Ask the Pediatrician: How to choose an insect repellent for your child

Warmer weather means more chances for kids to go outside to play, hike and enjoy the fresh air with family and friends. Warmer weather also means preventing insect bites.

Biting insects such as mosquitoes and biting flies can make children miserable. More worrisome is that bites from some insects can cause serious illnesses.

Depending on where you live, you may already be familiar with illnesses that spread from insects to people. For example, Lyme disease, West Nile virus and Zika spread through the bite of a mosquito or tick. Recently, insect-borne illnesses are on the rise, due in part to the effects of climate change.

One way to protect your child is to use insect repellents. Choose one that is effective at preventing bites from insects commonly found where you live. Follow the instructions on the label for proper use.

Keep in mind that most insect repellents don't kill insects. Insects that bite—not ones that sting—are kept away by repellents. Biting insects include mosquitoes, ticks, fleas, chiggers and biting flies. Stinging insects include bees, hornets and wasps.

The American Academy of Pediatrics and Centers for Disease Control and Prevention recommend using an insect repellent product that has been registered by the Environmental Protection Agency. These products contain ingredients such as DEET, picaridin, oil of lemon eucalyptus or another EPA-registered active ingredient. Visit bit.ly/44Rt1mI to search for EPA-registered insect repellents

Several insect repellents with DEET are approved as safe and effective. The concentration of DEET in a product indicates how long the product will be effective. You can choose the lowest concentration to provide protection for the among of time spent outside. For example, 10% DEET provides protection for about two hours, and 30% DEET protects for about five hours. A higher concentration works for a longer time, but anything over 50% DEET does not provide longer protection.

DEET products can cause skin rashes especially when high concentrations are used, but these reactions are rare.

Until children are at least 2, their skin may be different than the skin of an older child or adult. Apply DEET sparingly when needed. Weigh the risks of exposure to potentially serious illness spread by insects and the possible risk of absorbing chemicals into the body. Parents of newborns and premature infants should be especially cautious.

Similar to products made with DEET, insect repellents with picaridin provide protection from mosquitoes and ticks for an amount of time that is based on the concentration of picaridin. For example, insect repellents that contain 5% picaridin can protect against mosquitoes and ticks for three to four hours. Products with 20% picaridin can provide protection for eight to 12 hours.

When choosing insect repellents made with lemon eucalyptus oil, look for EPA-registered products. These products should not be used on children younger than 3. These insect repellent products contain no more than 30% lemon eucalyptus oil. Products with 8% to 10% concentration of lemon eucalyptus oil protect for up to two hours, and products containing 30% to 40% oil of lemon eucalyptus provide six hours of protection.

"Pure" oil of lemon eucalyptus products have not been tested for safety as insect repellents and are not registered with the EPA as insect repellents.

Tips for applying insect repellent on your child

Do:

• Choose products in the form of sticks, lotions or unpressurized sprays.
• 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—not under clothing.
• Use just enough repellent to cover your child's clothing and exposed skin. Using more doesn't make the repellent more effective.
• Use spray repellents in open areas to avoid breathing them in.
• 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.
• Keep repellents out of young children's reach to reduce the risk of unintentional swallowing.
• Use mosquito netting over baby carriers or strollers in areas where your baby may be exposed to insects.

Don't use:

• Sprays in pressurized containers if children might accidentally inhale or get into their eyes.
• Repellent on children's hands because they may put their hands (and insect repellent) in their mouth and eyes.
• Repellent candles if your child is at risk of breathing problems from fumes.
• Insect repellent directly on 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.
• Insect repellent on cuts, wounds or irritated skin.
• Combination sunscreen/repellent products. Sunscreen needs to be reapplied often—every two hours while in the sun, and after swimming or sweating. Applying this product may expose your child to too much insect repellent.

Examples of "natural" insect-repellent ingredients include citronella, geranium, peppermint and soybean oil. These are deemed safe but have not been approved for effectiveness by the EPA. Most keep insects away for only a short time. Some natural repellents can cause skin irritation.

Other products not proven to be effective against mosquitoes include wristbands soaked in chemical repellents and ultrasonic devices that give off sound waves designed to keep insects away.

Natural and other alternative repellents may be good if there is no concern about getting a serious insect-borne illness. If there is a health concern—such as for Lyme disease in an area known to have ticks—use DEET, picaridin or another approved effective product.

What if my child has a reaction to an insect repellent?

If you suspect your child is having a reaction to an insect repellent, such as a rash:

• Stop using the product and wash your child's skin with soap and water.
• Call your child's pediatrician or Poison Help at 1-800-222-1222 for help.
• If you go to the doctor's office, take the repellent container with you.

Talk with your child's pediatrician if you have any questions about protecting your child from insect bites.