Summer has finally arrived! We welcome the warmer temperatures, longer days, and extended periods of time we have to spend outdoors. Some families enjoy camping, swimming, or just playing around in the backyard. Others may be taking a vacation to a beach or the mountains. Regardless of how you plan to spend your summer, as parents you need to be prepared to prevent conditions that could rain on your proverbial parade.
Insect bites: to know them, is to loathe them. The redness, swelling, and itching that inevitably wakes your child, and you, up at 2 am. For most children, the bites are just irritating. With a little TLC, topical hydrocortisone cream and cool compresses, they are gone in a couple of days. However, some children can get very ill. Not only are little ones at risk for secondary bacterial skin infections from scratching at the bites, but mosquitoes can carry diseases such as West Nile, Dengue, and Chikungunya viruses.
As I was writing this blog post, I received an update that the first case of West Nile virus of 2019 was just reported in Oklahoma. Most people that have been infected either have no signs of illness or have very mild symptoms. People at highest risk for severe illness are those over 50 years of age. Chikungunya and Dengue viruses were seen in Oklahoma as recently as 2016 and 2017, respectively. These viruses are not historically endemic to the United States and are almost always found in individuals who have travelled to islands in the Caribbean, Africa, Asia, or Europe. Neonates and adults > 65 years of age are most vulnerable to Chikungunya, while older children and adults are at greater risk for complications and severe illness with Dengue. Currently, there are no vaccines to prevent the viruses and no specific medications to treat them.
Ticks, which are actually arachnids, can also carry diseases such as Rocky Mountain Spotted Fever, tularemia, ehrlichiosis and Lyme disease. In Oklahoma, the risk of contracting Lyme disease from the black-legged deer tick is extremely low. According to the Centers for Disease Control (CDC), since 2012 there have only been 2 confirmed cases of Lyme disease in Oklahoma, both occurring in counties in southwestern Oklahoma. Keep in mind that even though these individuals had cases reported in Oklahoma, it does not mean that they contracted the disease in Oklahoma. Symptoms of a tick-borne illness begin approximately 5-14 days after the tick bite and can include sudden onset of fever, muscle aches, headache, and may or may not be accompanied by a rash. Early treatment is crucial and consists of antibiotics and confirmatory blood tests.
The most important step you can take to protect your child is to prevent a bite from occurring. Current guidelines from the CDC and the American Academy of Pediatrics recommend using insect repellent on children > 2 months of age. Products containing 10-30% DEET have been proven safe and most effective for the longest period of time against the widest range of insects and ticks. It is not recommended to use DEET/sunscreen combination products as the sunscreen needs to be applied far more frequently than the insect repellent and may result in overexposure to DEET. DEET-free products such as 20% Picaridin have been shown to be as effective against mosquitoes as 10% DEET, however the potency against ticks diminished after the first hour of application.
Other products available include oil of lemon eucalyptus, which has not been studied in children under 3 years of age (should not be used in this population) and has half of the potency of DEET. There are a limited number of studies rating the efficacy of essential oils (citronella, cedar, rosemary, geranium, lemongrass and peppermint) against insect bites. The research shows the protection from bites is far less with the oils than with DEET-containing products and the oils can cause sensitivity reactions on the skin, especially when exposed to sunlight. Interestingly, IR3535, the compound in Avon Skin So Soft Bug Guard Plus, can be effective in low-risk situations. Clothing and tents treated with Permethrin are also recommended as barriers to bites.
Additional measures you can take to protect your little ones include: avoiding or limiting time outdoors at dusk or dawn, wearing a wide-brimmed hat, light-weight, long-sleeved shirt, long pants tucked into socks, avoiding brightly-colored or floral clothing, avoiding standing water, flowerbeds, garbage cans, and avoiding scented lotions, hair products, etc.
Dog bites are a common injury in children, especially between the ages of 5-14. Most often, the bite comes from a familiar dog, either the family pooch or the neighbor’s hound. Dog bites account for 90% of all animal bites, but very few of these, < 10 %, become infected. Most smaller children sustain bites to the head and neck, older children and adults will have wounds on their extremities.
Comparatively, cat bites represent a much smaller percentage of bites, but approximately 50% become infected. This is because of the shape of their teeth and the types of bacteria in their mouth. Cat bites produce puncture wounds that deposit bacteria deep within the tissues, leading to infection of the skin as well as underlying structures. Sorry to report that the study results are not favorable for “crazy cat ladies” as the overwhelming majority of cat bites occur on the extremities of adult females.
