infants & toddlers
Summer Preventative Medicine:
Sun protection, Insect Repellants, Ticks & Heat Illness
By Donna Lombardi, MD

Summer has finally arrived... that time of the year when we must protect ourselves and our families when spending time outdoors. Here are some helpful hints for you on sun exposure, insect bites, ticks and heat illness.

The Academy of Dermatology and the American Academy of Pediatrics both endorse the use of sunscreens as an important part of a total sun protection program that also includes sun avoidance and sun protective clothing. The best way to prevent skin cancer is to prevent sunburn. Sun damage begins in childhood and is cumulative. UV light, from sun exposure, can reach the skin not only directly, but through reflection from snow, sand, water, sidewalks, and turf. UV exposure increases 4% for every 1,000 feet elevation above sea level. The following are some ways to help decrease the risk of sunburn and sun damage.

  • Keep infants out of the sun.
  • Avoid peak UV light exposure between 10 am and 3 pm in the summer.
  • Cover your baby with a long shirt and a wide-brimmed hat.
  • Place your baby under a sun umbrella at the beach.
  • Because of the uncertain absorption of sunscreens through the skin of newborns, their use is not recommended for babies under six months. If you use a sunscreen, it should contain titanium dioxide and be PABA free.
  • For children over six months select a sunscreen with an SPF (sun protective factor) of 15 or higher. Ideally, sunscreens should be applied at least 30 minutes before the onset of sun exposure and should be reapplied every four hours, as well as immediately after swimming or profuse sweating and even on cloudy days. A "waterproof" sunscreen stays on for about 30 minutes in water.
  • Protect your child's eyes. Years of exposure to ultraviolet light increases the risk of cataracts. Buy sunglasses with UV protection.

The active ingredient in some insect repellents is DEET (diethyltoluamide). Excessive application of repellents containing DEET can cause seizures and coma through absorption across the skin. To avoid these complications use products that contain less than 10% DEET. Examples are Skedaddle! cream, Off! and Skintastic for Children lotion. The insect repellent should be applied mainly to clothing and shoes. Never apply it to your children's hands to prevent contact with their mouth or eyes. Avoid rashes or skin that is abraded or sunburned since absorption is increased in these areas. Since one application lasts 4 to 8 hours, apply twice a day.

The most common tick-borne disease in the U.S. is Lyme Disease. Lyme Disease is endemic in CT. It occurs primarily in the spring and summer, and this year tick infestation has been projected to be particularly high because of the mild winter. Lyme Disease is a multi-system infection with greatest involvement of the skin, neurologic system, and joints. The disease is transmitted to humans by the deer‰ tick. Tick-borne diseases are very treatable illnesses if caught early and treated properly with antibiotics.

Tick-borne diseases are largely preventable. If tick-infested areas cannot be avoided, parents can minimize their child's exposure by taking the following precautions.

  • When hiking, wear long clothing and tuck the end of pants into your socks. Wear light colors so that ticks will be more visible.
  • Apply an insect repellent with at least 20% DEET or Permethrin to clothing, shoes and socks. Do not apply insect repellent with this concentration of DEET directly to skin.
  • At least once a day carefully inspect the skin for ticks, particularly under the arms, in the groin, behind the ears, along the hairline, and on the legs, especially the backs of the knees.
  • Remove ticks with tweezers, grasping the tick as close as possible to the site of attachment and pulling straight up from the skin to avoid breaking the body and leaving mouth parts in the skin. Always use gloves when handling a tick. After removing the tick, wash the bite site with soap and water. Preserve the tick for identification.
  • Removing ticks promptly may prevent infection, because transmission of Lyme Disease requires 18 to 24 hours of feeding. If the tick has been attached to the skin for longer than 24 hours it is imperative to watch for a rash (red circular rash with central clearing), fever, malaise or flu-like illness. These symptoms or any concerns should be discussed with your physician.
  • If you have a dog or cat, wash him with an anti-tick soap during the spring and summer months and perform regular tick checks on him. Ask your veterinarian about Lyme vaccination, anti-tick shampoo, cream, collars, and long-acting oral medication.

Heat stroke is a potentially life-threatening condition. The body's temperature may be 105 F or higher, and the skin is hot, red and dry. In heat exhaustion, the body temperature is normal or near-normal, but the child sweats profusely and the skin is moist and clammy. It is imperative to get your child to a cool environment, remove the clothing, cover the body with towels cooled in ice water, and call for medical assistance. Children and adolescents who exercise in hot weather are vulnerable to heat illnesses that may be serious, even life-threatening. In addition, infants may develop heat illnesses because the body's mechanism for regulating temperature is not fully developed. Fortunately, a few common sense precautions can help prevent heat illness.

  • Avoid strenuous exercise during periods of high heat and humidity.
  • Wear lightweight clothing. Change clothing that becomes wet with perspiration.
  • Drink cool water before exercise and during regular rest periods. Sweetened drinks do not have any advantages over water. Salt tablets are not helpful in preventing heat illness.
  • Never leave an infant in a closed car, even for a short period of time, and even if outdoor temperatures are moderate.


Donna Lombardi, MD is a practicing pediatrician at Maple Avenue Pediatrics in Fairlawn, N.J. NOTE: This information should not be used as a substitute for the medical care and advice of your personal healthcare provider.


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