Organic” or “Natural” insecticides or repellants – those are just  marketing words. In the world of chemistry, the word “organic” means that the molecule contains carbon. Organic compounds are no more or less likely to be dangerous to people or the environment than non-organic compounds; likewise, “natural” in no way implies that something is safe or effective (or even “natural” in the sense that most people mean that term.) These words are tossed around as part of the typical salad of meaningless marketing-speak on labels. Ignore them.

There are also devices that act as traps, using chemicals or gas to attract the mosquitoes from your yard. Although I don’t have much independent confirmation that these work, they are probably environmentally friendly and safe.

Some children do seem more attractive to others to mosquitoes, and some children seem to have more exaggerated local reactions with big itchy warm welts. To minimize the reaction to a mosquito bites, follow these steps:

1. Give an oral antihisamine like Benadryl, Zyrtec, or Claritin (do NOT use topical Benadryl. It doesn’t work, and can lead to sensitization and bigger reactions.)
2. Apply a topical steroid, like OTC hydrocortisone 1%. Your doctor can prescribe a stronger steroid if necessary.
3. Apply ice or a cool wet washcloth.
4. Reapply insect repellent so he doesn’t get bitten again.
5. Have a Popsicle
6. Repeat all summer!

Updated and adapted from a post in 2013

Mosquito wars: Why do some kids get bitten more than others?

The Pediatric Insider

© 2014 Roy Benaroch, MD

“I have three children. But it’s only the middle one who gets bitten by mosquitoes! We’re outside for 20 minutes, and he’s covered with big itchy welts. They never bite the rest of us. I’m beginning to wonder what is wrong with him?”

I’ve wondered this myself—why are some people more mosquito-attractive than others? I’ve got some theories:

1.  Some kids play more in the shade where mosquitoes lurk.
2. Some kids are less sensitive to mosquitoes on their skin, so they don’t slap them away before being bitten.
3. Some kids have a bigger reaction than others, so bites are more noticeable. (The welts you see are an allergic reaction to, essentially, mosquito spit. Like any other allergy, some people are more sensitive to others. It’s possible some people get bitten and don’t react at all.)
4. Some children are just plain tastier. Mmmm, say the mosquitoes.

So what can you do about it? For families who have one or more bite-attracting kids, you need a good mosquito bite prevention and treatment plan for the summer.

 Prevention

Mosquitoes are more than an itchy nuisance. Though uncommon, serious diseases such as West Nile Encephalitis, dengue fever, and now chikungunya fever can be spread by mosquito bites in the USA. The itchy bites can be scratched open by children, leading to scabbing, scarring, and the skin infection impetigo. Prevention is the best strategy.

Try to keep your local mosquito population under control by making it more difficult for the insects to breed. Empty any containers of standing water, including tires, empty flowerpots, or birdbaths. Don’t let gutters or drainage pipes to hold water. Mosquitoes are “home-bodies”—they don’t typically wander far from their place of birth. So reducing the mosquito population in your own yard can really help.

There are yard sprayers either applied professionally or as a home job to reduce the local mosquito population. I have no personal experience with these products, and couldn’t find much in the way to independent assessments on the web. There’s no reason to think they wouldn’t work—but I’m kind of leery about the idea of spraying chemicals all over the place when there are simpler options. Still, for very sensitive people or heavy infestations, this might be a good idea.

There are also devices that act as traps, using chemicals or gas to attract the mosquitoes from your yard. Again, I don’t have much independent confirmation that these work, but they ought to be environmentally friendly and safe. If any of you visitors have used either these traps or the yard/mister sprays, let us know how well they worked in the comments.

Biting mosquitoes are most active at dusk, so that’s the most important time to be vigilant with your prevention techniques. Light colored clothing is less attractive to mosquitoes. Though kids won’t want to wear long pants in the summer, keep in mind that skin covered with clothing is protected from biting insects. A T-shirt is better than a tank top, and a tank top is better than no shirt at all!

Use a good mosquito repellent. The best-studied and most commonly available active ingredient is DEET. This chemical has been used for decades as an insect repellant and is very safe. Though rare allergies are always possible with any product applied to the skin, almost all children do fine with DEET. Use a concentration of about 10%, which provides effective protection for about two hours. It should be reapplied after swimming. Children who have used DEET (or any other insect repellant) should take a bath or shower at the end of the day.