As parents, we are responsible for teaching our kiddos how to be cautious and kind around animals. Children should move slowly around animals and always ask permission before petting an animal that doesn’t belong to the family. Allow the dog to sniff you or your child before petting. Do not approach the dog during feeding or sleeping times. Teach children to be gentle with animals and remember to never leave your child alone with an animal.
Stinging insects can ruin a day faster than a melted ice cream cone. Unfortunately, there are no topical products that can prevent stinging bites. The best protection is avoidance. Check for nests in tire swings, trees, trash cans and have them removed by an exterminator. Avoid bright colors and floral clothing as this can attract them. Avoid foods that attract insects: PB&J, popsicles, ice cream, watermelon, soda, punch. You know, all the goodies that you would typically have at a picnic! Teach your kiddos not to swing, swat or run if an insect comes near. Have them walk away slowly. If a nest is disturbed and they are swarmed, have them curl up as tight as possible, put their face down and arms over their head. Children with known insect sting allergies should carry an epi-pen at all times and should never be left alone outside.
Growing up as a fair-skinned, blue-eyed, red-haired little girl, I had more sunburns than I care to admit. I spent the majority of the day outside swimming in the pool, riding my bike, playing in the backyard, just like everyone else. Of course, I used sunscreen, but clearly not enough. I spent many days looking like a candy cane, half blindingly white, half cherry red until the burn would fade and a short-lived tan would appear. Those days were accompanied by many miserable nights with my mom spraying my singed flesh with a putrid-smelling, clothes-staining topical anesthetic just so I could lay down and rest. Not only was it painful at the time, but it is still painful because as I am getting, ahem, older, I am now seeing the damage that was done from repeated sunburns and prolonged sun exposure. I am now the mother of two children, one of which is a competitive swimmer, also fair-skinned and red-haired. I am constantly reminding him to use his sunscreen correctly. When he gets huffy, I gently remind him that he would like to still resemble a human at the age of 70 and not a Samsonite suitcase.
The American Academy of Pediatrics (AAP) recommends using a broad-spectrum (UVA and UVB) sunscreen with a sun protection factor (SPF) of at least 15 on children 6 months and older. SPF refers to how good a sunscreen can block harmful radiation from the sun. The higher the number, the more protection. SPF 15 blocks about 93% of UVB rays vs 98% with SPF 50. Studies have shown that sunscreens with SPFs > 50 offer little to no additional benefit. Sunscreen needs to be applied 15-30 minutes before sun exposure in order to form a protective barrier on your skin. It should be reapplied at least every 2 hours, after swimming or heavy sweating.
There have recently been concerns raised about sunscreen being absorbed into the body. The results of a small maximum-use clinical trial were published in May 2019 that concluded more studies need to be conducted to determine if there are any detrimental effects caused by the absorption of organic sunscreen into the blood. It was also stated that the findings should not discourage the use of sunscreen. The Federal Drug Administration (FDA) stated that while more information is being gathered, people should continue to use broad-spectrum sunscreen to help prevent skin cancer. The American Academy of Dermatology and the AAP continue to support the use of sunscreen in individuals >6 months of age. We know that early and repeated exposure to the sun, especially sunburns, can greatly increase the risk of developing skin cancer and we encourage you to protect your children from what we know can harm them.
Other ways to protect your little ones include trying to limit sun exposure between 10 am and 4 pm and dressing him/her in cool, tightly woven clothing, a wide-brimmed hat and sunglasses with UV protection. Infants < 6 months of age should be kept out of direct sunlight if possible and under a canopy, umbrella, or tree. They should be dressed in light-weight clothing that covers the arms and legs as well as a hat to shade the face and neck. If sunlight is unavoidable, it is acceptable to apply a very small amount of sunscreen to exposed areas of infants, such as the face.
A couple of key points to remember:
Use insect repellent with DEET on infants and children > 2months of age- the most effective for the longest time against the widest range of critters.
Teach children good pet manners. No pulling tails, dressing the cat up in a tutu, or petting random animals.
Don’t stir the hornet’s nest or run from the bees who want your ice cream.
Use sunscreen diligently on everyone > 6 months of age. Apply 15-30 minutes before going outdoors, reapply at least every 2 hours, after swimming or sweating.
Don’t forget that we are here if you have any questions.
Bites stink and burns hurt, but you can help prevent them from occurring. Have a safe, fun-filled summer everyone!