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Rocky Mountain Spotted Fever: Another Illness from Ticks

RMSF in child RMSF in child

Rocky Mountain spotted fever (RMSF) is a bacterial disease spread through the bite of an infected tick. It was first discovered in the western mountains of the United States. That's how the disease got its name. But it occurs throughout the country—especially in mid-Atlantic and southern states.

The disease can occur in children of any age. Those who spend time outdoors or who have pets that may carry infected ticks, are at higher risk from Rocky Mountain spotted fever. Infections can occur at any time of year, but in most areas, cases happen in May through August, or whenever the weather is warm.

Outbreak of Rocky Mountain spotted fever

The Centers for Disease Control and Prevention is warning of an outbreak of Rocky Mountain spotted fever in people who have traveled to or live in Tecate, Mexico, since July 2023. At least five people were hospitalized and three people died. Four of the infections were in people under age 18 years. If you or a family member has traveled to Tecate or another city in northern Mexico and develop symptoms during travel or within 2 weeks of returning home, seek medical attention. Learn more about the outbreak here.

How does Rocky Mountain spotted fever spread?

Children usually get Rocky Mountain spotted fever from the bite of a tick that is infected with bacteria called Rickettsia rickettsii. Ticks that most commonly spread this bacteria include the American dog tick, Rocky Mountain wood tick and the brown dog tick.

Signs and symptoms of Rocky Mountain spotted fever

Symptoms of Rocky Mountain spotted fever usually appear about a week after the tick bite, but it can range from 2 days to 2 weeks.

  • Flu-like symptoms are common, including fever, muscle pain, headaches, vomiting, nausea, and loss of appetite.

  • Rash usually develops by the sixth day of the illness. A Rocky Mountain spotted fever rash tends to appear first on a child's wrists and ankles, but within hours it can spread to the torso. It also may spread to the palms of the hands and soles of the feet. Often, it starts out as flat red splotches or pinpoint dots but may change and become bumpy or purplish.

  • Other symptoms can include joint pain, stomach pain and diarrhea. In severe cases, blood pressure can drop and cause the child to act confused. As the infection spreads, many organs, including the brain, may be affected.

When to call your pediatrician

If your child was bitten by a tick and develops any of these symptoms, contact your pediatrician right away. The doctor will examine your child and run tests to confirm the diagnosis of Rocky Mountain spotted fever.

How is Rocky Mountain spotted fever treated?

If your pediatrician suspects your child has Rocky Mountain spotted fever, they will prescribe an antibiotic called doxycycline. Treatment with Rocky Mountain spotted fever medication usually continues for 7 to 10 days or until the child's fever has been gone for at least 3 days. It is important that your child takes all of the medicine that is prescribed to get rid of the infection.

With early treatment, nearly all children make a full recovery. In rare cases, Rocky Mountain spotted fever can cause serious illness or even be deadly. If the infection is not treated, it can cause damage to blood vessels, nerves and organs such as the heart, lungs and kidneys. Not receiving proper Rocky Mountain spotted fever treatment can cause other serious problems including hearing or vision loss, and gangrene in the fingers and toes that could lead to amputation.

How to prevent Rocky Mountain spotted fever

There is no vaccine to prevent RMSF. The best way to prevent illness is to avoid tick bites. Ticks live in grass, scrub vegetation and wooded areas and on animals. If you plan to be outdoors, wear a long-sleeved shirt, pants and hat, ideally in lighter colors that make ticks easier to spot. Avoid wearing sandals.

Here are more tips to protect your family from ticks.

  • Use insect repellent products that have been registered by the Environmental Protection Agency, and always follow directions. DEET is considered the best defense against ticks. Learn more about DEET and other insect repellents for babies and children here.

  • Keep ticks off pets. Ticks can be brought into the house on your pets. Use a flea and tick preventive product on your pets and check their fur for ticks or signs of tick bites.

  • Wash up. Wash the insect repellent off with soap and water when your child comes inside. Taking a bath or shower can also help remove loose ticks, which can take 4 to 6 hours to firmly attach to skin.

  • Do tick checks. Check for ticks daily, especially 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. If you find a tick on your child's skin, the sooner it comes off the less likely it will spread infection it may carry. But it's important to remove it carefully.


Rocky Mountain spotted fever is relatively rare but can be serious if not treated early. Especially if you live in a tick-infested area, take steps to prevent it, know the symptoms. Rocky Mountain spotted fever can develop in people who do not know they have been bitten by a tick. Call your pediatrician right away with any concerns.


Last Updated
American Academy of Pediatrics (Copyright @ 2023)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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