Children and West Nile virus

Can my child be at risk for West Nile virus?

YES! While children are less likely than adults to become ill from West Nile, children’s tendencies to spend a lot of time outdoors, especially in the summer months, puts them at risk for getting bitten by mosquitoes. This is the primary route of exposure to West Nile virus. Children who have weakened immune systems may be at higher risk for a severe infection. Infants also have the potential to be exposed to West Nile through breast milk. However, since 1999, only 3 infants are thought to have been infected through breast milk. There is a possibility that a mother could pass a West Nile virus infection on to her unborn fetus. For this reason, it is recommended that pregnant women avoid mosquito bites.

How can I reduce my child’s risk of getting West Nile virus?

There are three steps to preventing West Nile virus in children:

	Discourage mosquitoes from biting
	Use mosquito repellent safely. Apply it to younger children, and teach older children how to safely use mosquito repellent. Teach children to wear protective clothing when possible: light-colored clothing with long sleeves. Be aware when mosquitoes are biting, which is often at dawn and dusk. Be sure mosquito repellent is available to children while at summer camp.
	Reduce mosquito populations around the home by eliminating standing water
	Regularly drain or tip out standing water from containers like toys, flower pots, cans, buckets, barrels and pool covers. Don’t forget to check outdoor play sets and toys for water accumulation. Empty and refill wading pools at least once each week Remove anything where water can collect, like old tires, and bottles and cans for recycling. Keep the water clean in bird baths, ornamental water fountains and ponds. Change the water at least once a week or keep the water circulated and aerated. Clean out clogged gutters and drain water on flat roofs. Clean and chlorinate swimming pools even if not being used.
	Prevent exposure to mosquitoes
	Be sure your windows and doors are properly screened; repair ripped screens and consider adding a screen door to doors that are often left open. Repair leaky outdoor faucets.

Recommendations about safe use of mosquito repellent for children

Four active ingredients have been registered by the Environmental Protection Agency for use in mosquito repellents applied to the skin. These are:

• DEET (Chemical Name: N,N-diethyl-meta-toluamide or N,N-diethyl-3-methyl-benzamide)
  
  
• Picaridin or KBR 3023 (Chemical Name: 2-(2-hydroxyethyl)-1-piperidinecarboxylic acid 1-methylpropyl ester)
  
  
• Oil of Lemon Eucalyptus or PMD, the synthesized version of lemon eucalyptus (Chemical Name: para-Menthane-3,8-dial)
  
  
• IR3535 (Chemical Name: 3-[N-Butyl-N-acetyl}-aminopropionic acid, ethyl ester)

The active ingredient and its concentration determines the amount of time that a repellent will be effective. Select repellents based on how long you plan to be outside.

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Adapted from the Centers for Disease Control and Prevention’s “How do I choose an Insect Repellent?”

Selecting the appropriate insect repellent for children

1 - 2 hours <10% DEET <10% picaridin 2 - 4 hours ~15% DEET ~15% picaridin ~30% oil of lemon eucalyptus 5 - 8 hours ~20%-30% DEET

DEET

• The maximum concentration of DEET recommended for children and infants is 30%.
  
• The best way to protect infants and toddlers less than 2 years is to limit their exposure with clothing but low concentrations of DEET are thought to be safe.

Picaridin

• No specific age restrictions have been developed for the use of picaridin on children.

Oil of lemon eucalyptus

• Oil of lemon eucalyptus oil is another effective repellent option, but it should not be used on children under the age of 3.

IR3535

• No specific age restrictions have been developed for the use of IR3535 on children.

Safety precautions

• Repellents are not recommended for infants younger than 2 months of age.
• Do not allow younger children to apply repellent themselves—do it for them.
• Do not apply repellent to the hands of children that are likely to place their hands in their mouths nor on open wounds. Instead apply the repellent to your hands and rub on the child.
• Do not apply repellent to skin that will be covered by clothing.
• After returning indoors, wash off repellent with soap and water.
• Pregnant and breast-feeding women should follow the above precautions. No special precautions are recommended.
• The Centers for Disease Control and Prevention (CDC) recommends against use of single combination products containing DEET and sunscreen because the instructions for insect repellent and sunscreen use are different (sunscreen usually needs to be applied more often than insect repellent). Instead use separate insect repellent and sunscreen products. Apply sunscreen first, then repellent.

Additional resources

• DEET alternatives considered to be effective mosquito repellents, American Academy of Pediatrics
• Mosquito repellent use for children, Centers for Disease Control and Prevention (CDC)
• Q & A on insect repellent use and safety (CDC)