What to Do if You Think Your Child Has Lyme Disease

Primarily caused by the bacteria Borrelia burgdorferi, Lyme disease is the most common tickborne disease in the US. By all predictions, 2017 is expected to be a banner tick year in several regions. If you have children, it is important to know what to expect.

Ticks can bite anyone. For the very young, the elderly, and the immune-compromised, Lyme disease can sometimes cause serious complications. Because children typically spend a lot of time outside, they have a higher risk for a picking up a tick without knowing about it.

To parents, the symptoms of a tickborne infection, like Lyme disease or anaplasmosis, can mimic other illnesses. Typical symptoms might include fever, fatigue, or chills, and muscle pain. Although Lyme disease is well known for its characteristic bulls-eye rash, the rash occurs in some cases but not others.

Understanding risk is an important part of knowing what to do about Lyme disease. This map, created by researchers at Clemson University and the University of Georgia shows where dogs were exposed to Lyme disease in 2016. If dogs are getting Lyme disease, their owners (and children) playing in the same areas are likely to pick up the infection, too.

Forecasted B. burgdorferi antibody prevalence in domestic dogs for 2016

Tips for Handling — and Avoiding — Lyme Disease in Children

If your child becomes sick and you suspect your child could have received a tick bite, contact your doctor. Even if you did not remove the tick or see it, early evaluation for Lyme or other tick-borne infections is a good idea. Keep in mind, an early clinical diagnosis of Lyme depends on symptoms and the opportunity of exposure, because blood tests may not definitively reveal Lyme disease for weeks after being bitten.

Researchers at the Children's National Health System recently presented information at the Pediatric Academic Societies Meeting in San Francisco, specifically tuned to the symptoms of Lyme disease in children. Scientists looked at electronic medical records of 79 children, with a mean age of nine, admitted to Children's main hospital from June 2008 through May 2015, who had confirmed cases of Lyme disease. Based on their findings, here is what you need to know:

• Increased numbers of ticks predicted for this year mean experts are expecting a boost in cases of Lyme disease. Take a look at the map and evaluate your risk.
• The blacklegged tick, Ixodes scapularis, transmits the Lyme bacteria. To efficiently transmit the pathogen ticks need to be attached and feeding on you, or your child, for approximately 36 hours. For patients with a tick attached for the duration, the bulls-eye rash often appears within seven to ten days of infection — giving you some idea of when your child was infected.
• A rash is an important message to get to your doctor quickly — the longer the infection goes untreated, the worse the symptoms could become. Symptoms can include headaches, meningitis, facial paralysis, swollen or arthritic knees, or heart arrhythmia.
• For children in this study, a headache was the prominent symptom of meningitis. Less common with these patients were symptoms like stiff neck and sensitivity to light. Facial palsy presented in each of the 37 patients with meningitis.
• Headache was a common symptom for children, and its resolution paralleled the amount of time it took to get treatment. Young patients diagnosed when their head hurt less than a week gained treatment relief by about 1.5 days. In contrast, those who suffered a headache for two weeks without treatment took approximately three days, or twice as long, to begin feeling better.
• Swelling of the knees was a symptom associated with later diagnosis of Lyme disease. Of the 42 patients who had knee problems, 29 sought follow-up with caregivers. For these, children were able to recover within one to four weeks with treatment.
• For children under eight years of age, the standard treatment for Lyme disease is oral amoxicillin three times a day for two to four weeks. The longer the infection has been brewing, the longer the course of antibiotics. For children who cannot tolerate amoxicillin, the antibiotic cefuroxime axetil (an antibiotic in the cephalosporin group) may be prescribed twice a day.
• Bottom line, the longer symptoms go untreated, the longer they will last.

Post-treatment Lyme disease syndrome is getting a lot of attention as a potentially chronic Lyme condition. In this research, only two of the children suffered continuing symptoms that met the criteria for post-treatment Lyme, leading researchers to speculate the chronic condition could be less likely to occur in children.

Working with Roberta DeBiasi, Division Chief of Infectious Disease at Children's National Health System, lead author Mattia Chason notes in a press release:

Patients who come in with early symptoms tend to resolve rather quickly. But for those with later symptoms, resolution can take quite some time. Those patients should see their doctors if there's any suspicion of Lyme to get treatment sooner rather than later.

An Ounce of Prevention…

For anyone, preventing tick-borne infection is a better idea than treating it. During their lifecycle, ticks come in different sizes — with the adult about the size of a sesame seed, and nymphs the size of a poppy seed. That is pretty easy to miss on your own body or that of your child.

Compared to dime, ticks are small and hard to see, making it easy for them to hitch a ride.

Researchers suggest tips for avoiding Lyme disease include:

• Watch for ticks, and understand they are patiently waiting in tall grass and bushes. Stick to the middle of the path. When hiking or in tick country, encourage your child to wear long pants and lightweight shirts with long sleeves. Good advice, but a hard sell.
• Use repellents with 20% to 30% DEET. Right now, there are no other repellents, or natural alternatives, that are found to be as effective as DEET.
• Make sure baths and showers happen after time spent outside. You can check for ticks and wash them off, pay attention to hair, under the arms, groin, and buttocks, and behind the knees.
• If you find a tick, remove with a gentle grasp of the mouthparts with tweezers, making a note of where you removed the tick. Don't just pull out the tick because you don't want to leave mouthparts embedded in the skin. Don't touch the tick. If the tick looks engorged, or you believe exposure could have occurred over 24 hours earlier — call your doctor for advice.

Ticks are out there. Don't let them ruin your summer with a case of Lyme disease. Keep a heads-up for their geographic region and make tick checks a routine part of time outside, for you, your children, and your canine friends.

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Walton LaVonda/US Fish and Wildlife Service