Bites

Practicalities Health Insects (cuts bites) Bites 

Ticks

The issue of ticks (small, wingless parasites that feed on the blood of wild and domestic animals) is best publicised in the northeast of the US where they are known to carry Lyme disease. They are also a potential problem in Europe, notably in the forests of central Europe. You should take care, for example if walking in Austria, and consider wearing clothing which covers the skin, especially legs and ankles, preferably smooth as this is harder for ticks to grip. You should also know in advance how to deal with a tick should someone in the party encounter one. Homeway sells a kit for doing so. It is also a good idea to watch out for flu-like symptoms of headaches and general aches and pains.

Nomad Medical sells a product called Bug Proof with which to treat clothing if ticks might be a problem. Bug Proof contains permethrin which is a contact acaricide to kill the ticks. Treatment is not recommended for children's clothing but instead it is suggested that children follow the path of adults wearing Bug Proof treated clothing as this will help clear a tick-free path.

Bees and Wasps

Prevention is the best approach and if you think this could be a problem it is best to avoid food which could attract them and to clean children thoroughly after they have eaten. If you are being plagued during a picnic or snack, take a couple of portions of the most likely item of interest and place it at a distance from yourselves.

According to Jungle Formula, wasps are attracted to different things at different times of year: April to mid August - water, meat and wood pulp, mid August to October - soft fruits and sugary products.

Cold water and ice can help with the pain. You should watch out for swelling and if the sting is in the mouth seek medical help immediately as swelling can affect breathing.

Ants, Spiders and Others

It is a good idea to make sure you have details of how to handle these [First Aid Book and Travel Titles], particularly if there is anything local you need to know about. If the bite requires anti venom this is generally available locally.

Mosquitoes

For the moment mosquitoes in Europe are more of a nuisance than a danger. Babies who have not been exposed to mosquitoes before will even take a couple of weeks to develop intolerance. However, in most other parts of the world protection against mosquitoes is vital. They carry not just malaria but other disease like Dengue Fever and Sleeping Sickness. Even in Europe bites when scratched may become infected.

Measures to Avoid

Preventing bites is the most important form of protection particularly from all mosquito-born problems and there are a variety of approaches.

1) Complete Avoidance
Given the dearth of suitable repellents for use on under 2s, the avoidance technique might be the best solution in this case. This option rules out anywhere tropical. Seaside areas are usually OK but avoid those with low lying land and/or lagoons. Queensland in Australia wouldbe anoption, though there is a slight worry there about dengue fever.

Mosquitoes don't survive above 1,500m even in more exotic areas, so this might be an option if you are feeling deprived of adventure.

2) Cover up
Light-coloured clothes are recommended in the evening against mosquitoes, keeping arms and legs covered. (Dusk is the main biting time.) That means providing long-sleeved shirts or t-shirts, and long socks to go under trousers so there isn't a biting gap, Mosquitoes can bite through lightweight fabrics so a certain density is preferable. Don't think that it's safe just because local children are running around uncovered. They get bitten. Long, loose cotton trousers tucked into socks or boots can also protect legs and ankles from bites when out and about during the day. A sun hat is also reported to offer a degree of protection against bites.

3) Minimise the attraction
Because mosquitoes are attracted by not just certain skin chemicals but also skin heat and humidity, it can be useful to wash or shower, especially sweaty feet, at the end of the day. Avoid highly scented perfumes, soaps or sprays. Even aftersun products may be best avoided for this reason.

4) Use nets and screens
This is only effective if close-fitting and free of holes and you remember to keep all doors/windows/screens shut particularly at night when mosquitoes are most active and when they may be attracted by lights. (Most bites are reported to take place during the hours of sleep.) Air conditioned rooms also seem to deter mosquitoes. Homeway Medical offers nets impregnated with the insecticide permethrin. World Health Organisation recommendations allow for a slightly larger hole size in the net if it is impregnated, allowing better air circulation. Ideally look for one with a generous skirt to tuck under the mattress.

