Insects (cuts bites)

Practicalities Health Insects (cuts bites) Mosquitoes 

Mosquitoes are particularly active at dawn and dusk, especially just as the sun is setting.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, Sleeping Sickness and more. In the US West Nile virus is now spreading across the continent. Even in Europe bites, particularly when scratched, may become infected.

Wherever you are, avoid stagnant water where mosquitoes breed.

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

Complete Avoidance

Given the dearth of suitable repellents for use on under twos, going somewhere where mosquitoes are not a problem might be the best solution for families with young children.

This option rules out most warm places with fresh water and anywhere tropical. Seaside areas are usually OK but avoid those with low lying land and/or lagoons such as the Camargue or even the marshlands of Alaska or Finland.

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

If you are simply worried about avoiding malaria you do not have to restrict your choices quite so thoroughly. The southern Mediterranean would be fine for example, or even Queensland in Australia - though there is a slight worry there about dengue fever.

Cover Up

Long, loose clothes are useful against most insects. Blue is apparently mosquitoes' favourite colour though all darks tend to attract them. Light-coloured and particularly tan/khaki and other neutral colours clothes are particularly recommended, keeping arms and legs covered. (Dusk is the main biting time, along with dawn). 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. 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.

Don't think that it's safe just because local children are running around uncovered. They'll get bitten.

Don't think that it's safe just because local children are running around uncovered. They get bitten too.

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.

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.

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 conditioning 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.

Use a Deterrent

These work by creating chemical interference which hampers the insects' targeting sensors.

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 repellent on the key points. 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.

However, if the problem and potential dangers are serious, advice is to cover all exposed skin.

Always keep repellents away from eyes and mouth and do not apply to children's hands. Always follow the directions carefully and only apply to exposed skin, not under clothing. Never use on cuts, wounds or irritated skin. If there is a suspected reaction to a repellent wash the treated skin and seek medical attention. Always keep the repellent out of the reach of young children.

There are a variety of options:

Natural
There are a growing number of these on the market, largely relying on lemon balm or citronella essential oil, though eucalyptus and pyrethrum flowers may also feature and cedar and lavender are considered a good general insect repellent along with peppermint, thyme, orange blossom, clove, cinammon,, geranium, nutmeg and garlic oils.

However, Neal's Yard Remedies warns that the skin of children under 18 months reacts to essential oils differently from older children and adults. Using an oil on the skin before this age - even when diluted is thought can result in sensitising the child for life. Use on clothing may therefore be advisable.

Where they work these options 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. [Suppliers]



• Mosi-guard Natural is made from a blend of lemon eucalyptus oil (Citriodiol) and is reported clinically tested and recommended by the London School of Hygiene and Tropical Medicine including for children under six (even from three months), and is said to be effective for up to six hours so fully so for probably two to three. Tests carried out in Tanzania and Scotland found Mosi-guard to be ‘as good as any DEET repellent' and it does appear to be the most effective of the natural options. [Suppliers]



• Mozzie 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. [Suppliers]



• zZap with botanical extracts, essential oils, vitamin E and Aloe Vera. [Suppliers]

• 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]

Ben's, a US range including Ben's 100 of 100% DEET, down to Ben's Family of 30% DEET.

• 
  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. [Suppliers].

• 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, [Suppliers] is reported to last for two weeks.

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. [Suppliers]

Afterbite Products

Once you've been bitten, the itch can be extremely irritating, particularly to young children, and 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 creates a small electrical charge (high voltage/low intensity), safe on any part of the body and on babies. The slight buzz felt is reported to localise the poison, inhibiting histamine release and facilitating the shutdown of surrounding blood celles due to electro spasm. The toxicity of the bite becomes neutralised with no disruption to the structure or function of neighbouring membranes. (Also reported useful on stinging nettle and jellyfish stings.) For best results needs to be used as soon as possible after being bitten. Own brand versions are also available for example in Boots and ASDA.
• Once Bitten is a compact pen containing calamine, clove oil and peppermint oil. This can be squeezed in a 'micro-dose' on to bites and stings to anaesthetise the affected area and reduce inflammation. Apparently it even works on jellyfish stings and is reported usable on any age from toddlers up.

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 [Health - Information]. 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, drugs are currently considered by the authorities the best of the alternatives. However, mefloquine for example is not considered safe for children and there are also restrictions on use of malarial drugs in pregnancy or breastfeeding infants of less than 11kg.

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.

More Information

The Malaria Reference Laboratory
(020) 7636 3924

Malaria Healthline
(0891) 600 350 (39p min cheap rate, 49p other times)

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.