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Ticks & Lyme: Healthy Advice

NP Ramey Harris-Tatar says: " Ah, spring has arrived and summer is close on its tail. The change of season brings beautiful sunny (and longer) days, flowers and trees blooming, lots of pollen, and, yes, the emergence of our insect friends. While some of these insects, like ladybugs, are fun and some are useful, such as bees, others, like ticks, we would probably prefer to live without. Since that is, unfortunately, highly unlikely, let’s review some of the ways we can prevent tick bites and what to do if your child is bitten by a tick.

First of all, the best treatment is prevention. When in an area more likely to have ticks, wearing long sleeve shirts and long pants can help reduce the likelihood of being bitten. Ticks are also easier to spot on lighter colored clothing. As the mother of two young boys, I’d like to say that this is not always practical, especially when it’s 80 degrees outside. Insect repellant can also be somewhat helpful. The Centers for Disease Control, or CDC, recommends using a repellent with at least 20% DEET on exposed skin, taking care to avoid the hands, eyes, and mouth. You can also use products that contain permethrin on clothing or gear.

While these methods definitely help, the best recommendation, I believe, is to do a “tick check” once a day. Ticks need to be attached and feeding for at least 36 hours to transmit Lyme disease (more about this later), so by checking every evening you ensure that, if bitten, the tick would be attached for no longer than 24 hours. I usually check my kids from head to toe, but pay particular attention to their hair, in and around their ears, their armpits, belly button, behind their knees, around their waist and their groin area. If you’ve been out in higher-risk areas (areas where branches and bushes are brushing against you), I also recommend examining your pets or any gear you had with you (stroller, backpack, etc.) as ticks can catch a ride home this way and attach to a person later.

If you do find a tick, what should you do? Remove the tick as soon as you notice it. Clean the area with alcohol and use tweezers or forceps to firmly grasp the tick very close to the skin surface. With steady motion, pull the tick’s body away from the skin in a vertical direction. Do not jerk or twist. Then clean the skin with soap and water and apply antibiotic ointment if possible. Avoid crushing the tick’s body. Do not be alarmed if the tick’s mouthparts remain in the skin. Once the mouthparts are removed from the rest of the tick, it can no longer transmit the Lyme disease bacteria. If you crush the tick, clean your skin with soap and warm water or alcohol. DO NOT use petroleum jelly, a hot match, nail polish or other products to remove a tick.

Let’s say your child has been bitten and now you’re concerned about Lyme disease. What exactly is Lyme disease? Lyme disease is caused by spirochetal infection by Borrelia burgdorferi (in the U.S.) and is transmitted by the bite of an infected Ixodes, or deer, tick. The disease can involve the skin, joints, nervous system and heart. It is most commonly transmitted by ticks in the nymphal stage which are typically most active during late spring and early summer. Adult ticks transmit the disease less commonly as they are less likely to bite humans and are more easily detected. Adult ticks are most active on warm days in the fall. The Ixodes ticks are small, examples of the different stages can be seen below:

Click to print tick card

As mentioned earlier, Lyme disease is rarely transmitted within the first 48 hours after a bite. This is because the B. burgdorferi are restricted to the tick gut during the first 36 hours of feeding. They then enter the tick’s midgut during feeding and migrate to the salivary glands after approximately 48 hours. Thus, by checking for ticks once every 24 hours, you limit the potential of transmission of Lyme disease even if your child is bitten by a tick.

Lyme disease usually occurs 3 to 30 days after a bite by an infected tick. The majority of people infected will have a characteristic rash, called erythema migrans or a bulls-eye rash. The rash can occur with or without other symptoms. Other individuals infected with Lyme disease may have fever, headache, muscle and joint pain. In the days to weeks after the bite infected individuals can also develop multiple erythema migrans lesions, facial or Bell’s palsy (loss of muscle tone on one or both sides of the face), severe headaches and a stiff neck, pain and swelling in the large joints, or changes in the heartbeat. If your child develops any of these symptoms you should have your child seen in the office.

Can my child be treated after a tick bite? Children who meet ALL the recommendations for prophylaxis can be given a single dose of doxycycline to prevent the development of Lyme disease. These children are 8 years or older (doxycycline cannot be given to children under 8) where a deer tick (not a dog tick) was attached for at least 36 hours and prophylaxis is given within 72 hours of tick removal. For those children who do not meet the criteria for prophylaxis, the Infectious Disease Society of America (IDSA) does NOT recommend prophylaxis with an alternative antibiotic. Since the majority of those infected with Lyme disease will develop the characteristic rash, observation of the tick bite site for a rash is an acceptable alternative for those who meet the criteria for prophylaxis.

