How to Deal with Pesky Mosquitos this Summer
by Tsippora Shainhouse, MD, FAAD, FRCPC.
For many of us, we are now in the dead of summer, which means playing outdoors all day, backyard BBQs in the late afternoon, and roasting marshmallows while singing around the campfire at night. While these outside activities are fun for you and your little ones, they are also an open invitation to mosquitos, who are looking for an outdoor meal of their own! With the recent press about the viral infections that can be transmitted to adults and kids through mosquito bites in both the US and around the globe, it is helpful to understand who is at risk for bites, how to treat them, and how to safely prevent them.
How to Identify a Mosquito Bite & Treatment
Mosquitos are 2-winged, flying insects that are attracted to bright colors, heat, humidity, carbon dioxide (expressed when we breathe), and human odors, especially those of young children. That is why they are the most common insect bites in kids. The initial bite causes mild, stinging irritation and a small pink bump due to a reaction to the mosquito saliva. If this is not your child’s first bite, then they will develop a pink, itchy, hive-like bump that can last hours to days. Sometimes you can see a small bite mark in the center. Most bites are very mild and resolve on their own. Symptomatic treatment includes: cool compresses and calamine lotion, which contains soothing zinc oxide. More irritated, itchy spots can be managed with oral anti-histamines and topical hydrocortisone cream. If your child is allergic to mosquito bites, they may develop severe redness and swelling around the bite site. This can usually be managed with oral antihistamines. If you observe any signs of lip, tongue, or eyelid swelling, or if you notice any difficulty speaking or breathing, call 911 immediately, as this may be a life-threatening anaphylactic reaction. Children with a known anaphylactic reaction to mosquito and other insect bites should carry an EpiPen with them at all times and know how to use it, or be accompanied by an adult who knows how to use it. EpiPens provide a small amount of adrenaline to temporarily halt the allergic reaction, giving you a short window of time to get to the hospital for further treatment.
Preventing mosquito bites can be tough in sweaty, sticky kids running around in the hot, summer weather. You can help prevent mosquito bites by keeping covered up in loose, light colored, long-sleeved shirts and pants when playing in buggy areas, avoiding scented products, and by wearing insect repellant. Most mosquitos like to bite in the late afternoon and at dusk, as the sun sets. Some of these mosquitos can transmit infections like West Nile virus (US), Chikungunya (US), dengue, and malaria in certain parts of the US and the world. However, day-biters have been in the news, as these are the mosquitos most likely to transmit infections like Zika virus in endemic areas. In the US, most of the cases of Zika due to local mosquitos have been observed in Florida and Texas. The cases diagnosed in New York and California have been associated with travel to other countries. If you are planning to vacation this summer, be aware that Zika virus has been found in South America, Puerto Rico, Mexico, Singapore, India, and the Caribbean. In fact, if you have been to an area that is known to have active Zika infection, it is advised to continue to wear insect repellant for 3 weeks after returning home, so as not to infect local mosquitos!
Mosquito repellants are effective at preventing bites when applied properly. They should be applied to clothing and exposed skin, but not to skin that is covered by clothing. It is important to use the proper concentration and to re-apply only as often as recommended on the bottle. While spray versions are easier to apply, especially over clothing, they can sometimes sting skin upon application and you must be careful not to miss a spot. Do not use combination sunscreen/mosquito repellants, as they can increase risk of toxicity, since the sunscreen must be applied in larger quantities and much more frequently than mosquito repellant. Instead, apply sunscreen and wait until it dries before spraying a separate insect repellant to exposed skin and clothing. It is safe to reapply sunscreen over the repellant throughout the day. Mosquito repellant bracelets are not effective and should not be depended upon as the sole mode of preventing mosquito bites.
Use mosquito repellants with ingredients that have been FDA approved for safe use in children and pregnant woman. The CDC/EPA (Environmental Protection Agency) recommend DEET and Picaridin.
DEET is the oldest and best insect repellant available. With a 20-50% concentration, it is effective and safe to spray on clothing and exposed skin. DEET does not work by killing mosquitos, rather, it works by making it hard for mosquitos to smell you and find you. Protection of the 25-35% concentration should last about 4-6 hours. Less concentrated versions smell better, but do not last as long and cannot be depended upon to prevent bite and virus transmission, if you are in an area of concern. Look for products with at least 20% DEET. The American Academy of Pediatrics recommends not using stronger than 30% DEET in children, and to avoid using it in children under 2 months of age. One brand to try is Off Deep Woods.
Picaridin (known as KBR 3023 or Icaridin outside the US) can be as effective as DEET, when used properly. The 20% concentration can provide up to 8 hours of protection. Sawyer Picaridin Insect Repellant and Avon Skin-So-Soft spray or aerosol are great options, and smell much better than DEET-based repellants. Choose a version without sunscreen. Apply your regular, broad-spectrum sunscreen first and then re-apply your sunscreen every 2-3 hours throughout the day. The mosquito repellant spray can last 8 hours and can be toxic if applied every 2-3 hours.
Oil of Lemon Eucalyptus (OLE) or para-methane-diol (PM) has been approved as a more natural mosquito repellant, but may require more frequent application.
While mosquito bites are mostly an itchy nuisance, preventing bites with clothing and insect repellants, particularly when playing outdoors in the early evening, can make your outdoor summer activities even more fun.