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Sunscreen, Insect Repellent and Other Safe Summer Remedies

Volume 7, Number 5 - July, 2003

Editors: Carol A. Rice, Ph.D., RN, Professor and Extension Health Specialist, and Janet M. Pollard, MPH, Extension Associate-Health

Download PDF version of this Newsletter [485K]

Inside HealthHints....

• Sunscreen, Insect Repellent and Other Safe Summer Remedies
• Plunge Into Safe Water Practices
• Swimmer's Ear
• Beat the Heat
• Making Sense of Sunscreen
• When Sunburn Strikes
• Unwanted Summer Guests
• What to Do When Bugs Bite
• Poison Ivy
• Play Safe: At Home and On the Road
• References

Sunscreen, Insect Repellent and Other Safe Summer Remedies

It's that time of year again...

Pull out the swim suits, dust off the camping equipment, wash the picnic blanket, air up the bicycle tires, purchase the sunscreen, and spray on the insect repellent -- summer is in full swing!

As we break into the summer fun, it is also important to think about our childrens' safety and protection. Injuries, accidents, and tragedies peak during the summer months (May through August) because children have less adult supervision, more free time, and spend more time outdoors. The National Safe Kids Campaign reminds parents and care givers not to take a vacation from safety (National Safe Kids Campaign, 2003d; National Safe Kids Campaign, 2003g). Close supervision, proper protective products, and other simple prevention practices can go a long way in keeping children safe this summer.

This issue of HealthHints will look at summer safety practices including safe swimming, insect repellents, sunscreens, safe time outdoors and on the road.

Plunge Into Safe Water Practices

"Drowning is the greatest summer risk for children ages 14 and under... (National Safe Kids Campaign, 2003c)." In fact, "drowning occurs more often during July than any other month (National Safe Kids Campaign, 2003f)."

When it comes to water safety, supervision is an absolute necessity. Whether near a pool, lake, beach, pond, river, puddle or bucket, kids are drawn to water and need constant supervision even around small amounts of water. Children can drown in as little as an inch of water in a five gallon bucket, as well as in a swimming pool or other body of water (SafeChild.net, 2003).

"Drowning is a quick and silent killer (National Safe Kids Campaign, 2003h)." In the time it takes to:

• cross the room for a towel (10 seconds) a child can become submerged in the bathtub (the same would be true for a wading pool)
• answer the phone (2 minutes), that same child can lose consciousness
• sign for a package at your front door (4 to 6 minutes), a child submerged in the bathtub or pool can sustain permanent brain damage (National Safe Kids Campaign, 2003h).

The following guidelines can help keep your family safe when in and around water:

• Learn to swim and teach your children to swim. Though this may seem an obvious statement, it is the best way to stay safe around water. You can start your children in swimming classes as early as age 4 (Mayo Clinic, 2003b). Children under age 4 are more likely to develop infections from swallowing too much water (National Safe Kids Campaign, 2003i). You can consider starting younger children in a class where the head is not submerged in the water (National Safe Kids Campaign, 2003i). Repeated exposure to the water can help children become familiar with the water, reduce fear, and build confidence. (Note: Make sure all instructors are Red Cross or YMCA certified).
• Supervise children closely. Even after children have learned to swim, they still need constant supervision. Always swim next to smaller children -- never allow them to swim alone. Avoid distractions such as reading or talking on the phone, which may take your attention away from the water. Whenever possible, swim in an area that has a lifeguard (Mayo Clinic, 2003b).
• Use life jackets. Use Coast Guard-approved life jackets for both swimming and boating. Never substitute air filled devices, such as water wings or inflatable tubes or rafts for a life jacket -- they do not protect against drowning and can give false confidence to a child allowing them to venture into dangerous depths (Mayo Clinic, 2003b).
• Be aware of the water. Be aware of undercurrents and changing nature of waves and undertows in lakes and oceans. Never allow anyone to dive into water that is less than 9 feet deep -- always supervise children diving (National Safe Kids Campaign, 2003a).
• Avoid alcohol. Alcohol affects balance, coordination, and judgment. Whether you are swimming or supervising, avoid alcohol -- it can affect your ability to swim, and may cause you to allow risky behaviors that you might otherwise deem unsafe for those you are watching (Mayo Clinic, 2003b).
• If you own a swimming pool, install a 5 foot high barrier fence on all four sides, with a self-closing, self-latching gate. Use a pool cover, but be sure not to let water collect on top of the pool cover (which may also contribute to drownings) (National Safe Kids Campaign, 2003i). Keep doors in your home that lead to the pool locked regularly. Have a first aid kit, emergency equipment, and a telephone near the pool in case of emergency. Learn cardiopulmonary resuscitation (CPR -- call your local Red Cross for classes available) (National Safe Kids Campaign, 2003a).
• Watch and listen for bad weather conditions. If you see lightning or hear thunder, stop your activities and seek shelter. Counting seconds between thunder and lightning is not a good method for determining how far away the storm is. Lightning can strike as far as 10 miles away and even on a clear blue day (Mayo Clinic, 2003e).
• Never allow a child age 14 or under to operate personal watercraft (National Safe Kids Campaign, 2003b).

