The DEET Question and Beyond  To keep mosquitoes away, many parents who travel with children put insect repellent near the top of their shopping list. Preventing itchy and annoying insect bites is important, but there are more compelling reasons to keep the bugs off. In many parts of the world, a host of exotic illnesses, such as malaria, dengue fever, Lyme disease, filiariasis, and leishmaniasis, can be transmitted through insects. Fortunately, your child's chances of contracting one of these diseases is low. But it takes only one bite from an infected insect to pass along a serious illness, so it pays to cut down on the number of bites. Plan your prevention strategy carefully before you leave home. To outsmart insects, you'll need this effective combination approach:

·         Prudent Use of DEET Repellent

·         Insect Avoidance

·        Permethrin Treatment of Bednets and Clothing

Prudent Use of DEET

The most widely used insect repellent worldwide is DEET (diethyl-meta-toluamide). It is also the most effective. Formerly, the U.S. allowed products with less than 15% DEET to be labeled safe for use in children, but in April 1998, the U.S. Environmental Protection Agency (EPA) stated that it could no longer certify that DEET was "safe" for children. The announcement has left many parents confused.
Did new information about DEET's safety prompt this change? No. The EPA was mainly concerned that there was not enough scientific data to prove DEET safe for long-term use in children. As a group, children are of special concern because they may be more vulnerable than adults to the potentially toxic effects of chemicals and pesticides that are applied to the skin.
The EPA's action might appear alarming, were not for DEET's actual safety record. Hundreds of millions of people have used DEET in the past 40 years, but there have been only 14 reported cases of neurological side effects, such as seizures, confusion, and dizziness. The only death reported was caused by intentional ingestion of 8 oz. of DEET. The more common side effects have included skin rashes and eye irritation. Because most of these side effects have occurred in children, parents must use DEET prudently. If used as directed, DEET is considered acceptable for children. Without doubt, it is certainly the best form of prevention against serious, travel-associated insect transmitted disease.
Helpful Tips

·         Choose a product that contains a low concentration of DEET. The EPA and the American Academy of Pediatrics recommend DEET concentrations of 10% or less for children.

·         Be aware that the higher the DEET concentration, the longer a product lasts. A product with 10% DEET lasts about 4 hours, while 35% concentration, which is often recommended for adults, can last up to 12 hours. (The only exception is a new 20%, 24-hour controlled release product mentioned below.) Products with 100% DEET are not recommended for anyone, as there are no significant benefits, and much higher potential toxicity.

·         If your child has sensitive skin, do a "patch test" before you need to use it. Put a small amount of repellent on the inside of the arm and watch for any reaction. Skin reactions usually occur in less than a day.

·         If a reaction, such as a skin rash or hives, occurs anytime your child is using DEET, discontinue use, wash the skin with soap and water, and seek medical care. Don't panic, though. The very rare neurological reactions that have been reported seem to be linked to repeated, often excessive use over a prolonged period.

·         Apply DEET repellent only to exposed skin, not under clothing or diapers. Do not apply DEET to children's palms to avoid possible ingestion or eye irritation. Never spray DEET onto the face; it is OK to apply with your hand, being careful not to apply too closely to the eyes.

·         Do not use DEET on infants under 12 months.

·         Do not let children apply DEET-containing products themselves, and store these products out of children's reach.

·         Avoid combination products that contain DEET plus sunscreen. They're impractical because sunscreen needs to be applied more frequently than DEET. Instead, use separate products on your child. Apply sunscreen first, followed by a mosquito repellent that contains DEET.

·         To lessen exposure, wash the repellent off the skin when insects are no longer a risk.

·         Be cautious with non-DEET repellents, such as oil of citronella or the Avon bath product Skin-so-Soft, which some parents view as being "safer" alternatives. These products do have some repellent properties, but it's unclear how they work, and their safety profiles been not been fully detailed. Also, these products are effective for only about 20 minutes--much too short a time to protect travelers who face the risk of potentially life-threatening insect-borne disease.

·         Non-DEET products may be useful in infants under 12 months, however. Because DEET is not recommended for use in babies, parents should consider non-DEET alternatives when traveling to areas with high risk of insect-borne disease. They should also take every precaution to keep their infants away from insects- using permethrin treated bednets and clothing.

·         Avoid strategies, such as taking Vitamin B1 or using electrical insect buzzers, which have not proven effective in repelling biting insects.