Insect Repellents for Children

https://en.wikipedia.org/wiki/Mosquito

Parents often ask which insect repellent they could use for their children. It is important to have some idea of what to recommend. The United States Environmental Protection Agency has issued the following guidelines regarding the safe and effective use of insect repellents:

• Follow the label directions to ensure proper use.
• Repellents should be applied only to exposed skin and/or clothing. Do not use under clothing.
• Store insect repellents safely out of the reach of children, in a locked utility cabinet or garden shed.
• Do not apply near eyes and mouth, and apply sparingly around ears.
• When using sprays, do not spray directly into face; spray on hands first and then apply to face. 
• Never use repellents over cuts, wounds, or irritated skin
• Do not spray in enclosed areas. Avoid breathing a spray product, and do not use it near food.
• After returning indoors, wash treated skin and clothes with soap and water.
• Do not use any product on pets or other animals unless the label clearly states it is for animals.
• Most insect repellents do not work on lice or fleas.
•  Use other preventive actions to avoid getting bitten.
• Consider repellant-treated clothing

Most E​ffective Repellents Include:

Deet- N1N-diethyl-m-toluamide:  

DEET is considered the “gold standard” of insect repellents, having been in use for over 50 years. It is effective against a wide range of species, including mosquitoes, flies, chiggars, fleas, and ticks (the transmission vector of Lyme disease). Products containing DEET currently are available in liquids, lotions, sprays. Formulations registered for direct application to human skin contain from 4 to more than 75 percent DEET, but concentrations between 10 and 35 percent are generally sufficient.

1. Deet is a safe and effective insect repellent when used in concentrations of  30% and less and are applied properly
2. Effective against mosquitoes, biting flies, fleas, gnats, chiggers, and ticks. Does not protect against stinging insects
3. Concentrations greater than 30%, too frequent applications, and oral ingestion are associated with toxicity including encephalopathy and seizures.
4. Should be applied to exposed skin or clothing, NOT under clothing.  The effectiveness will be decreased when the child sweats or gets wet. The parents should avoid applying to open abrasion, around the mouth and eyes, and on the hands that children may place hands in their mouths. 
5. Brand Names include Off, Repel, and Skeedaddle Insect Spray
6. Products available that combine sunblock with Deet should not be used because sunblock will need repeated applications and Deet should be applied once/day.
7. Not recommended for infants less than two month of age. 
8. As the concentration of Deet increases, the duration of activity increases.  This peaks at about 30%.  Select the concentration that coincides with the amount of time to be spent outdoors. If child will e outside for 1-2 hours, 10% concentration should suffice. Protection with 30% concentration is ~4-5 hours
9. Wash treated skin after coming indoors as well as treated clothing.
10. Toxic effects include irritability, weakness, ataxias, tremors confusion, agitation, hypotension, seizures, and coma.  There may be also local skin irritation, itching,
11. Toxic effects related o overuse and safety record is strong.
12. No adverse effects in pregnanrt and lactating females.

 Picaridin: 

Picaridin is a colorless, nearly odorless plant-derived liquid that is used as an insect repellant against flies, mosquitoes, chiggers, and ticks. Picardin products were sold in Europe and Australia for several years before being introduced into the US market in 2005. Products contain a range of 5-20 percent of the active ingredient.

1.   Permetherin-impregnated clothing such as pre-treated shoes, socks, and pants repel and kill ticks, mosquitoes, and other insects and retain this effect after repeated laundering (at least 70 cycles).
2. Permetherin is also found in treated tents, tarps, sleeping bags, and mattresses.
3. The combination of permethrin-treated clothing and a DEET-based repellent on any exposed skin may provide the best protection available against insect bites.

Citronella:  

Citronella comes from dried cultivated grasses and has a distinctive odor that masks the CO2 or lactic acid on our bodies that mosquitoes and other pests find attractive.  It has been used for over 50 years as an insect repellent. However, oil of citrunella is included on the list of chemicals that may not require EPA registration in some cases.  Unless a product containing citronella is EPA registerd, in has not been subject to EPA review and EPA can not corroborate its effectiveness.  Oil of citronella products are commonly sold as repellent candles but only skin applied products offer some protection in certain circumstances.  Only has short time of protection of 20-30 minutes.

1. Natural insect repellent
2. Length of protection is less than DEET and must be applied more frequently
3. There are candles and incense available that can decrease the number of mosquitoes in the environment
4. Buzz Away, Natrapel

Permethrin:

Permetherin is registered for use as both an insecticide and a repellent.  Permetherin products are used on clothing, shoes, bed nets, and camping gear.  Permetherin impregnated clothing such as pre-treated shoes, socks, and pants repel and kill ticks, mosquitoes, and othe insects and retain this effect after repeated laundering.  Premetherin is also found in treated tents, tarps, sleeping bags, and mattresses.

1. Has not been approved for application to the skin for insect repellent use. May be applied to clothing to protect against ticks.

General Recommendations

1. Should be EPA approved
2. Read label carefully and follow directions 
3. Wash off product when come indoors
4. Do not spray directly on face.  Spray on hands and then apply to the face.
5. Never apply directly to breaks in the skin.
6. Adults should be responsible for applying.
7. National Pesticide Network 800 858-7378

Reference

1. Fradin M. Day J. Comparative Efficacy of Insect Repellents Against Mosquito Bites. NEJM:347 July 4, 2002
2. Katz T. et. al. Insect repellents: Historical perspectives and new develoopments.  Journal of the American Academy of Deermatology May 2008