One final note about keeping healthy in the swimming pool:

The pool is everyone's bath water, so to speak, and chlorine does not kill all germs. Do not allow any family member who has diarrhea to enter the water. Everyone has invisible amounts of fecal matter on his or her bottom that ends up in the water. Teach children to avoid swallowing the water. Help wash children, especially their bottoms, with soap and water before entering the pool, and take children to the bathroom often. Change diapers away from the pool to avoid contamination (National Center for Infectious Diseases, 2000).

Beat the Heat

Whether you're out in the pool, on the lake trying to stay cool, or enjoying the summer sunshine out in the backyard, it is important to be sure you protect yourself and your family from the damaging effects UV radiation from the sun can have on the skin, including sunburn, skin cancer, and premature aging of the skin.

The following guidelines can help:

• The best way to protect against the sun is to cover up. Wear a hat, sunglasses, and cotton clothing with a tight weave (American Academy of Pediatrics, 2003b).
• Stay in the shade whenever possible -- particularly, try to avoid sun exposure during peak hours from 10am to 4pm (American Academy of Pediatrics, 2003b).
• Keep babies under 6 months of age out of direct sunlight -- get under a shade tree, an umbrella, or stroller canopy (American Academy of Pediatrics, 2003b).
• Dress babies in lightweight clothing that covers the arms and legs, and use a brimmed hat (American Academy of Pediatrics, 2003b).
• Use a sunscreen with a sun protection factor (SPF) of at least 15, even on cloudy days (American Academy of Pediatrics, 2003b).
• Apply sunscreen at least 30 minutes before going outside and before putting on clothes to allow it to dry and avoid it rubbing off.
• Reapply sunscreen every 1 to 2 hours during regular activity and every 30 minutes if swimming or sweating heavily.

Making Sense of Sunscreen

The term sun protection factor (SPF) tells you how powerful a certain sunscreen is. SPF lets you know how much longer you can stay in the sun when you're wearing that particular sunscreen. For example, if you are normally in the sun for 20 minutes before you start to burn a little bit, a sunscreen with an SPF of 15 would allow you to be out in the sun 15 times longer (about 5 hours). This number, however, is only a guide. The sunscreen would only protect you for 5 hours in perfect conditions. It would have to cover all exposed areas and you would have to be careful not to let any of the sunscreen get rubbed or washed off. In addition, time of day, location, and altitude affect how fast you burn.

Until recently, people felt that a sunscreen with an SPF of 15 was the best to use. But, recent studies have shown that an SPF of 30 offers more protection. It is important to note that sunscreens with very high SPFs (45+) do not really offer that much more protection than those with an SPF of 30, but you don't lose anything by choosing a higher SPF.

New FDA guidelines should make choosing the right sunscreen a little easier. Three protection labels will be added to all sunscreens. Sunscreens with an SPF of 2 to 11 will be labeled "minimum"; those with an SPF of 12 to 29 will be labeled "moderate"; and sunscreens with an SPF of 30+ will be labeled "high."

Sunscreens can also vary in price from a few cents per ounce for generic brands and a few dollars per ounce for designer brands. Studies show that the price of sunscreen is not related to its effectiveness.

For some high-risk individuals who are especially sensitive to the sun's rays, however, cost may make a difference. Many times the cost of a sunscreen suggests a special way that the product was made. For example, a sunscreen made especially for babies may cost more than regular sunscreen, but the difference in price is worth it when you figure that the baby sunscreen was created with a special formula that won't burn if the baby gets it in their eye.

