Caring for Our Children (CFOC)

Chapter 3: Health Promotion and Protection

3.4 Health Protection in Child Care

3.4.5 Sun Safety and Insect Repellent

3.4.5.2: Insect Repellent and Protection from Vector-Borne Diseases

Content in the STANDARD was modified on 4/5/2017.

 

Most insects do not carry human disease and most insect bites only cause mild irritation. Insect repellents may be used with children older than 2 months in child care where there are specific disease outbreaks and alerts. As with all pesticides, care should be taken to limit children’s exposure to insect repellents (1). Caregivers/teachers should consult with a child care health consultant, the primary care provider, or the local health department about the appropriate use of repellents based on the likelihood that local insects are carrying potentially dangerous diseases (e.g., local cases of meningitis from mosquito bites). This information should be shared with parents/guardians, and collective decisions made about use.
Insect repellent requires the written permission of parents/guardians and label instructions must be followed. It does not require written permission from a primary care provider.

Repellents containing DEET
Repellents with 10%-30% DEET offer the broadest protection against mosquitoes, ticks, flies, chiggers, and fleas. Caregivers/teachers should read product labels and confirm that the product is 1) safe for children and 2) contains no more than 30% DEET. Most product labels for registrations containing DEET recommend consultation with a physician if applying to a child less than six months of age.
The use of DEET should reflect how much time the child will be exposed to biting insects (2):
  • 10% DEET is generally effective for two hours.
  • 24% DEET is generally effective for five hours.
  • Products with more than 30% DEET should never be used on children.
  • Do not use products that combine insect repellent and sunscreen. This is because sunscreen may need to be re-applied more often and in larger amounts than repellent.
  • If sunscreen is also used, apply sunscreen FIRST. DEET may decrease the SPF of sunscreens by one-third. Sunscreens may increase absorption of DEET through the skin).
Other Types of Insect Repellents
Picaridin and IR3535 are other products registered at the Environmental Protection Agency (EPA) identified as providing repellent activity sufficient to help people avoid the bites of disease carrying mosquitoes (4). Para-menthane-diol (PMD) or pil of lemon eucalyptus products, according to their product labels, should NOT be used on children under three years of age (4,5).

General Guidelines for Use of Insect Repellents with Children
As noted above, insect repellents may be applied to children older than two months. In addition to consulting label instructions, teachers/caregivers may follow these guidelines:
a.    Apply insect repellent to the caregiver/teacher’s hands first.
b.    When applying insect repellent on a child, use just enough to cover exposed skin.
c.    Do not apply under clothing.
d.    Do not use on children’s hands.
e.    Avoid applying to areas around the eyes and mouth.
f.     Do not use over cuts or irritated skin.
g.    Do not use near food.
h.    After returning indoors, wash treated skin immediately with soap and water.
i.     Caregivers/teachers should wash their hands after applying insect repellent to the children in the group.
j.     If the child gets a rash or other skin reaction from an insect repellent, stop using the repellent, wash the repellent off with mild soap and water, and call a local poison center (1-800-222-1222) for further guidance (4). If repellent is used on broken skin or an allergic reaction is observed, discontinue use and notify the parent/guardian.
 
Protection from ticks
In places where ticks are likely to be found (6), caregivers/teachers should take the following steps to protect children in their care from ticks:
 
a.    Remove leaf litter and clear tall grasses and brush around homes and buildings and at the edges of lawns;
b.    Place wood chips or gravel between lawns and wooded areas to restrict tick migration to recreational areas;
c.    Mow the lawn and clear brush and leaf litter frequently;
d.    Keep playground equipment, decks, and patios away from yard edges and trees;
e.    Ensure that children wear light colored clothing, long sleeves and pants, tuck pants into socks; and
f.     Conduct tick checks of children when returning indoors (7).

How to Remove a Tick (8):
It is important to remove the tick as soon as possible. Use the following steps:
a.   If possible, clean the area with an antiseptic solution or soap and water. Take care not to scrub the tick too hard. Just clean the skin around it;
b.   Use blunt, fine tipped tweezers or gloved fingers to grasp the tick as close to the skin as possible;
c.   Pull slowly and steadily upwards to allow the tick to release;
d.   If the tick’s head breaks off in the skin, use tweezers to remove it like you would a splinter;
e.   Wash the area around the bite with soap;
f.    Following the removal of the tick, wash your hands, the tweezers, and the area thoroughly with soap and warm water.

