Answering parents' questions about DEET, 'natural' repellents.

MIAMI BEACH -- Children's insect repellent products that contain alternative ingredients marketed as "natural" are becoming more widely available, and parents have plenty of questions about their use, Dr. Elizabeth Connelly said at the annual Masters of Pediatrics conference sponsored by the University of Miami.

Efficacy varies among insect repellents that do not contain N,N-diethyl-m-toluamide (DEET). Soybean oil, citronella oil, vanillin, oil of eucalyptus, and picaridin are examples of the active ingredients found in natural products.

The marketing of alternative insect repellents continues to expand. Even Disney has entered the market for children's dermatologic products, she said. Disney's Gentle Naturals product line contains a DEET-free bug repellent.

Dermatologists are likely to get more questions about products they recommend now that DEET-free formulations are available at drugstores, Target, and Wal-Mart.

"I am constantly bombarded with questions by parents about insect repellents, sunscreens, and sun protection products," said Dr. Connelly, a pediatric dermatologist at the University of Miami.

Remember "not all 'natural' repellents are safe," she said. Oil of eucalyptus, for example, should be used only in children 3 years and older.

Picaridin, which comes from black pepper, is odorless, and physicians could recommend it to parents and children who do not like the smell of traditional repellents, but is it not as effective as DEET. Of all the Off! brands, only the Clean Feel repellent contains picaridin. 'All other formulations of Off! contain DEET," said Dr. Connelly, who said she has no financial interest in any of the products mentioned in her talk.

"You might be asking: Do these natural oils work? Citronella, patchouli, and clove, especially, work almost as well as DEET," Dr. Connelly said. Patchouli oil is derived from mint.

Apply all insect repellents sparingly, and avoid use under clothing or near open wounds, Dr. Connelly said. Avoid use of combination repellent/sunscreen products. Also, beware of wipes that contain DEET because the DEET gets on the child's hands and fingers go in the mouth or around eyes. "I recommend children wash off DEET before bedtime," Dr. Connelly added.

Products with DEET "should not be applied more than once a day. I don't think that is something parents know," Dr. Connelly said. Parents may be confused because the label advises application every 4 hours for adults. DEET should not be used in infants younger than 2 months. This and other recommendations from the American Academy of Pediatrics 2003 guidelines on use of DEET insect repellents are still valid, she added.

The Food and Drug Administration also provides guidelines at www.fda.gov/cder/ emergency/repellants.htm.

BY DAMIAN McNAMARA

Miami Bureau