For most people though, any sunscreen that contains an FDA approved sunblocking agent will provide adequate protection. Your best bet is to try out several different products and find the one that works best for you.

For those who do a lot of swimming or activities that cause heavy perspiration, the FDA has recently recommended two water-resistance categories for sunscreen. They are, "water resistant" and "very water resistant." Water resistant sunscreens are those that retain their labeled SPF after being worn in the water for 40 minutes. Very water resistant sunscreens retain their labeled SPF after 80 minutes in the water. It is important to note that no sunscreen is truly "waterproof" and claims to that effect are false. These new FDA guidelines take some of the confusion out of purchasing a water-resistant sunscreen.

Many manufacturers recommend using sunscreen every day. This is a good idea since we are all exposed to the sun's rays even on cloudy or cold days. However, many lotions, cosmetics and lipsticks/balms contain sunscreen. In many cases, these products have a high enough SPF factor to protect you on a daily basis so that you only have to apply regular sunscreen if you are planning on spending an extended amount of time outdoors.

(This section of the HealthHints Newsletter has been adapted from the 2003-2004 Consumer Decision-Making Contest Study Guide: Sunscreen. Prepared by Jennifer Janssen, Extension Project Specialist, Family Development and Resource Management, Texas AgriLife Extension Service.)

Unwanted Summer Guests

Along with the summer sunshine and warmer temperatures come a few unwanted summer guests -- pests. Mosquitos, biting flies, and ticks are back this time of year -- some carrying serious health risks, such as West Nile Virus, Lyme Disease, and St. Louis Encephalitis (To learn more about these conditions see the "Health Topics A-Z" section of the Centers for Disease Control website at http://www.cdc.gov). Safely using an appropriate insect repellent can help you ward off bugs. So how do you choose insect repellent that is safe and effective for you and your loved ones?

When choosing an insect repellent, it is important to consider the form (e.g., spray, lotion, cream or stick), concentration of active ingredients, whether or not the product has Environmental Protection Agency (EPA) approval, cost, and current outdoor conditions.

Insect repellents come in many forms and concentrations. It is important to consider the activities you will be involved in as well as the current environment when choosing an insect repellent. Although companies are not required to list the length of time a product remains active per application, Consumer Reports (June 2000 issue, see www.consumerreports.org) offers evaluations of various products on this topic.

Note: "The safest form of insect repellent is proper clothing. Cover your head and neck with a full-brimmed hat and shield your ankles and wrists. Tuck pant cuffs into socks and wear light colored clothing, which is less attractive than dark clothing to biting insects and also makes it easier to spot any ticks or insects that have landed. Check clothes regularly for bugs (National Library of Medicine, 2003a)."

Various forms of chemical insect repellent to choose from include the following:

• Aerosol and pump-spray products are intended for skin applications as well as for treating clothing.
• Liquid, cream, lotion, spray, and stick products enable direct skin applications.
• Products with a low concentration of active ingredient may be appropriate for situations where exposure to insects is minimal.
• Higher concentrations of active ingredient may be useful in highly infested areas or with insect species that are more difficult to repel.
• Repellents containing a higher concentration of active ingredient (such as DEET) provide longer-lasting protection.

Most repellents rely on some percentage of N, N-diethyl-metatoluamide, called DEET, a chemical developed more than 50 years ago by the U.S. Army and the Department of Agriculture. DEET doesn't kill bugs, but its vapors discourage them from landing or climbing on you. It's generally acknowledged to be the most effective mosquito repellent there is. Consumer Reports found that a product's hours of effectiveness generally increase with its percentage of DEET.

DEET is available in many different concentrations ranging from 4 percent to 100 percent. It is the active ingredient in most insect repellents. Approximately 230 products containing DEET are currently registered with the United States Environmental Protection Agency (EPA). Check the container to ensure that the product bears an EPA-approved label and registration number. Never use a product that has not been approved by the EPA!

Most insect repellents that are available in stores are labeled with the chemical name for DEET. Choose a repellent that offers appropriate protection for the amount of time you will be outdoors. A higher percentage of DEET should be used if you will be outdoors for several hours, while a lower percentage of DEET can be used if time outdoors will be limited.

The Centers for Disease Control and Prevention (CDC) recommend adults use an insect repellent that contains less than 35% DEET, while children should use a product that contains no more than 10% DEET. Repellents with DEET should be used sparingly on children 2 though 6 years of age and not at all on infants younger than 2 years of age.