5) Use an insecticide
Options include:
? A plug-in burner which burns up a vaporising tablet. These are available from MASTA, Nomad and Travelextras (an option with dual voltage function and using liquid or standard mat tablets) as well as high street outlets including some supermarkets during the summer. Note that different countries and even different electricians install sockets so the plug sits either vertically or horizontally. Open models for use in one type will not hold the tablet when placed in the other. A model with flex which would work with either type of socket is available from Safariquip. [Suppliers]

? Insecticide coils These are lit for a slow burn at one end to create smoke, so are not ideal with children, particularly as the recommended place to locate them is on the floor. However, Homeway and Safariquip do offer a cover for them which would offer some protection. See our supplier list.

6) Use a deterrent
Beware manufacturers claims of repellent time of up to X hours. Complete cover will probably be for around a third of this and for effective protection you will need to re-apply.

With children avoid aerosol sprays which mean the product is like to be inhaled. Instead opt for either a lotion or a pump spray.

As the aroma which attracts the mosquitoes is believed to come from certain points on the human body the best treatment appears to be to place a repellent on these. First put the product on the child's ankles, then on the back of his or her hands (to avoid sucking it off fingers) and then use the backs of the hands to rub a little on either side of the neck. Don't allow children to rub in the product themselves unless you wash hands thoroughly afterwards. It will almost certainly end up being consumed, probably along with anything eaten with fingers at dinner.

Note that ultrasound buzzers are reported useless.

Deterrents

Natural

There are a growing number of these on the market, largely relying on citronella essential oil though eucalyptus and pyrethrum flowers may also feature and cedar and lavender are considered a good general insect repellent. However, note that Neal's Yard Remedies warns that the skin of children under 18 months reacts to essential oils very differently from older children and adults. Using an oil on the skin before this age - even when diluted for example 10 drops to an eggcup full of oil, is thought may result in sensitising the child for life. Use on clothing may therefore be advisable.

These options where they do work do so usually for between 30 and 60 minutes (though the manufacturers may claim differently).

If you want to give one a go options include:
? Alfresco, a moisturiser which acts as a mosquito repellent, made from botanical ingredients including melissa, geranium and lavender, invented when working in the Chelsea Physic Garden, making use of plants traditionally known to deter biting insects. It has been recommended by the School of Hygiene and Tropical Medicine in London as safe for use on children.

? Burt's Bees lemongrass Insect Lotion, Porch Incense, and more.

? Mosi-guard Natural is made from a blend of lemon eucalyptus oil and is reported clinically tested and recommended by the London School of Hygiene and Tropical Medicine including for children under 6 (even from three months), and is said to be effective for up to six hours so fully so for probably two to three.

? Mozzi Patch a fabric patch containing citronella which can either be attached to something like a belt, headboard, pram etc, or work in a small plastic holder round the wrist, belt etc. The USP is that there is no immediate contact with the body.

? Natrapel, the top selling Deet-free repellent in the US, in either a pump spray or lotion, containing 10% citronella in water based solution, with Aloe Vera to moisturise. Reported effective for two to three hours.

? zZap with botanical extracts, essential oils, vitamin E and Aloe Vera.

Deet-based products

Deet (Diethyl meta toluamide) is considered by many travel specialists as the only really effective deterrent against mosquitoes. However, it may have side effects and in 1988 a report in the Lancet indicated that it is absorbed through the skin and advised against using repellent of more than 50% Deet for babies and children because of their thinner skin and greater skin surface compared to adults.

Homeway feels that 20-25% concentration is appropriate where exposure is minimal or for no more than three hours. However, some travellers feel that anything below 25% is unlikely to be effective.

The producers of Mosi-guard meanwhile indicate that Deet should be avoided on all children under 6 years, with particular caution expressed when the chemical is combined with permethrin. "Preliminary research in the USA demonstrated that simultaneous use of Deet and permethrin caused neurological damage to animals and recent work implicates Deet as a possible causal factor in Gulf War Syndrome," the company states, though elsewhere this is disputed. Impregnated wrist bands are now considered by some suppliers particularly dangerous and in all events Deet should not be used over cuts, wounds or irritated skin and should be kept away from eyes and mouth.

Deet cannot be used on certain types of manmade clothing as it melts them, as it does certain plastics, including watch faces. However, you could put it on natural fabrics, for example on a bandana round the neck.