Take care not to do the following:
a.    Do not use sharp tweezers.
b.    Do not crush, puncture, or squeeze the tick’s body.
c.    Do not use a twisting or jerking motion to remove the tick.
d.    Do not handle the tick with bare hands.
e.    Do not try to make the tick let go by holding a hot match or cigarette close to it.
f.     Do not try to smother the tick by covering it with petroleum jelly or nail polish.
RATIONALE
Mosquitoes and ticks can carry pathogens that may cause serious diseases (i.e., vector-borne diseases such as West Nile virus and Lyme disease) (7).
Zika is a mosquito-borne virus that usually causes mild illness that lasts from several days to a week. The mosquito that spreads Zika virus is found everywhere in the world including the United States. Zika can be passed from a pregnant woman to her fetus. Infection during pregnancy can cause certain birth defects (9). Information and recommendations regarding Zika are rapidly evolving. Please visit the Centers for Disease Control and Prevention (CDC) Zika updates page for the most recent information: http://www.cdc.gov/zika/index.html (9). 
COMMENTS
Insect repellents should be EPA-registered and labeled as approved for use in the child’s age range.
Aerosol sprays are not recommended. Pump sprays are a better choice. Regardless of the type of spray used, caregivers/teachers should spray the insect repellent into her/his hand and then apply to the child. It is not recommended to directly spray the child with the insect repellent to prevent unintentional injury to eyes and mouth. Preschool children, toddlers, and infants should not apply insect repellent to themselves. School age children can apply insect repellent to themselves if they are supervised to make sure that they are applying it correctly.
Parents/guardians should be notified when insect repellent is applied to their child since it is recommended that treated skin is washed with soap and water.
If a product gets in the eyes, flush with water and consult the poison center at 1-800-222-1222.
Several resources are available on reducing exposure to ticks and mosquitoes based on habits, protective attire, and insect repellent use. The following resources offer detailed information on preventing exposure to ticks and mosquitoes in early care and education settings:
  • Preventing Tick Bites on People by the Centers for Disease Control and Prevention at http://www.cdc.gov/lyme/prev/on_people.html.
  • UCSF California Childcare Health Program’s (CCHP) Health and Safety Note for child care centers:
1. Integrated Pest Management: Mosquitoes: http://cchp.ucsf.edu/sites/cchp.ucsf.edu/files/ipm_mosquitoes.pdf
2. CCHP IPM Handout for Family Child Care Homes: Mosquitoes: http://cchp.ucsf.edu/sites/cchp.ucsf.edu/files/Mosquitoes_FCCH_IPM.pdf
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
3.2.2.1 Situations that Require Hand Hygiene
3.4.5.1 Sun Safety Including Sunscreen
5.2.8.1 Integrated Pest Management
REFERENCES
  1. National Pesticide Information Center. 2015. Pesticides and children. http://npic.orst.edu/health/child.html. 
  2. Aronson, S. S., T. R. Shope, eds. 2017. Managing infectious diseases in child care and schools: A quick reference guide, 4th Edition. Elk Grove Village, IL: American Academy of Pediatrics.
  3. Center for Disease Control and Prevention. 2015. Chapter 2 - Protection against mosquitos, ticks, & other anthropods. https://wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travel-consultation/sun-exposure. 
  4. Centers for Disease Control and Prevention, Division of Vector-Borne Infectious Diseases. 2015. West nile virus: Insect repellent use and safety. http://www.cdc.gov/westnile/faq/repellent.html.
  5. Centers for Disease Control and Prevention. 2016. Avoid bug bites. https://wwwnc.cdc.gov/travel/page/avoid-bug-bites. 
  6. Centers for Disease Control and Prevention. 2015. Geographic distribution of ticks that bite humans. https://www.cdc.gov/ticks/geographic_distribution.html. 
  7. Centers for Disease Control and Prevention, Division of Vector-Borne Infectious Diseases. 2010. Lyme disease: Protect yourself from tick bites.http://www.cdc.gov/ncidod/dvbid/lyme/Prevention/ld_Prevention_Avoid.htm.
  8. Centers for Disease Control and Prevention. 2015. Tick removal. https://www.cdc.gov/ticks/removing_a_tick.html. 
  9. Centers for Disease Control and Prevention. 2016. About zika. https://www.cdc.gov/zika/about/index.html. 
  10. ADDITIONAL REFERENCE:

    U.S. Environmental Protection Agency. 2016. Find the insect repellent that is right for you. https://www.epa.gov/insect-repellents/find-insect-repellent-right-you.
     
NOTES

Content in the STANDARD was modified on 4/5/2017.