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A review in provides an overview of current evidence on the safe use of the popular insect repellent N, N-diethyl-3 meta-toluamide (DEET) in children. It outlines pediatric recommendations relating to DEET and federally approved and naturally-derived DEET alternatives that provide similar protection at a lower toxicity.

First author, Helana Ghali, BS, a medical student at Morsani College of Medicine at the University of South Florida, discussed key points with the Reading Room. The exchange has been edited for length and clarity.

What prompted this review?

Ghali: This review provides a comprehensive overview of DEET amidst confusion and conflicting information surrounding its safety. We sought to address and clarify misconceptions about DEET, especially concerning its use on children.

We have observed concerns among parents and caregivers about potential neurotoxicity related to DEET insect repellents. This review summarizes pediatric DEET usage guidelines and explores naturally derived alternatives approved by the Environmental Protection Agency that provide similar protection with low toxicity for those who prefer natural options.

What did you conclude about DEET safety and efficacy?

Ghali: We found that DEET insect repellents are safe for children when used according to label instructions. Instances of neurotoxicity and skin conditions related to DEET are uncommon.

Additionally, DEET generally offers greater effectiveness compared to many other options, including natural alternatives. However, the best insect repellent choice may vary based on factors such as the desired duration of protection and the specific type of insect.

Pediatric usage guidelines from the American Academy of Pediatrics (AAP) advise using the lowest concentration of DEET necessary for the exposure period and limiting applications to once daily and only on exposed skin.

The AAP also advises DEET for use on children older than two months and at concentrations lower than 30%. Finally, the product should also be washed off immediately once there is no longer a risk of arthropod exposure.

Is there any particular area of DEET-related diagnosis or treatment that you believe dermatologists may not be sufficiently aware of?

Ghali: Dermatologists may not be aware that DEET products can occasionally cause rare cases of immunologic contact urticaria. Nonetheless, the literature reports very few skin-related issues, particularly among children, associated with DEET use.

What are the bottom-line takeaways for dermatologists?

Ghali: The key takeaway is that DEET insect repellents are safe for use on children. Parents can confidently use DEET without concern for skin irritation or neurotoxicity, provided they follow the label instructions.

Additionally, other EPA-approved, naturally derived alternatives with similar efficacy to DEET include citronella oil and oil of lemon eucalyptus (or OLE). Other options may include 2-undecanone, permethrin, clove, petitgrain, and peppermint oils that offer arthropod protection. However, more safety studies are needed for these options.