A new study reviews the impact of screentime on the brain development of children and adolescents and the imprinting of neurological changes that remain permanent and not in a good way.

Summer season and the mosquitos are out. A review of DEET and alternatives especially for young children. Info below.

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DEET

The most common side effects of DEET in children are mild skin reactions (irritation, rash, erythema), which account for the vast majority of reported adverse events. A Cochrane review of over 47,500 participants found adverse events were limited to mild skin reactions, with an overall prevalence of only 0.6%.[1] Serious adverse events are exceedingly rare.

Skin Reactions (Most Common)

– Contact dermatitis, skin irritation, and rash are the predominant adverse effects. Products with concentrations >50% carry higher rates of skin irritation.[1][2][3]

– Numbness can occur with inadvertent application to the lips or mouth, attributed to sodium and potassium channel blocking effects.[4]

Neurological Effects (Rare)

– Seizures are the most prominent serious adverse event reported in children, occurring in 72% of the rare pediatric encephalopathy cases documented in the literature. However, these cases are extremely uncommon relative to the hundreds of millions of annual DEET applications, and the reported rate may not differ from the background seizure rate in the general population.[5][6]

– A review of the DEET Registry (1995–2001) identified 296 moderate-to-major severity cases total, of which 41% were in children ≤19 years old. Among children, 42% of reported cases involved seizures. Importantly, many cases were associated with improper application, excessive dosing, or unintentional ingestion rather than standard topical use.[7][6][5]

– When encephalopathies do occur, they often resolve without long-term sequelae.[2]

Key Reassurance Points

– Decades of use and safety surveillance show a very low risk of adverse effects when DEET is used as labeled. The IDSA guidelines note that despite public concern, the evidence supports DEET’s safety profile with proper use.[6][8]

– No clear relationship has been found between case severity and DEET concentration or concurrent medication use.[7]

– DEET has been shown to have no effect on the developing fetus with proper use in pregnant women.[2]

The overall message is that DEET has an excellent safety profile when used according to label instructions, with mild skin irritation being the only common side effect. The theoretical risk of serious neurological events should be weighed against the well-documented protection against potentially life-threatening vector-borne diseases.[8]

Would you like to explore how the safety profile of DEET compares to alternative repellents like picaridin or IR3535 in the pediatric population?

References

1. Topical Repellents for Malaria Prevention. Gabaldón Figueira JC, Wagah MG, Adipo LB, Wanjiku C, Maia MF. The Cochrane Database of Systematic Reviews. 2023;8:CD015422. doi:10.1002/14651858.CD015422.pub2.
2. Is DEET a Dangerous Neurotoxicant?. Swale DR, Bloomquist JR. Pest Management Science. 2019;75(8):2068-2070. doi:10.1002/ps.5476.
3. Traveling Safely with Infants and Children. Michelle Weinberg and Patrick W. Hickey. CDC Yellow Book.
4. Neurotoxicity and Mode of Action of N, N-Diethyl-Meta-Toluamide (DEET). Swale DR, Sun B, Tong F, Bloomquist JR. PloS One. 2014;9(8):e103713. doi:10.1371/journal.pone.0103713.
5. Toxic Encephalopathy Associated With Use of DEET Insect Repellents: A Case Analysis of Its Toxicity in Children. Briassoulis G, Narlioglou M, Hatzis T. Human & Experimental Toxicology. 2001;20(1):8-14. doi:10.1191/096032701676731093.
6. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America. 2021;72(1):e1-e48. doi:10.1093/cid/ciaa1215.
7. Adverse Events Associated With the Use of Insect Repellents Containing N,n-Diethyl-M-Toluamide (DEET). Osimitz TG, Murphy JV, Fell LA, Page B. Regulatory Toxicology and Pharmacology : RTP. 2010;56(1):93-9. doi:10.1016/j.yrtph.2009.09.004.
8. Assessment of Methods Used to Determine the Safety of the Topical Insect Repellent N,n-Diethyl-M-Toluamide (DEET). Chen-Hussey V, Behrens R, Logan JG. Parasites & Vectors. 2014;7:173. doi:10.1186/1756-3305-7-173.

