Lyme disease is a tick-borne disease caused by bacteria called Borrelia burgdorferi. It was initially identified in the 1970s in Lyme, CT, and neighboring areas. Although Lyme disease can occur in people of all ages, the incidence is highest in children aged 5 to 9 years, as well as middle-aged adults 45 to 54 years old. The bacteria that cause Lyme disease are transmitted by the bites of deer ticks that carry the bacteria. Deer ticks are no bigger than a poppy seed. The infections frequently occur in people who are camping, hiking, or participating in other outdoor activities in the summer and fall. In the United States, most cases of Lyme disease have occurred in the northeast part of the country, from southern Maine to northern Virginia.
Lower numbers have been reported in the upper Midwest, particularly Wisconsin and Minnesota, as well as on the West Coast, especially northern California. Tick-infested areas include wooded regions, marshes, high grasses, gardens, and beach areas.
Signs and Symptoms
In the early stages of Lyme disease, your child may develop a distinctive circular red rash called erythema migrans at the site where the tick has bitten her. This rash will appear after an incubation period of 7 to 14 days. The rash tends to be surrounded by a light ring or halo. Some people have described it as having a bull’s-eye–like appearance. It can be warm to the touch and in some people, it may itch or burn. Most people, however, will not feel anything out of the ordinary. The rash may grow in size over a period of days or weeks. Along with the rash, your child can develop other symptoms, many of them flu like, that may include
- Fever
- Fatigue
- Headaches
- Mild neck stiffness
- Muscle and joint aches
In some youngsters, the disease is more widespread throughout the body, and multiple rashes can develop in addition to these symptoms. Some children experience involvement of the nervous system, including meningitis and temporary paralysis of the facial muscles (Bell palsy). Fortunately, if children are treated effectively in the disease’s early stages, it is unlikely that it will progress to a later stage. In the late stage, children can develop a form of arthritis called Lyme arthritis that affects the knees and other large joints, a type of meningitis, infection of the brain, or infection of the heart that can lead to an abnormal heart rhythm.
What You Can Do
If you find a tick on your child’s skin or clothing, remove it promptly and carefully. Ticks must be attached to the skin for at least 36 hours before they can transmit the Lyme disease bacteria.
- Use a cotton ball soaked in alcohol to gently clean the area of the skin around the tick bite.
- Next, grab the tick with fine tweezers as close to the skin as possible and slowly pull it straight out. Do not use a twisting motion and try not to squeeze the tick’s body. If you use your fingers to get rid of the tick, protect them with a tissue, cloth, or gloves and then wash your hands once the tick is removed.
- Cleanse your child’s bitten area with alcohol or another first-aid ointment. Be sure the tick is dead before you dispose of it.
When to Call Your Pediatrician
Contact your pediatrician if you suspect that your child has been bitten by a tick and she develops the rash or other findings associated with Lyme disease.
How Is the Diagnosis Made?
Your pediatrician will diagnose Lyme disease by recognizing its rash, as well as by identifying the other common symptoms. The doctor will also take into consideration whether your child lives in or has traveled to a region where Lyme disease is common. Although a biopsy of the rash can be performed, there is no commercially available test to identify the Lyme disease organism. Blood tests for Lyme disease are not usually performed or recommended immediately after a tick bite. This is because the body’s immune system hasn’t produced enough antibodies against the infecting bacteria to make them detectable in the first few weeks of the infection.
Treatment
Your pediatrician will prescribe oral antibiotics if your child has Lyme disease. The most common medication used in children aged 8 years and older is doxycycline. Children younger than 8 years are usually prescribed amoxicillin instead. If your child is allergic to drugs in the penicillin family, alternative medications such as cefuroxime and erythromycin will be chosen. All of these drugs are typically prescribed for a course of 14 to 21 days.
Antibiotics are also recommended for the later stages of the disease to manage symptoms such as Lyme arthritis and facial nerve palsy. Infections involving the central nervous system (the brain and its covering) are treated with intravenous antibiotics.
What Is the Prognosis?
With prompt and proper treatment of Lyme disease in its early stages, your child will have a very good chance of making a full recovery. Even with the best treatment, however, her symptoms may last for several weeks, although the rash itself might disappear in a few days.
Prevention
If you live in a part of the country where cases of Lyme disease have been reported or visit such a region, keep your child away from tick-infested areas as much as possible. When she’s outdoors, she should stay on cleared trails and away from overgrown grass and brush. In high-risk areas, take the following precautions:
- Your child should dress in a long-sleeved shirt and long pants to cover her arms, legs, and other exposed areas as much as possible. Her pants should be tucked into socks or boots, and long-sleeved shirts should be buttoned at the cuff. Have her wear a hat and closed-toe shoes, especially in densely wooded areas.
- You can spray a chemical called permethrin onto your child’s clothing. It can kill ticks on contact. Do not spray permethrin directly on the skin.
- A number of other tick and insect repellents available can be applied directly to your child’s skin. Choose a product that contains a substance called DEET (diethyltoluamide). Apply it every 1 to 2 hours for maximum protection. Follow the instructions on the label, and use the product lightly on your child’s face and hands. Do not use the repellent on any irritated skin or open sores.
- Once your child has come indoors, wash her skin with soap and water to remove the repellent. At the same time, take a couple of minutes to inspect her body and clothing for the presence of ticks. They may hide behind her ears or attach themselves to the hair on her head and the back of her neck. If she is wearing light-colored clothing, it will be easier to spot any ticks that may be present.
- Pets may bring ticks into the house and should be inspected if they have been outdoors in tick-infested areas. Treatments to prevent ticks on pets can be obtained from your veterinarian.
- Giving antibiotics to prevent Lyme disease in a child who is well but on whom a tick was found is not recommended. A vaccine for Lyme disease was approved in the United States in 1998, but it has been unavailable since 2002 because of low demand. There is a version of the vaccine for pets.