Two other agents that are effective insect repellants are picaridin and oil of lemon eucalyptus. These have no advantage over DEET, but some families prefer them because of their more pleasant smell and feel. (Picaridin, oddly, smells like Fritos.) Other products, including a variety of botanical ingredients, work for only a very short duration, or not at all.

Treatment

No matter what you do, occasional bites are going to happen. To minimize the reaction to mosquito bites, follow these steps:

1. Give an oral antihistamine like Benadryl, Zyrtec, or Claritin (do NOT use topical Benadryl. It doesn’t work, and can lead to sensitization and bigger reactions.) For kids who get bitten a lot, it makes sense to just give an oral antihistamine daily, before the bites.
2. Apply a topical steroid, like OTC hydrocortisone 1%. Your doctor can prescribe a stronger steroid if necessary.
3. Apply ice or a cool wet washcloth.
4. Reapply insect repellent so he doesn’t get bitten again.
5. Have a Popsicle
6. Repeat all summer!

Chikungunya fever: A new infection, coming your way soon

The Pediatric Insider

© 2014 Roy Benaroch, MD

I first heard about chikungunya about ten years ago, when outbreaks of this mosquito-borne illness were becoming common among travelers to India. It hasn’t taken long to spread to the Caribbean, and soon enough it’s likely to become widespread in the United States.

Sometimes called “Chikungunya Fever,” the illness causes fever and severe joint pain that can be debilitating, and can last for weeks. Fatalities are rare, and there is no specific treatment and no vaccine. Unlike West Nile Virus, the virus that causes Chikungunya triggers symptoms in almost everyone who is exposed.

The chikungunya virus is spread by the bite of one of two species of mosquitoes—species that are widespread in especially the southern USA. Those same mosquitoes can also transmit dengue, which has already started appearing in Florida and Texas.

We live in a big, interconnected world, with plenty of travelers and plenty of ways for new infections to cross continents and seas. In addition to new strains of influenza and the spread of resistant microorganisms, in the last ten years we’ve seen the emergence of new serious respiratory infections like MERS and SARS. Old infections, like tuberculosis, are back. And once-defeated vaccine-preventable diseases have returned to many communities, especially where vaccine uptake has fallen.

Germs have been around far longer than we have, and they will patiently wait for us to drop our defenses. We will not win this battle anytime soon. But we can still fight back:

• Prevent mosquito-borne infections by preventing mosquito bites. Keep them off of your skin and out of your yard.
• Continue to fund a strong public health infrastructure to track and identify health risks. We need to continue to pay attention, not just here, but throughout the world.
• Advocate for universal vaccination of all children. It is always better to prevent infections than treat them. Vaccines need to be a public health priority, and no child should be denied vaccines because of financial reasons. Parents who are scared of vaccines because of misinformation need to hear the truth from friends, relatives, and their doctors.

Mosquito prevention and treatment, updated

The Pediatric Insider

© 2010 Roy Benaroch, MD

Jen wanted to know about mosquito sprayers and misters: “With all of this rain, we have a ton of mosquitoes out  Our neighbors really like the Mosquito Tuxedo misting system.   I’m not sure which is better or worse:  Misting chemicals (organic insecticide – whatever that means), spraying chemicals directly on the children’s bodies, or letting them get bitten by mosquitoes!”

I remember a trip to the Florida Everglades as a child with school—surrounded by mosquitoes, alligators, and miles of swamp. Our teachers told us that mosquitoes are a vital part of the food chain, and essential to the ecosystem. Blah blah blah.

I hate those bloodsuckers. The mosquitoes, I mean. Not the teachers.

Anyway: mosquitoes are more than an itchy nuisance. Though uncommon, serious diseases such as West Nile Encephalitis and dengue fever can be spread by mosquito bites in the USA. The itchy bites can be scratched open by children, leading to scabbing, scarring, and the skin infection impetigo. Prevention is the best strategy.

