Mosquito and insect bites/prevention

Prevention is the key when it comes to dealing with mosquitoes. The news reports are predicting that this season is looking to be a nasty one for mosquito and ticks Make sure that you have intact screens on all windows. This seems like a no brainer but if you are getting bites, check for holes or cracks where the insects might be getting in. Get rid of any standing water that is around your house; do a double check to make sure there are no pots, bird baths...etc. that are places where mosquitoes can breed. The larvae are dependent on water for breeding. Unfortunately just dumping out the water might not be good enough because it won’t dislodge the larvae that might be attached to the side. You really need to give a good scrub. Nurse Lainey taught me about Mosquito bits and mosquito dunks. You can add these to any water features to keep the mosquitoes from breeding. There tends to be increased mosquito activity during dusk and dawn so that is when most of the biting happens. (For the travelers out there, pay heed: the mosquitoes that carry Zika don’t have a time preference.) Try to wear (keep your child covered with) long pants/ long sleeves etc. Light colored clothing is recommended. If you are going into a heavy mosquito area use bug spray on exposed skin and clothing. Mosquito repellent works only on the surface to which it is applied directly. They will actually bite skin only four centimeters away from where the repellent is applied, so the wristbands or just spraying clothing does not offer full protection. As for the traditional electric bug zappers, some bug experts would rather that you don't use them. The violet light may be irresistible to some flying insects, (and that zap is such a satisfying noise), but mosquitoes are actually not attracted to the light. Some of the innocent and beneficial insects are the ones getting fried. If you are seeing mosquitoes around your house, San Francisco's Environmental Health Department will send an inspector to investigate (415-252-3805.) They will check the area around your home (including sewers) to see if they can find any breeding areas. Alas, longs sleeves alone aren’t going to do the trick if you are out in a buggy area. There are plenty of natural products on the market that claim to be repellents, ranging from Vitamin B to catnip. Most of these are generally safe, but unfortunately the scientific studies show that they are mostly ineffective. We have the luxury in the Bay Area of not having some of the more notorious mosquitoes, so the bites are mostly an aggravation rather than a health risk. If you are local to the Bay Area, it is not a big deal to give something a try to see how it works on your family. However, If you are traveling to an area where there are more dangerous mosquitoes, I would stick with the strong stuff. No kidding around. The EPA has five registered insect repellents. DEET is likely the most well known option. It is the only product labeled safe for infants as young as 2 months old. It comes is different concentrations. The concentration of DEET in a product indicates how long the product will be effective. A higher concentration does not mean that the product will work better; It means that it will be effective for a longer period of time. Therefore, products containing lower concentrations of DEET may need to be reapplied, depending on the length of time a person is outdoors. Oil of Lemon Eucalyptus is considered one of the least toxic options but interestingly, the age recommendation for it is for 3 years and older.(Natural lemon eucalyptus oil is not the same as Oil of Lemon Eucalyptus) Some people are sensitive to the smell of this, it is worth sniffing it before you buy it. Picaridin  is odorless and is approved for children 6 months (recently lowered from 2 years) and older.

Dr Anne especially likes the Sawyer product Avon Skin so Soft Bug Guard PLUS IR3535 Insect Repellent has been around for years but seems to be more commercially available than it used to be (also for over 6 months of age.) It comes in a highly rated product that combines Avon Skin So Soft and an SPF 30 sunscreen Bite Blocker is a botanical formula that claims to provide protection for up to 8 hours. The reviews mention a strong odor, but otherwise it gets high rating. Before applying anything topical to the skin for the first time, do a little test patch on the skin to make sure there is no sensitivity before you widely spritz or wipe on any of these products. You will need to read the labels to see how often you need to reapply. Avoid contact with eyes and keep all of these safely away from kids. I would also be cautious about getting any insect repellents on the hands especially if your child is young enough that those hands are going into the mouth a lot. If you are also using sunscreen, apply sunscreen first and insect repellent second. All of the EPA recommendations are considered safe, and they are clearly better than getting bitten, but at the same time, let’s use them wisely. The EPA has created the following tool to help you find the proper product for you needs EPA guide to finding the right repellent Some products are more effective than others for certain types of mosquitoes, so the product you choose might depend on where you are going and what you might be most at risk for. It is always good to check in at cdc.gov/travel prior to any travel. Mosquitoes don’t like fans! The nasty insects are lightweight enough that a good breeze may make it hard for them to zoom in on their target. The Off! Clip on  gets some folks who swear by it. If you are looking for an alternative to the DEET, it might be worth giving it a try (perhaps it is the fan aspect that makes it work…) If you are interested, Here is some current info on some of the mosquito borne illnesses that have been in the headlines the most in the past year or so. West Nile Virus is the one most likely to be circulating here in the Bay area https://www.cdc.gov/westnile/ If you see any dead birds, give them a wide berth and report them to 1-877-968-2473 (WNV -BIRD) or online at westnile.ca.gov. That website also will give you the up to date numbers on how many West Nile virus cases there are in California, county by county. It is updated weekly. Zika https://www.cdc.gov/zika/index.html Chikungunya https://www.cdc.gov/chikungunya/ DEALING WITH A BITE If the prevention has failed,treat the itching. Scratching at a bite will make it worse. There is a fairly new product called a mosquito zapper that I just learned about from Nurse Heidi. Some patients are startled from the noise, but others claim that it is great for minimizing the reaction. Over the counter hydrocortisone cream probably works the best, but other topical treatments can include calamine lotion, or mixing up a paste of baking soda with a bit of water. A cold black tea bag compress can also be very soothing. Black tea contains tannins, which seem to help. Some kids can have enormous reactions. Eyes and ears can be remarkably swollen. Topical treatment won’t be enough for these. Give a dose of Zyrtec or Benedryl right away. Scroll to the bottom for dosing info If the antihistamine doesn’t make a difference or if there is fever or severe discomfort, those kids need to be seen. If your little one is getting bitten, check the bedroom carefully. Look at the mattress and all the corners of the room; bites could be from spiders, fleas or other culprits. Here are some bonus facts about mosquitoes: Both males and females make that awful whining noise, but only the females bite humans. Mosquitoes are especially attracted to people who drink beer. Mosquitoes love the smell of sweaty feet. Mosquitoes can sense CO2 from up to 75 feet away. Mosquitoes only fly as fast as 1-1½ miles per hour. Some blood types may be tastier than others. O seems to be the favorite, A the least. B lands somewhere in the middle. Mosquitoes love pregnant women (regardless of their blood type) possibly because they emit a little extra CO2. Zyrtec Dosage Chart The dose of cetirizine depends on age: 6 - 12 months of age: 2.5 mg given once daily (maximum dose 5 mg daily) 12 - 24 months of age: 2.5 given once or twice daily (maximum dose 5 mg daily) 2 - 6 years of age: 2.5 - 5 mg given once daily (maximum dose 5 mg daily) Over 6 years of age: 5 - 10 mg given once daily (maximum dose 10 mg daily) Zyrtec comes in a 1mg/ml solution (so 2.5 mg = 2.5 ml). There is also a 10mg/ml oral drops preparation (so 5 mg is 1/2 ml). Make sure you check the strength of the solution. Benedryl dosage will be the same volume as your tylenol dose. The liquid says for children 4 and over; we still use it for our younger patients who need it. Benedryl makes most kids sleepy but can have the opposite effect.