By Guest Columnist Catherine Casey, MD
This summer, my 7-year old son goes to camp for the first time. Real camp. The kind where he’ll stay outside all day in the woods, far from any electronics. The kind where he’ll build forts out of sticks and swim and sing camp songs. The kind where he’ll come home sunburned and covered in ticks.
Well, hopefully not that last part. Eight hours a day in the outdoors, five days a week, for eight weeks in a row sounds exactly like what a kid needs after a long year at school. Unfortunately, there can be some drawbacks to being exposed to the elements of summer. So how do we protect our young outdoorsmen and women?
Being a mom and a doctor, my priorities go in the following order: safety, effectiveness, and cost. For any of you who have been to a drugstore lately, you will know that there is a mind-boggling array of choices out there, both for sun protection and for insect repellents. How does a concerned, cost-conscious parent make a choice? Just for future reference, all the brands mentioned below are available for less than $10 a bottle—and no, I don’t get any kickbacks for mentioning them.
Let’s start with sun protection. First off, don’t forget the basics: hats, protective clothing, and avoiding the peak hours of 10 a.m. to 3 p.m. if possible. The kind of sun protection you rub on your skin comes in two basic flavors: sunblocks and sunscreens. Sunblocks work exactly like they sound—by providing a physical barrier to UVA and UVB rays and reflecting them away from your skin. Sunscreens, on the other hand, work by using chemicals that absorb these rays and convert them into less dangerous forms, like heat.
According to dermatologist Dr. Anne Ramsdell, sunblocks are the more effective of the two options, and also have a better safety record. Look for ingredients like zinc oxide or titanium dioxide, and an SPF of at least 30. Don’t pay attention to SPFs above 50, since they’re more hype than science. A good, inexpensive option I found that fits this description is Coppertone Water Babies Pure and Simple. Remember to reapply every 60-80 minutes and after swimming.
What about the bugs? In our region, we have a vast array of biting and stinging insects, some of which can transmit serious illnesses. Ticks are especially bad in this area and can carry a variety of illnesses, including Lyme disease, Rocky Mountain Spotted Fever, and Ehrlichiosis. In fact, we recommend that anyone in our area with the “summertime flu”—fevers, chills, and body ache—see their doctor and be evaluated for a possible tick-borne illness.
Since prevention is always preferable to treatment, have your child wear light-colored clothing—long-sleeved shirts and pants tucked into shoes, if the weather permits. For extra protection, you can buy clothing pre-treated with the insect repellent permethrin, or buy permethrin online and treat your clothing yourself. Permethrin provides excellent protection against ticks, and spraying it on your child’s shoes can prevent ticks in their nymph form from crawling up from the leaf litter onto their skin. Note that permethrin is applied to your child’s clothing and allowed to dry before your child wears it.
The most studied and effective types of insect repellent that you spray or rub on (and that’s you, the parent, spraying or rubbing it on your kid—they shouldn’t do it themselves) contain either DEET, picaridin, oil of lemon eucalyptus, or IR3535. If the idea of putting any insecticide on your child’s skin scares you and you don’t mind them getting a few mosquito bites, fear not. Do careful tick checks every night and your kid should be in the clear. Ticks need to be attached at least 36 hours to transmit disease. There are also many herbal alternatives available; however, most have not been shown to offer protection for more than a couple of hours (some even wear off after 20 minutes, while the ones listed below should last up to 8 hours—a bit more camp-worthy). Here’s a brief rundown on each of them:
DEET has been studied the longest—since the 1950s. There have been reports of toxicity in infants exposed to high levels of DEET. Therefore, it is not recommended for infants under two months of age. In Consumer Reports field testing, the DEET-containing insect repellants performed the best. Aim for a DEET concentration between 10 and 20 percent. Lower concentrations are not as effective, and higher concentrations don’t provide more protection. Also, DEET is safe to use on cotton, wool, and nylon, but can degrade rubber, spandex, and other synthetic materials. Off! Family Care Smooth and Dry is a good option.
Picaridin is a more recent, synthetic compound related to chemicals found in black pepper. It performed almost as well as DEET in Consumer Reports testing and may be a good alternative for children with sensitive skin. It does not have a strong smell. Natrapel is a common brand containing picaridin and is available at outdoor stores and online.
Oil of Lemon Eucalyptus is a plant-derived insect repellent. It did moderately well in Consumer Reports testing. The main drawback of oil of lemon eucalyptus is its strong smell, which some say is a mix between citrus and plastic beach ball. It is not recommended for children under three years of age. Also, do not use pure oil of lemon eucalyptus, as this has not been tested for safety. Repel Lemon Eucalyptus can be ordered online.
IR3535 is a chemical available exclusively through Avon, the makers of Skin-So-Soft. While some studies suggest that it offers 4-6 hour insect protection, one by the USDA suggested it was 10 to 100 times less effective than DEET.
So what about those products that combine both insect repellent and sun protection in one? It sounds like the perfect answer, but unfortunately, there are some drawbacks. First, certain compounds, like DEET, interact with certain sunscreens, like oxybenzone, and make them less effective. Second, sunblocks and sunscreens need to be reapplied frequently in order to be effective, whereas insect repellents should be applied as little as possible to minimize toxicity—ideally just once per day for a child, and then again only if the bugs start biting. Both should be reapplied after swimming.
So head to your favorite local or online store and pick up one container of sunblock and one container of the insect repellent that best suits your child’s needs. Get ready for happy camping!
Dr. Catherine Casey practices family medicine at U.Va. Family Medicine and Specialty Care Crozet at the Shops at Clover Lawn.