Try to keep your local mosquito population under control by making it more difficult for the insects to breed. Empty any containers of standing water, including tires, empty flowerpots, or birdbaths. Avoid allowing gutters or drainage pipes to hold water. Mosquitoes are “home-bodies”—they don’t typically wander far from their place of birth. So reducing the mosquito population in your own yard can really help.

Biting mosquitoes are most active at dusk, so that’s the most important time to be vigilant with your prevention techniques. Light colored clothing is less attractive to mosquitoes. Though kids won’t want to wear long pants in the summer, keep in mind that skin  covered with clothing is protected from biting insects. A T-shirt is better than a tank top, and a tank top is better than no shirt at all!

Use a good mosquito repellent. The best-studied and most commonly available active ingredient is DEET. This chemical has been used for decades as an insect repellant and is very safe. Though rare allergies are always possible with any product applied to the skin, almost all children do fine with DEET. Use a concentration of about 10%, which provides effective protection for about two hours. It should be reapplied after swimming. Children who have used DEET (or any other insect repellant) should take a bath or shower at the end of the day.

Two other agents that are effective insect repellants are picaridin (the active ingredient in Cutter Advance) and oil of lemon eucalyptus. These have no advantage over DEET, but some families prefer them because of their more pleasant smell and feel. Other products, including a variety of botanical ingredients, work for only a very short duration, or not at all.

Jen asked about yard sprayers or misters. I have no personal experience with these products, and couldn’t find much in the way to independent assessments on the web. There’s no reason to think they wouldn’t work—but I’m kind of leery about the idea of spraying chemicals all over the place, when we know that DEET sprayed on your child is effective and safe for both kid and environment.

About “Organic insecticides”—it’s just a marketing term. In the world of chemistry, the word “organic” means that the molecule contains carbon. Organic compounds are no more or less likely to be dangerous to people or the environment than non-organic compounds; likewise, “natural” in no way implies that something is safe or effective (or even “natural” in the sense that most people mean that term.) These words are tossed around as part of the typical salad of meaningless marketing-speak on labels. Ignore them.

There are also devices that act as traps, using chemicals or gas to attract the mosquitoes from your yard. Again, I don’t have much independent confirmation that these work, but they ought to be environmentally friendly and safe. If any of you visitors have used either these traps or the yard/mister sprays, let us know how well they worked in the comments.

Some children do seem more attractive to others to mosquitoes, and some children seem to have more exaggerated local reactions with big itchy warm welts. To minimize the reaction to a mosquito bites, follow these steps:

1. Give an oral antihisamine like Benadryl, Zyrtec, or Claritin (do NOT use topical Benadryl. It doesn’t work, and can lead to sensitization and bigger reactions.)
2. Apply a topical steroid, like OTC hydrocortisone 1%. Your doctor can prescribe a stronger steroid if necessary.
3. Apply ice or a cool wet washcloth.
4. Reapply insect repellent so he doesn’t get bitten again.
5. Have a Popsicle
6. Repeat all summer!

This is an update of an original post from June, 2010

West Nile Virus is here

The Pediatric Insider

© 2012 Roy Benaroch, MD

The CDC has reported that infections with West Nile Virus (WNV) have hit a record high, with 1100 documented human infections in 38 states so far this year (including 21 cases in my home state, Georgia.) And with a soggy GulfCoast, things are going to get worse before they get better.

WNV was first found in Africa in the 1940s, and spread to the US in 1999. It has since become the most common cause of mosquito-born illness here. About 80% of infections are entirely asymptomatic—meaning you wouldn’t even know if you were infected. Almost all of the remaining infections cause a relatively mild, flu-like illness called West Nile Fever, with symptoms like fever, headaches, body aches, sometimes nausea and vomiting, and more rarely swollen lymph nodes and rash. The rarest illness occurs when the virus invades the brain, causing West Nile Encephalitis in about 1 in 150 infected people. Symptoms can then include disorientation, seizures, coma, paralysis, and death. Older people are much more likely to have severe cases of WNV infection.

