Mosquito bites can carry significant problems

Q: Do mosquito bites cause problems and how do I keep my family from getting bitten?

With summertime heat and outdoor activities we are at risk of getting bitten by mosquitoes. While mosquito bites are certainly itchy and annoying, they can be associated with significant problems.

Bites can cause redness, a firm bump, itching and blistering. Try not to scratch as this makes them react more vigorously and can cause a localized skin infection. Treatment includes washing the area, applying an ice pack for 10 minutes, and using an anti-itch cream such as an “after bite” cream or over-the-counter antihistamine or steroid cream. You can also apply a paste made of baking soda and water for 10 minutes to help relieve the itching.

Some people react more vigorously and may have larger areas of swelling, redness, and have oozing of clear fluid from the bite. It is important to monitor for infection which can be marked by rapidly spreading redness, red streaks coming out from the bite, purulent drainage, fever, and increasing pain and heat at the site. If you have concerns about a skin infection, please contact your child’s health care provider.

Infections can be transmitted through mosquito bites. Recently, eight cases of locally acquired malaria have been detected in the U.S.

Malaria, caused by a parasite that infects mosquitoes, is common in other parts of the world, causing 241 million infections annually, but uncommon in the U.S. (only about 2,000 cases/year and limited to immigrants and travelers returning from international travel). The last time locally acquired malaria was found in the U.S. was in 2003 and there were only 8 cases, so the risk to residents who have not traveled to malaria-prone areas is extremely low.

West Nile virus (WNV) is much more common and there have already been cases in New Mexico this year. About 80% of people who are infected with WNV have no symptoms; one in five may experience fever, headache, body aches and/or joint pain, vomiting, diarrhea, and rash; and 1 in 150 people will suffer from encephalitis or meningitis, which are inflammation of the brain or the covering of the brain and spinal cord, respectively. There is no specific treatment other than treating symptoms.

The Zika virus is another mosquito-borne infection with similar symptoms to WNV, but it can also cause birth defects. It is treated with symptomatic care, as well. Thankfully, there have been no reported cases of Zika virus infection in the U.S. since 2018.

The best advice is to avoid bites.

Limit or avoid outdoor activities where mosquitoes are more commonly found, especially at dusk and dawn. Keep windows closed and ensure there are no gaps or holes in screens if you must keep them open. Regularly empty outdoor containers where water has collected to prevent breeding.

Wear lightweight pants and long sleeves and use an Environmental Protection Agency (EPA) approved repellent. There are many non-approved treatments available, including “chemical-free” products, but these have not been proven to prevent bites and may be dangerous to children.

There are also “natural” repellents containing ingredients such as citronella or geranium which are safe but only work briefly, are not proven to be effective, and can cause skin irritation. Wristbands, stickers, and ultrasonic devices have not been proven to prevent bites.

An effective chemical ingredient in repellents is DEET which has been proven to be safe to use on children down to 2 months of age. It is okay to use a product containing up to 30% DEET but please do not layer this under and over clothing and be sure to wash it off with soap and water after use.

Other common, safe and effective ingredients in repellents are: picaridin, oil of lemon eucalyptus (OLE), IR3535, para-menthane-diol (PMD), and 2-undecanone. Do not use OLE or PMD on children younger than 3 years old. Permethrin is a chemical that may be applied to clothing but should not be applied directly on skin. Avoid placing repellent on hands as kids may rub their eyes or put their hands in their mouths, and do not apply it to the eyes, mouth, irritated skin, or to cuts.

Use care with sprays to prevent inhalation and adults should spray some in their hands to then apply to a child’s face. If needing to use sunscreen and repellent, apply sunscreen first. I do not recommend combination sunscreen-repellent products as sunscreen needs to be applied more frequently than repellent.

A great resource to check on EPA approved products, their ingredients, and length of effectiveness can be found at https://tinyurl.com/yxd6rfbn.

Melissa Mason is a general pediatrician with Journey Pediatrics in Albuquerque. Please send your questions to melissaemason@gmail.com.