It is advised that a Deet product should be washed off the skin using soap and water, as soon as possible, particularly if used on consecutive days. The same goes for your clothes.

Options for children

? Jungle Formula available from Boots with a junior version in roll-on form recommended for use from two years with just 20% concentration as opposed to the 35% or 50% in its products for adults.

? Repel is available in 20% Deet Family Formula as well as 55% Sportsman Formula at 100%. (Suppliers)

Non-Deet chemical repellents

Tests so far do not indicate the problems encountered with Deet though it is early as yet to be certain.

Options include:
? Autan originally with Deet, now uses Bayrepel from the manufacturers Bayer, reported as effective as 10 or 20% Deet repellents. A Family Formula lotion is reported safe for children from the age of two years. Available at Boots.

? Healthway Medical [Suppliers] has an option tested by the London School of Tropical Medicine and Hygiene. ‘Dermatalogically found in tests to have no deleterious effect on sensitive skins' so reported safe for children.

? Protec either the Lotion with Aloe Vera claiming 100% effectiveness for more than two hours or Protec Plus for malarial areas with protection reported equivalent to a 10% Deet-based product with 100% effectiveness for two hours. The chemical used is Merc 3535 from a German pharmaceutical company.

A Repellent Used on Clothes
The advantage is that the substance will not be absorbed through the skin in the same way as the alternatives above. They are, incidentally, designed not to stain fabric. Options include:
? Repel Clothing Treatment from Healthway Medical or Safariquip [Suppliers] for use on cuffs, collars, trouser bottoms and hats, is reported to last seven days.

? Bug Proof from Nomad, is reported to last for two weeks.

Afterbite Products

Once you've been bitten the itch can be extremely irritating, particularly to young children, so you might like to carry something to treat. Things get worse the more bites there are as apparently each new bite triggers the itchiness of the previous ones. Note however that any antihistamine creams should not be exposed to strong sunlight (for example on the beach) when on the skin as they can create sensitivity.

? A cold compress can help.

? Products reported to help include Witch Hazel, Forever Living Aloe Vera Gelly, lavender or Tea Tree essential oils, calamine lotion and Tiger Balm.

? After Bite, Autan Bite Ease and Sting Ease are all designed to offer fast relief. An ammonia smell is a downside, as is the possibility of a reaction on sensitive skin.

? Antisan and Piriton are cooling sprays/bite treatments. An oral treatment, for example Piriton or Clarityn may be suitable from 12 months but can cause drowsiness.

? Zanza-Click, available from Travelextras [Suppliers] is reported to work by creating a small electrical charge, safe on any part of the bodies and on babies. The slight buzz reported felt is believed to disperse the poison, so reducing the irritation at the point of the bite.

Malaria

Some experts report that malaria, which until 10 years ago was relatively easy to both prevent and cure, has now become resistant to virtually all drugs.

If you are going to be somewhere where there might be malaria, go to the experts for advice [Information - above]. Not only is it a very nasty disease (more virulent in its African form) it appears that children are more vulnerable to it than adults.

Even well travelled GPs are not in a position to have the latest information on which drug combinations are currently considered the most effective for the parts of the world you are visiting. As the insects evolve tolerance to the options the goalposts shift constantly and you need to combine the latest information with the options considered acceptable for children. Not all are suitable. There were reports in 1998 that zinc and vitamin A can improve immunity to malaria but neither have been found as effective as a drug like mefloquine so this would have to be in addition to the drugs.

All malaria tablets are pretty horrible. Chloroquine is available in syrup form but is still fairly vile. One suggestion if feeding any to children is to crush the tablets and mix with a little jam on a spoon, but even so you will need co-operation. Bear in mind that you will have to keep doing this for four weeks after you return.

The Malaria Reference Laboratory
tel: 020 7636 3924
Malaria Healthline tel: 0891 600 350 (39p min cheap rate, 49p other times)
Should be able to provide more information.

Malaria Foundation International
Set up to 'facilitate the development and implementation of solutions to the health, economic and social problems caused by malaria'. Up-to-date press releases and academic articles as well as a calendar of malaria oriented conferences and events.