12 June 2019
As we begin to enjoy the warmer weather of spring and summer with our children, many of our patients and parents begin to worry about ticks and Lyme disease. There continues to be a lot of research to better understand Lyme disease, but there is also a lot of misinformation on the internet and social media.
Lyme Disease: How Is It Caused?
Lyme disease is caused by an infection from a bacterial species of the spirochete (parasite) Borrelia burgdorferi, transmitted to humans by infected black legged deer ticks. Deer ticks typically live harmlessly on small mammals, such as field mice and deer. Some people may be surprised to know that ticks cannot jump or fly! They rest on the tips of grasses and shrubs waiting for a host to brush by, and then they quickly climb aboard.
Transmission of Lyme disease primarily occurs from infected female adult ticks or nymphs (baby ticks), which are about the size of a poppy seed. Because the life cycle of these ticks is well known, Lyme transmission predictably occurs in the spring, summer and early fall (approximately April through September). Ticks are typically found in wooded or grassy areas, with Lyme disease being most prevalent in the Northeast and upper Midwest.
A Tick Must Be Attached 36-48 Hours For You to Get Lyme Disease
IMPORTANT TO KNOW: A tick must be attached for at least 36 to 48 hours before it transmits Lyme disease. Therefore, doing DAILY tick checks is the best way to prevent Lyme disease!
What Do I Do if I Find a Tick?
Ticks have a tendency to hide in “nooks and crannies,” so make sure to check your child’s armpits, groin, folds of the ears and scalp for these little guys. Even running your hands/fingers through your child’s hair can be a good way to check the scalp.
To remove a tick:
- Use fine-tipped tweezers, grabbing as close to the skin as possible (do NOT use folklore remedies like petroleum jelly, heat or nail polish to remove a tick).
- Pull upwards (away from the body) with steady, even pressure until the tick releases. If parts of the tick are not removed in their entirety, you may try to remove these parts with clean tweezers. If you cannot remove them easily, leave them alone and allow the skin to heal. The body will expel any remnants on its own, and further manipulation can just increase the risk of secondary skin infection or irritation.
- After removing the tick, thoroughly clean the bite area and your skin with rubbing alcohol or warm soap and water.
To see the correct way to remove a tick:
We recommend this visual guide from the CDC and this video from Tick Encounter/The University of Rhode Island.
What Do I Do Next After Removing the Tick?
If you suspect it is NOT a deer tick (dog ticks are usually much larger, brown in color and have striped markings on the back) OR you suspect it is a deer tick which has only been attached for <36 hours and is not engorged, NO FURTHER ACTION is needed. Removal of the tick is the only preventive measure that is needed.
If you suspect it is an engorged deer tick which has been attached >36 hours, or you are unsure of the duration of attachment, your child may be prescribed a prophylactic/preventive dose of antibiotics. This must be administered, however, within 72 hours of removing the tick. It can be helpful to save the tick in a sealable plastic bag or container for your pediatrician to evaluate it.
As always, it is important to contact your physician if you have any questions or concerns. It may be useful to discuss your specific situation further to determine the next course of action.
We do NOT recommend sending the tick to the lab to be tested for Lyme for several reasons. First, even if the tick tests positive for Lyme, it does not mean that the infection has been transmitted to the host and, therefore, treatment would not be recommended.
Second, it may take several weeks for the test results to come back, and we are going to be using the above-mentioned factors to determine if prophylaxis or treatment is warranted. Also, if a child develops symptoms during that time, we would recommend starting treatment anyway, regardless of the results.
Third, a negative test can give a false sense of security. In many cases, Lyme disease can occur with no history of a tick bite, and this negative test does not exclude the possibility of another infected tick bite that may have gone undetected.
How Do I Avoid Getting Lyme Disease?
While you should try to prevent tick bites year-round, you need to be extra vigilant in warmer months (April-September) when ticks are most active. Ticks are out and about whenever the temperature is above 40 degrees Fahrenheit.
To avoid being bitten, follow these simple guidelines:
- Avoid wooded and brushy areas with high grass and leaf litter.
- Wear light long sleeves and/or pants when hiking or walking in wooded areas. Keep pants tucked into socks.
- Clothing can be sprayed lightly with insect repellent, containing 10-30% DEET. Do not spray insect repellent directly on children’s skin, however. For the skin, you can apply Skintastic or Avon Skin-So-Soft with good repellent quality and demonstrated safety, but please don’t use this on an infant less than 6 months of age.
- Do daily “tick checks.” Before or after bathing is a good time to check. Older children or adults should use a hand-held or full-length mirror to check all of their body parts. Make sure to check under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and on the hairline and scalp.
- Remove ticks quickly and correctly (see above).
- Be on the lookout for fever or rash.
- Prevent ticks on animals with flea/tick collars or other treatments.
- Discourage deer by removing plants that attract them and/or by building barriers or fencing to keep them out. Deer are the main food source of adult ticks.
What are the Symptoms of Lyme Disease?
Fortunately, 90% of children infected with Lyme disease exhibit the classic red “bullseye” rash that is typical of this early stage, developing within 7-14 days after a tick bite. This rash is usually flat, not painful, is at least 5 cm in diameter and continues to expand over days, possibly weeks. It may also be accompanied by additional symptoms, including fever, headache, dizziness, body aches and fatigue.
Testing for Lyme infection at this stage is not helpful because results are often negative and an accurate diagnosis can be made visually. Early stage Lyme disease is easily treated with 14-21 days of oral antibiotics and 90% of patients have complete resolution of symptoms.
Early disseminated stage
The early disseminated stage of Lyme disease occurs 3-5 weeks after the initial bite and can cause multiple red bulls-eye rashes, facial nerve palsies (Bell’s palsy), meningitis and carditis. In children with Lyme, 3% will exhibit facial nerve palsy and 1% meningitis.
Late stage Lyme disease includes arthritis with redness, pain and swelling of a joint, as well as more significant cardiac and neurologic symptoms. Depending upon the individual case, early disseminated Lyme and late stage Lyme can be treated with 21-28 days of oral or IV antibiotics.
If you think your child has been bitten by a tick, please come see us.
If you suspect your child may have contracted a disease from a tick bite, please make an appointment with Westchester Health Pediatrics to see one of our pediatricians for an accurate diagnosis and immediate treatment. The sooner we can begin treatment, the faster we can thwart the development of the disease and prevent long-lasting consequences. Whenever, wherever you need us, we’re here for you.