Should I have my child tested? When a child has the typical erythema migrans rash, no testing is necessary and they will be treated with a course of antibiotics. If these children had a blood test they would likely test negative as the rash often appears prior to the development of a diagnostic, adaptive immune response that can be measured with a blood test. If your child has any of the symptoms for early, early disseminated, or late disseminated Lyme disease as listed above, then you should make an appointment to see your health care provider. If your child does not have any symptoms then the recommendation is to observe your child but not to perform any testing. If at any point they do develop symptoms, then they should be seen in the office.

So, the best way to prevent Lyme disease is to prevent a tick bite by wearing long pants and long-sleeved shirts, using insect repellant, and, most importantly, doing a “tick check” daily. If your child is bitten, then remove the tick promptly. If the tick is attached for at least 36 hours and your child meets the other criteria for prophylaxis, then you can call the office for an appointment. If your child develops the erythema migrans, or bulls-eye rash, or any of the other symptoms described above you should also bring them in for an appointment. If they have no symptoms then the best course of action is observation. And please don’t hesitate to call the office with any questions and continue to enjoy the outdoors!

Useful Links and Resources
We know that there is an enormous amount of information available via the Internet regarding child-rearing, health, and medicine. It can be difficult to sift through this information and decide if it is trustworthy.

We have assembled some links to websites we believe will be of interest to many patients and families. On theses sites, you can find information on common illnesses and diseases, along with information on preventative medicine. Additionally, some identified sites may be fun and educational for children.

This website is not responsible for any information found on these or any other associated or linked websites. A link to another website does not imply an endorsement of the site's content or services.

Please use these sites for informational purposes only. If you have specific questions about illnesses please make an appointment to see us at our office.  
Government Agencies
Centers for Disease Control and Prevention
CDC Vaccine Information
Consumer Product Safety Commission
The American Red Cross
National Library of Medicine
Mercury and Vaccines
Professional Associations
American Academy of Pediatrics
American Academy of Child and Adolescent Psychiatry
La Leche League: national breastfeeding support group
Food, Allergy and Nutrition
Healthy Eating
Kids and Snacks
Dieting vs Proper Eating Habit
Anorexia and Bulimia
The Food Allergy and Anaphylaxis Network
Asthma and allergy Foundation of America
WebMD Allergy
First Aid
Red Cross
A Proper First Aid Kit
Common Household Child Injuries
Protecting Your Medicine Cabinet
Diseases and Conditions
Animal Bites
Lyme Tick Disease
Eastern Equine Encephalitis
Attention Deficit Disorder
The Food Allergy and Anaphylaxis Network
Lice Resources
Family Health & Safety updates on recalled products, advocacy news, and other important information. government website for Consumer Product Safety; excellent source for recall information and other safety news.
Check Yourself: for teens with questions about drug and alcohol abuse
Zero to Three
Just for Parents
Just for Teens
Just for Kids
Mobilize: online community for teens to volunteer, find a cause, or share a passion
Family TLC
AAP Press Room/Seasonal Safety Tips
AAP Car Seat Safety
Kids Health Car Safety
Cheap Car Insurance Safety Tips
National Highway Traffic Safety Administration
Fun Stuff For Kids
How Stuff Works for young writers & artists international magazine written by and for kids
Kids National Geographic for school-age kids and parents, a how-to magazine with cool projects comprehensive magazine with projects, instructions, and ideas...even for the non-crafty parents! your guide to family events, activities and parenting resources
Wild Animal Baby magazine: from the National Wildlife Federation, a monthly subscription magazine for children ages 12 months to 4 years.
Your Big Backyard magazine: the NWF's magazine for toddlers. Features nature projects, stories, and fun facts about animals and nature.
Books and Your Family
American Librarians Association: great site for book recommendations, including booklists
Family TLC Activities
Complementary and Alternative Medicine
National Center for Comp. & Alt. Medicine
Toxicology Data Network
Local Hospitals
Children's Hospital Boston
Emerson Hospital
Winchester Hospital
Brigham and Women's Hosptial
Massachusetts General Hospital
Lahey Clinic Hospital

The information in these website links is not intended be a substitute for professional medical advice. It is provided for educational purposes only.

You assume full responsibility for how you choose to use this information.

Please call us or seek other qualified medical advice for your medical concerns.
Knowlege and information about all aspects of your health are key components of living a healthy lifestyle for you and your family.