DEET or no DEET?

I was asked this question by a mom when she saw me looking at my options for insect repellent (bug spray) at a local pharmacy. She also recently moved to CT from NYC. Now that we live in the suburbs and are surrounded by wooded areas we have to worry about tick bites, in addition to mosquito bites. The mom was concerned about the safety of putting DEET on her infant. I reassured her that it is recommended and is safe as long as she follows the directions for application.

The CDC and AAP recommend the use of products that contain 30% or lower concentration of DEET in children older than 2 months of age. Just make sure it is applied correctly (avoiding the eyes and not covering areas that have been sprayed with another layer of clothing). The best way to avoid tick bites is to wear long pants that are tucked into socks; apply DEET-based repellents to exposed skin and to pants below the knees and the tops of socks. It is recommended to use products with at least a 20% DEET concentration; the higher the concentration, the longer the duration of protection. For instance, a product with 7-10% DEET will last about 90 minutes, whereas 25% will last up to 8 hours. Some products marketed for families only contain 7% DEET; this will increase the likelihood of being bitten first as compared to someone who is wearing a higher concentration of DEET. Keep an eye on the child who is wearing the lower concentration.

Avoid sunscreen/insect repellent combinations. It is ok to reapply sunscreen, but bug spray is only reapplied if the insects start to truly bother you after a few hours. So, it is best to buy separate products. More is not better. It is also recommended that sunscreen be applied first, followed by the bug spray, otherwise the sunscreen will be less effective if applied at the same time.

Be sure to perform "tick checks" (don't forget the armpits, groin, and neck areas) as soon as you return home from your outings (even if it's just your own backyard) and wash the areas that have been sprayed with soap and water.

Disclaimer: I have no affiliations with Vertellus. I just really liked their information about DEET.

Plop, plop then blink, blink, blink?

Ahhh, today was the first day that I woke up with minimal sneezing and eyes that didn't itch or look bloodshot. It has been torture for the past couple of weeks, but I survived with over-the-counter (OTC) cetirizine (Zyrtec) 10 mg that I took by mouth once a day and OTC ketotifen (Zatitor) eye drops twice daily. They don't make me symptom-free, but they definitely dampen my misery. I even started breaking my dose in half and taking it twice a day; 5 mg in the morning and 5 mg in the evening, and it's been working out. Sometimes this is done with other medications to maintain a better drug level in the blood.

Since I'm still nursing my son, my first concern is his safety; how will these antihistamines affect him? Cetirizine is generally considered safe, but it is unknown how much of the medicine will distribute into the breast milk. I have been watching him for excessive irritability and drowsiness, and he's been fine. There is little information about ketotifen and breastfeeding. So, I make sure I practice good technique when applying eye drops. The amount of drug that drains into the tear duct into the nose, where much of the drug will get absorbed into the bloodstream, can be minimized. Good tip to remember: put in the drops, gently put pressure on the tear duct with eyes closed for at least 30 seconds (up to 2 minutes). Of note, applying more drops is not better; 1 drop is more than enough, even if some of it drips out of the corner of your eye. If your doctor tells you to put in 2 drops, avoid the plop, plop method; put in one drop at a time. Try not to blink right away because that will flush the eye drop out of the eye like a windshield wiper.

Kids suffer from seasonal allergies, too. Some kids who also have asthma may need higher doses of their controller medicines, or start additional ones, like montelukast (Singulair), to prevent the asthma attacks triggered by seasonal allergies. Check with the pediatrician or pharmacist first if your child has other conditions (and especially if they are younger than 2 years of age) before giving them OTC antihistamines, like diphenhydramine (Benadryl) or loratadine (Claritin). Make sure the proper measuring tool is used for syrups. If the medicine is to be taken once daily, give it at bedtime so the morning symptoms are covered. Try to use the proper technique for eye drops. One plop, but no blinking...just light pressure on the tear duct. Oh, and be sure to wash your hands before and after.

Other resources:
The FDA has good information about breastfeeding, but other sources may be more current regarding the transfer of medications into breastmilk. Kellymom.com provides evidence-based information on breastfeeding and parenting. The American Academy of Allergy, Asthma, and Immunology (AAAAI) has kid-friendly information about allergies and asthma.

Achoo!

I first taught my daughter to sneeze into the crook of her arm about a year ago so that she would not spread her germs when she played with the toys at summer camp or held hands with her buddies. I also sent her with a pack of tissues in her pocket. She did not have a fever at any point and she played and ate normally, thus I knew it was a common cold and not the flu. The CDC has been very resourceful these past 2 weeks about getting information out to the public and to health care professionals. Here is a list of other common symptoms of the flu to look for and what to do if you notice them.

Even with two young children at home and a husband with asthma, I did not panic with all of the hype surrounding the pandemic swine flu (sorry H1N1 flu virus). I have been receiving email updates from the CDC, WHO, FDA, thank goodness for large storage capacity in cyberspace, but I have decided to just stay alert about the situation and not let it change our routines. The seriousness of the situation is real, but I felt like we, as a country, were living like a season of the show 24, only things happened over more than 24 hours. However, the intensity, drama, and ridiculousness of some of the reactions to the updates about the flu are the same. Now schools can reopen and guidelines have been released as to when schools should be closed. Sadly, some kids in some states have lost the opportunity to expand their knowledge because school trips have been canceled. Admittedly, we ARE getting mixed messages. First we're told not to panic, then some states declare emergencies even though there were only a handful of cases.

Seriously, let's just calm down, breathe, and take the normal precautions we usually do to avoid getting sick or getting others sick. If you want to prepare for the pandemic flu alert, the CDC provides a checklist. Actually, it's a pretty good list to go through to prepare for any emergency. Finally, teach your kids to wash their hands frequently (a thorough wash is to use soap and warm water and sing "happy birthday to you"), sneeze into the crook of their arm or use a tissue and throw it away immediately, stay away from others who are sick, and keep them home if they are sick. If the flu is suspected, though, do call your child's pediatrician; antiviral medications do shorten the course of illness if started soon after infection. The American Academy of Pediatrics has quick tips.

I bought some more alcohol-based hand sanitizer to keep in my bag and I'm doing laundry using hotter temperatures, but those are not drastic measures. How have you changed your routine because of the swine flu pandemic?