Although DEET is generally considered safe when used according to directions, some people prefer not to use it. For that reason, Consumer Reports tested several products that use plant oils instead. A soybean-oil-based product has been shown to provide protection for a period of time similar to a product with a low concentration of DEET (4.75%). It is important to remember that essential oils, while derived from plants that grow naturally, are chemicals, too. Some are potentially hazardous if ingested, applied over wounds, cuts, irritated skin, or mucus membranes such as the eyes.

With any type of insect repellent, it is essential to use the product safely and effectively. Here are some insect repellent guidelines to help you keep your family safe from summer pests:

• Read and follow all directions and precautions on the product label.
• Do not apply over cuts, wounds, or irritated skin.
• Do not apply to hands or near eyes and mouth of young children.
• Do not allow young children to apply this product, and do not apply to children's hands (since children tend to put their hands in their mouths or rub their eyes). When using on children, apply to your own hands and then put it on the child.
• Do not spray in closed areas. Avoid breathing a repellent spray, and do not use near food.
• Use just enough repellent to cover exposed skin and/or clothing.
• Do not use under clothing.
• Avoid over-application of the product.
• After returning indoors, wash treated skin with soap and water.
• Wash treated clothing before wearing it again.
• Wash hands after application.

A few other Dos and Don'ts to help ward off bugs when you're outside include:

DOs

• DO make sure picnic areas are screened in.
• DO use insect repellent candles or electric bug "zappers."
• DO keep garbage cans closed and clean.
• DO wipe off sweat as soon as possible, since it attracts insects.
• DO shake out towels and clothes if you've been swimming.
• DO keep emergency department and poison control center phone numbers handy.
• DO keep an appropriate medical kit if any family member is allergic to insect bites or stings.

DON'Ts

• DON'T wear perfume, perfumed sun lotions, or hair spray.
• DON'T wash with scented soaps or apply scented creams or cosmetics.
• DON'T go near rotting fruit, like apples that have fallen from a tree, or in a picnic area.
• DON'T kick or move logs.
• DON'T wear jewelry or shiny buckles (American Academy of Dermatology, 2003).

(Except where otherwise noted, this section of the HealthHints Newsletter has been adapted from the 2003-2004 Consumer Decision-Making Contest Study Guide: Insect Repellent. Prepared by Courtney Schoessow, Program Coordinator for Health Education and Rural Outreach through the Texas A&M University Health Science Center School of Rural Public Health. October 2002).

What to Do When Bugs Bite

Sometimes bugs cannot be completely avoided. If you or a family member is bitten or stung, here are some helpful guidelines for treatment:

• Move to a safe area to avoid more bites or stings.
• If stung, try to remove the stinger quickly (to prevent a large amount of venom from being pumped into the skin) by scraping or brushing it off with a firm edge, such as a fingernail, credit card, or the back of a knife. Swab the site with disinfectant. If the stinger is not very visible, you may have to pinch it out with your fingers or a pair of tweezers.
• Soak a cloth in cold water and press it over the site to relieve pain and swelling from a sting, or apply ice or an ice pack.
• Apply 0.5% or 1% hydrocortisone cream, calamine lotion, or baking soda paste to a bite or sting several times a day until symptoms subside. Consult a doctor about appropriate use of hydrocortisone or calamine lotion before using on small children.
• Consult your doctor about using an antihistamine.
• If bitten by a tick, remove the tick promptly and carefully. Use tweezers to grasp the tick near its head or mouth and pull gently to remove the entire tick without crushing it. Wash hands after removal and apply antiseptic. If possible, seal the tick in a plastic bag in case it needs to be shown to your doctor later. Otherwise flush the tick down a toilet or bury it. See your doctor if you develop a rash, fever, muscle aches, or joint pain.
• For bites and stings that result in a severe reaction, such as difficulty breathing, swelling of lips or throat, faintness, confusion, rapid heartbeat, hives, nausea, cramps, or vomiting, call 911 for emergency medical assistance. While waiting for help, have the person lie down, if alert, consider giving the person an antihistamine. If unconscious and breathing, lay the person on his/her side to allow drainage from the mouth. If no breathing, movement, or response to touch, begin cardiopulmonary resuscitation (CPR). Check to see if the person is carrying an allergy kit containing epinephrine -- follow instructions on the kit.