Picaridin (also known as icaridin) has an excellent safety profile with even fewer adverse effects than DEET, and the Wilderness Medical Society states it may have a superior safety profile compared to DEET (Recommendation grade 2B).[1]

Most Common Side Effects

– Mild skin reactions — itching, rash, and skin irritation — are the most frequently reported adverse effects, consistent with DEET but generally less common. In a large community mass-use study in Cambodia (~25,000 participants), all 22 adverse reactions were mild and manifested primarily as skin conditions, occurring mostly in the first few months of use.[2][3]

– Perceived side effects reported by families in that study included itching, headache, dizziness, and unpleasant smell, though few discontinued use.[2]

Toxicity Data

A review of the National Poison Data System (2000–2015) covering 68,429 insect repellent exposures found that among picaridin exposures, 92.9% were managed outside a healthcare facility, with no reported cases of major effect or death and only one case of moderate effect.[4] Primary symptoms from accidental ingestion included ocular irritation/pain, vomiting, red eye/conjunctivitis, and oral irritation — all managed with simple dilution/irrigation/wash.[4]

Key Advantages Over DEET in Children

– No neurological toxicity has been reported with picaridin, unlike the rare seizure cases associated with DEET.[1][4]

– Picaridin is odorless and does not damage synthetic fabrics or plastics, making it more practical for use on children’s clothing and gear.[1]

– Comparable efficacy to DEET: 20% picaridin provides approximately 10 hours of protection against arthropods.[1]

Pediatric Use Guidelines

The AAP recommends a maximum concentration of 10% picaridin for children ≥2 months old.[5] The CDC and EPA list picaridin as safe for children without age restriction (≥2 months), applied per label instructions.[6][7] Risk assessment data confirm that no significant toxicological risks exist from typical usage of picaridin in any population subgroup, including children, though children had the lowest margins of exposure.[8]

Overall, picaridin represents an excellent alternative to DEET for pediatric use, with comparable efficacy and a potentially superior safety profile — particularly the absence of any reported neurotoxicity.

Would you like to explore whether there are specific clinical scenarios (e.g., tick-endemic areas vs. mosquito-endemic areas) where one repellent may be preferred over the other?

References

1. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Management of Tick-Borne Illness in the United States. Ho BM, Davis HE, Forrester JD, et al. Wilderness & Environmental Medicine. 2021;32(4):474-494. doi:10.1016/j.wem.2021.09.001.
2. Safety of a Topical Insect Repellent (Picaridin) During Community Mass Use for Malaria Control in Rural Cambodia. Heng S, Sluydts V, Durnez L, et al. PloS One. 2017;12(3):e0172566. doi:10.1371/journal.pone.0172566.
3. Topical Repellents for Malaria Prevention. Gabaldón Figueira JC, Wagah MG, Adipo LB, Wanjiku C, Maia MF. The Cochrane Database of Systematic Reviews. 2023;8:CD015422. doi:10.1002/14651858.CD015422.pub2.
4. The Toxicity of Picaridin Containing Insect Repellent Reported to the National Poison Data System. Charlton NP, Murphy LT, Parker Cote JL, Vakkalanka JP. Clinical Toxicology (Philadelphia, Pa.). 2016;54(8):655-8. doi:10.1080/15563650.2016.1186806.
5. The Pretravel Consultation. Rupert J, Groh T, Allen R. American Family Physician. 2025;111(3):245-253.
6. Traveling Safely with Infants and Children. Michelle Weinberg and Patrick W. Hickey. CDC Yellow Book.
7. Mosquitoes, Ticks, and Other Arthropods. C. Roxanne Connelly and John E. Gimnig. CDC Yellow Book.
8. Risk Assessments for the Insect Repellents DEET and Picaridin. Antwi FB, Shama LM, Peterson RK. Regulatory Toxicology and Pharmacology : RTP. 2008;51(1):31-6. doi:10.1016/j.yrtph.2008.03.002.