Almost all cases of WNV infection are transmitted by mosquito bites, and the best way to prevent exposure is to avoid mosquitoes:

• Avoid outdoor activity at dusk and dawn, when mosquitoes are most likely to bite.
• Wear long sleeved shirts and pants to keep skin covered.
• Cover any exposed skin with an effective mosquito repellent. The best one is DEET, which is recommended for anyone over 2 months of age. Children should use a product with not more than 30% DEET. Other repellants such as picaridin and oil of lemon eucalyptus might also work fairly well, though other “herbal” types of products don’t work at all.
• Prevent mosquitoes from breeding by draining any containers of water, like clogged gutters or buckets.

Mild symptoms of WNV infection such as fever and aches are best treated with rest, extra fluids, and fever-reducing medicine. Anyone with neurologic symptoms should seek medical care immediately. Infected individuals do not need to be isolated—WNV is not contagious from person to person.

As a side note: once influenza season begins, flu infections and WNV infections will often seem very similar. Protect yourself from flu and from WNV worry by getting a flu vaccine soon.

Mosquito bites: Prevention, treatment, and vitamins

The Pediatric Insider

© 2010 Roy Benaroch, MD

Summer has barely begun, and LeeAnn has already had enough of mosquitoes. She wants to know, “Does taking Vitamin B1 really help keep mosquitoes from biting? How much is safe for children?”

I remember a trip to the Florida Everglades as a child with school—surrounded by mosquitoes, alligators, and miles of swamp, our teachers told us that mosquitoes are a vital part of the food chain, and essential to the ecosystem. Blah blah blah.

I hate those bloodsuckers. The mosquitoes, I mean. Not the teachers.

Anyway: mosquitoes are more than an itchy nuisance. Though uncommon, serious diseases such as West Nile Encephalitis and dengue fever can be spread by mosquito bites in the USA. The itchy bites can be scratched open by children, leading to scabbing, scarring, and the skin infection impetigo. Prevention is the best strategy.

Try to keep your local mosquito population under control by making it more difficult for the insects to breed. Empty any containers of standing water, including tires, empty flowerpots, or birdbaths. Avoid allowing gutters or drainage pipes to hold water. Mosquitoes are “home-bodies”—they don’t typically wander far from their place of birth. So reducing the mosquito population in your own yard can really help.

Biting mosquitoes are most active at dusk, so that’s the most important time to be vigilant with your prevention techniques. Light colored clothing is less attractive to mosquitoes. Though kids won’t want to wear long pants in the summer, keep in mind that skin  covered with clothing is protected from biting insects. A T-shirt is better than a tank top, and a tank top is better than no shirt at all!

Use a good mosquito repellent. The best-studied and most commonly available active ingredient is DEET. This chemical has been used for decades as an insect repellant and is very safe. Though rare allergies are always possible with any product applied to the skin, almost all children do fine with DEET. Use a concentration of about 10%, which provides effective protection for about two hours. It should be reapplied after swimming. Children who have used DEET (or any other insect repellant) should take a bath or shower at the end of the day.

Two other agents that are effective insect repellants are picaridin (the active ingredient in Cutter Advance) and oil of lemon eucalyptus. These have no advantage over DEET, but some families prefer them because of their more pleasant smell and feel. Other products, including a variety of botanical ingredients, work for only a very short duration, or not at all.

What about LeeAnn’s question about vitamin B₁? Also known as thiamine, this vitamin is very safe to give to your children—it’s water-soluble, meaning that excessive amounts will come out in the urine. Several websites recommend this, but the few studies I could find showed that it wasn’t effective. It’s usually sold as 100 mg tablets, and one of these a day for a school-aged child would be safe to try.

Some children do seem more attractive to others to mosquitoes, and some children seem to have more exaggerated local reactions with big itchy warm welts. To minimize the reaction to a mosquito bites, follow these steps:

1. Give an oral antihisamine like Benadryl, Zyrtec, or Claritin (do NOT use topical Benadryl. It doesn’t work, and can lead to sensitization and bigger reactions.)
2. Apply a topical steroid, like OTC hydrocortisone 1%. Your pediatrician can prescribe a stronger steroid if necessary.
3. Apply ice or a cool wet washcloth.
4. Reapply insect repellent so he doesn’t get bitten again.
5. Have a Popsicle
6. Repeat all summer!