(American Academy of Pediatrics, 2003a; Mayo Clinic, 2003a; Mayo Clinic, 2002d; National Library of Medicine, 2003b)

Play Safe: At Home and On the Road

According to the National Safe Kids Campaign, unintentional injury will bring an estimated 3 million children to the emergency room this summer. Make sure your family plays it safe this summer, whether on foot or on wheels. Follow these safety guidelines:

• In the car, make sure all children have their own child safety seat or seatbelt appropriate for their size and age, and that they are properly fastened. Be sure to place all children in the back seat(s). Study your vehicle owner and car seat safety manuals carefully.
• Make sure children wear properly fitted helmets and other protective gear every time they ride their bikes, scooters, skates, or skateboards.
• Teach children the rules of the road and how to obey all traffic laws.
• Never allow children under age 10 to cross the street by themselves.
• Make sure children wear retroreflective materials and carry a flashlight when it's dark, at dusk, or dawn.
• Supervise children at playgrounds and make sure there is a safe play surface, such as mulch, gravel, rubber, or fine sand.
• Make sure children wear the right, properly fitted protective gear when practicing or playing team sports (National Safe Kids Campaign, 2003e).

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References

• American Academy of Dermatology (2003). Take a bite out of summer [on-line]. Available: http://www.aad.org/Kids/bugbites.html.
• American Academy of Pediatrics (2003a). Caring for your baby and young child: Birth to age 5 -- Insect bites and stings [on-line]. Available: http://www.aap.org/pubserv/insect.htm.
• American Academy of Pediatrics (2003b). Summer safety tips [on-line]. Available: http://www.aap.org/advocacy/archives/summertips.htm.
• City of Longview, Washington (2003). Treating sunburn [on-line].
  Available: http://www.cl.longview.wa.us/Whats_New/Press/
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• Clark County Health Department (2003). Recognizing and treating heat-related illness [on-line].
  Available: http://www.cchd.org/download/fact_sheet/heat_related_english.pdf.
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  0DBA09BB-826A-41F7-9AC55B351B6BBAAA.
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  5CCDEA1D-9195-4ACA-8632D82CCB63B06A.
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  175EBBB9-3436-4B88-B7AC655D9A36341F.
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  Available: http://www.mayoclinic.com/invoke.cfm?
  objectid=23A587C2-7E90-4B6F-B003D2BCB70B6CCA.
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  B1CBCBF8-BCD9-46AE-A2BF23A1D66D7957.
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  4BDD41CB-A236-4E91-A456C54F813B5232.
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  Available: http://www.safekids.org/tier3_cd.cfm?content_item_id=1032&folder_id=540.
• National Safe Kids Campaign (2003c). Nearly half of all unintentional injury-related deaths among children occur during summer [on-line].
  Available: http://www.safekids.org/tier3_cd.cfm?folder_id=300&content_item_id=2110.
• National Safe Kids Campaign (2003d). Summer [on-line]. Available: http://www.safekids.org/tier2_rl.cfm?folder_id=660.
• National Safe Kids Campaign (2003e). Summer: Protecting your family [on-line]. Available: http://www.safekids.org/tier3_cd.cfm?folder_id=660&content_item_id=2091.
• National Safe Kids Campaign (2003f). Summer: Why kids are at risk [on-line].
  Available:http://www.safekids.org/tier3_cd.cfm?folder_id=660&content_item_id=2090.
• National Safe Kids Campaign (2003g). Trauma season: A national study of seasonality of unintentional childhood injury [on-line].
  Available: http://www.safekids.org/tier3_cd.cfm?folder_id=301&content_item_id=2111.
• National Safe Kids Campaign (2003h). Water [on-line]. Available: http://www.safekids.org/tier2_rl.cfm?folder_id=1741.
• National Safe Kids Campaign (2003i). Water: Frequently asked questions [on-line].
  Available: http://www.safekids.org/tier3_cd.cfm?folder_id=181&content_item_id=4356.
• National Library of Medicine (2003a). Bug-repellent safety [on-line]. Available: http://www.nlm.nih.gov/medlineplus/ency/article/001969.htm.
• National Library of Medicine (2003b). Insect bites or stings [on-line]. Available: http://www.nlm.nih.gov/medlineplus/ency/article/000033.htm.
• SafeChild.net (2003). Avoiding summer dangers for children [on-line]. Available: http://www.safechild.net/for_parents/summer_dangers060303.html.

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