Little Bug, Big Consequences: Understanding Lyme Disease

Warm weather is back, making it a great time for kids to enjoy nature. A hike in the woods or exploring creeks can be a wonderful family activity at a time when other typical outings may still be limited because of the ongoing COVID-19 pandemic. However, along with good weather, spring brings out those pesky — and potentially dangerous — Lyme disease-carrying ticks.

So, while communing with nature is great for kids, it’s important for parents to understand Lyme disease, its symptoms and how to prevent it.

What is Lyme disease?

• Lyme disease is caused by bacteria and is transmitted through the bite of infected ticks.
• Blacklegged ticks (also called deer ticks) are most common in the northeast, mid-Atlantic and northcentral regions of the United States, but they can be found in almost every state.
• Deer ticks live in forests or in grassy, wooded and damp areas near bodies of water.

How is Lyme disease transmitted?

At each stage of its life — as larvae, nymphs and adults — a tick requires a blood meal. Ticks normally feed on animals, ground-feeding birds or reptiles. Humans are a back-up food choice.

• Most people are infected by nymphs, which are less than 2 mm (about 1/16 of an inch) long and most abundant in the late spring and early summer months. Adult ticks, which are larger and more common in cooler months, are easier to see and remove before they have the chance to transmit bacteria. In general, it takes about 36 to 48 hours of attachment before an infected tick can transmit Lyme disease to humans. Ticks can attach to any part of the human body, but their favorite places are the neck, hairline, armpits and groin.
• Lyme disease is only transmitted through the bite of infected ticks; you can't get Lyme disease from mosquitos, fleas, lice, other insects or another person.

Symptoms and treatment of Lyme disease

If you and your children live near or have recently visited an area where ticks are common, you should call your pediatrician immediately if your child has any of these symptoms:

• A red rash that looks like a small pink circle. This rash expands, growing outward to look like a bull's-eye. There may be one circle or a few. The rash may look irritated or be itchy. The rash should not cause blisters or ulcers, but there may be a small scab in the center from the tick bite. Note: About 20% to 30% of infected people don’t get a rash.
• Headache
• Chills
• Fever
• Fatigue
• Muscle and joint aches

Bull's-eye rash caused by Lyme disease Symptoms can appear as long as 30 days after a tick bite, but usually show up within three to seven days. All of these symptoms are suggestive of early Lyme disease, which occurs within a month after a bite from an infected tick.

The good news: Early Lyme disease is easy to diagnose and responds to treatment with antibiotics. However, some patients never experience any symptoms of early Lyme disease and may present a few weeks or months after a tick bite with a variety of symptoms that include meningitis or facial muscle palsy, multiple rashes or an irregular heartbeat. Late Lyme disease can present months or possibly even years after a bite from an infected tick. The most common form of late Lyme disease is arthritis. The knee joints are most commonly involved.

The best route is to avoid a tick bite altogether by taking precautions.

Preventing tick bites

Here are some steps to take to prevent tick bites:

• Avoid areas where ticks live or stick to well-trod trails or paved paths.
• Dress kids in long pants and long sleeves when walking or playing in shaded, wooded areas. A hat is also helpful. Dark colored clothes make ticks easier to spot.
• Pull your child’s hair back in a ponytail.
• Spray insect repellent with less than 30% DEET on your child's clothes and exposed skin, avoiding the face and ears. Do not use any products that contain DEET on children younger than 2 months old.
• Perform a thorough “tick check” after your child has spent time in wooded areas. Don't forget to look along the hairline, on neck and underarms. Then send them to the shower, which also will wash off any remaining insect repellent.
• The Centers for Disease Control and Prevention (CDC) also has a lot of helpful information on prevention of Lyme disease. Find it here.

What to do if you find a tick on your child

So, you found a tick on your child. Here’s how to remove it:

• Use fine-tipped tweezers to grasp the tick as close to the skin as possible. Try not to squeeze the tick's body. Slide one side of the tweezers under the tick’s head. Use the other side to grasp its head.
• Pull firmly until the tick lets go. Don't twist it or rock it from side to side. If part of the tick is left on the skin, it will fall off on its own. If the part that is left is the mouth, use the tweezers to pull it off the skin.
• Flush the tick down the toilet or place it in a baggie, then the trash.
• Wash the site with soap and water and apply rubbing alcohol or first-aid ointment.
• For more information about safe tick removal, check out these do’s and don’ts.

After you have removed the tick, call your pediatrician to see if your child should be evaluated. If your child develops a rash or flu-like symptoms, take them to the doctor so treatment can begin as soon as possible.

Reviewed by: Sanjeev Swami, MD, Director of the Outpatient Infectious Diseases Clinic in the Division of Infectious Diseases at Children's Hospital of Philadelphia