When the weather turns warm, you may want to use an insect repellent to protect your child from bites by mosquitoes, biting flies, gnats, chiggers, ticks, or other "bugs." In choosing a repellent, you need to keep in mind what insects you want to protect against and which substances are safe and effective.

The best all-purpose insect repellent is a substance called N,N-diethyl-m-toluamide, commonly known as deet. It is the active ingredient in most commercially available repellents. Deet is available in products packaged as sprays, aerosols, gels, liquids, sticks, and impregnated towelettes. Although deet has been used safely for 40 years, it is best not to apply products with a deet concentration of more than 10% to children’s skin. Check the label of the product you are considering for the concentration.

Be sure to apply the deet product to all exposed areas except the hands (particularly of small children) and the skin near the eyes and mouth. Also keep repellent away from cuts or any patches of irritated skin. Deet will remain effective for several hours, but will wash off with water and sweat, so it’s best to reapply it from time to time. The substance also may damage plastics and spandex.

If you prefer a plant-derived product, consider a repellent in which the active ingredient is citronella. Although citronella is effective, it does not protect as long as products containing deet. Soybean oil is another "natural" repellent that works well.

When clothing or other objects rub the skin,some repellent may come off. Evaporation, wind, heat, sweating, and water have the same effect and shorten protection time.

Using an insect repellent with sunscreen. The sun protection factor (SPF) of sunscreens may decrease when an insect repellent containing deet also is applied. Therefore, if you use sunscreen and deet-containing insect repellent on your child at the same time, choose a sunscreen with a higher SPF than you usually use. If you apply one of the new combination sunscreen and insect repellent products, keep in mind that it may not protect as well against sun as the SPF on the label would suggest.

Many parents worry that their child will be bitten by a tick and get Lyme disease. The best protection against ticks is permethrin, which is available in a spray repellent. Permethrin should not be applied directly to the child’s skin, however, because its safety when used that way has not been firmly established. Spray permethrin repellent on clothing, shoes, tents, netting, sleeping bags, and the like.

It will last for several washings. On the child’s skin, use a deer-containing repellent.

• Whatever repellent you choose, observe the following guidelines, developed by the Environmental Protection Agency (EPA), for the safe use of insect repellents:
• Verify that the repellent has an EPA-approved label
• Read the entire repellent label before each use · Use the repellent only as directed by the manufacturer and only for the insects it claims to be effective against · Keep repellents out of the reach of children
• Apply only to areas specified by the label
• Use enough repellent to cover exposed skin or clothing, but avoid frequent applications
• On returning indoors, wash repellent off skin with soap and water
• If you suspect a repellent-induced toxic reaction, wash off the repellent and call the poison control center. If you go to a doctor’s office or other facility, take the repellent with you.
• For information on the active ingredients in repellents, contact the National Pesticide Telecommunications Network at 800-858-7378.
• It is open 24 hours a day, seven days a week.

92 CONTEMPORARY PEDIATRICS Vol. 15, No. 6