|Although SARS and West Nile virus infections have taken center stage this year, there is still a lot of fear and confusion related to tick bites in children, especially as people continue to worry about Lyme disease and other tick-borne infections.
Most parents know that they should carefully remove a tick when they find one, but then what?
Does your child need antibiotics?
Should the tick be tested?
Should your child be tested?
In general, the answer is no to all of those questions. You don't usually need to test your child or the tick and your child doesn't need antibiotics after a tick bite. Instead, you should just watch your child for symptoms, especially a rash developing at the site of the tick bite and/or a fever. Saving the tick in a container might be helpful though.
The risk of these illnesses depends a great deal on where you live, for example, with only a few parts of the United States at high risk for Lyme disease, including states in the northeastern, mid-Atlantic, and upper north-central regions, and to several counties in northwestern California. Most cases are reported in New York, Connecticut, Pennsylvania, New Jersey, Wisconsin, Rhode Island, Maryland, Massachusetts, Minnesota and Delaware. So if your child is bitten by a tick in New Mexico or Idaho, you probably don't have to worry much about Lyme disease.
Other things to keep in mind:
- tick infections, except Rocky Mountain spotted fever, are usually not transmitted from dog ticks, which are larger than the deer ticks that carry many of these infections. Dogs and other pets can carry deer ticks though.
- ticks are most likely to transmit infection after feeding for two or more days, so you can greatly reduce your child's risk of infection by doing daily tick checks, especially when you child is outdoors a lot, such as when hiking or camping, in high risk areas.
- there is usually a seasonal pattern to tick infections, such as Lyme disease and Rocky Mountain spotted fever which are most common during the late spring and summer months in the United States (May through August)
Removing a Tick
The safest and easiest way to remove a tick that is attached to your child is to just pull it off. You can use tweezers or your fingers to grasp it close to the skin and gently pull it off. Avoid squeezing or twisting the tick, since this can cause it to inject more secretions into your child or it can cause the head or other body parts to break off and remain in the skin. Once the tick is removed, you should dispose of it and wash the area of the bite and your hands with warm soapy water.
You should also avoid trying to remove a tick by burning it, applying nail polish, alcohol, or other substances to the tick, as these methods rarely work.
Symptoms of Tick Infections
The symptoms of tick infections depend on what bacteria the tick was carrying. The most commonly recognized symptom is usually a rash, which can look like:
- the classic "bull's-eye" rash, erythema migrans, that occurs with Lyme disease
- a similar red, expanding rash with central clearing following the bite of the lone star tick in the southeast or southcentral United States, causing Southern tick-associated rash illness (STARI).
- the more subtle rash with small, flat, pink, non-itchy spots (macules) on the wrists, forearms, and ankles that children with Rocky Mountain spotted fever can get
But not all tickborne illnesses cause a rash. Human ehrlichiosis can cause nausea, vomiting, diarrhea, cough, joint pains, confusion, and only occasionally, a rash. And babesiosis may cause a fever, chills, sweating, myalgias, fatigue, hepatosplenomegaly, and hemolytic anemia. And even with Lyme disease, not all infected people develop the rash.
Other infections that can be caused by ticks include Tick Paralysis, Tick-borne Relapsing Fever, Tularemia, and Colorado Tick Fever.
So you often just need to watch for these symptoms following a tick bite and remind your Pediatrician that your child was bitten by a tick.
Lyme disease is caused by the bacterium, Borrelia burgdorferi, which are transmitted to humans by the bite of infected deer ticks.
In addition to the rash described above, other nonspecific symptoms of Lyme disease can include fever, malaise, fatigue, headache, muscle aches (myalgia), and joint aches (arthralgia). After being bitten by an infected tick, it usually takes 7 to 14 days until the rash develops, but may be as short as 3 days and as long as 30 days.
If untreated, weeks to months later some patients may develop arthritis, including intermittent episodes of swelling and pain in the large joints; neurologic abnormalities, such as aseptic meningitis, facial palsy, motor and sensory nerve inflammation (radiculoneuritis) and inflammation of the brain (encephalitis); and, rarely, cardiac problems, such as atrioventricular block, acute inflammation of the tissues surrounding the heart (myopericarditis) or enlarged heart (cardiomegaly).
Talk to your Pediatrician if your child develops any of these symptoms following a tick bite. Testing and treatment is available for children with Lyme disease.
Rocky Mountain Spotted Fever
Although people are usually more aware of Lyme disease, Rocky Mountain spotted fever (RMSF) is the most severe and most frequently reported rickettsial illness in the United States.
Five to ten days following a bite from a tick infected with the Rickettsia rickettsii bacteria, including the American dog tick (Dermacentor variabilis) and Rocky Mountain wood tick (Dermacentor andersoni), children can develop fever, nausea, vomiting, severe headache, muscle pain, lack of appetite, a rash, abdominal pain, joint pain, and diarrhea. Although many of these symptoms can occur in other childhood infections, the rash is fairly characteristic, appearing 2-5 days after the fever starts. It begins as small, flat, pink, non-itchy spots (macules) on the wrists, forearms, and ankles. These spots turn pale when pressure is applied and eventually become raised on the skin and by the sixth day or later after onset of symptoms, it can become a characteristic red, spotted (petechial) rash and may appear on the child's palms or soles.
Like Lyme disease, your risk for getting RMSF depends on where you live. Over half of the cases occur in the south-Atlantic region of the United States (Delaware, Maryland, Washington D.C., Virginia, West Virginia, North Carolina, South Carolina, Georgia, and Florida). The highest incidence rates have been found in North Carolina and Oklahoma.
Also like Lyme disease diagnosis is based on a child's symptoms and laboratory testing, and treatment with antibiotics is available.
Human ehrlichiosis occurs primarily in the southeastern and south central regions of the country and is primarily transmitted by the lone star tick, Amblyomma americanum. It is much less common than Lyme disease and RMSF.
Symptoms usually begin 5-10 days after a tick bite and generally include fever, headache, malaise, and muscle aches. Other signs and symptoms may include nausea, vomiting, diarrhea, cough, joint pains, confusion, and occasionally rash.
Ehrlichiosis can be a severe illness, especially if untreated, and as many as half of all patients require hospitalization.
Avoiding Tick Infections
Since the Lyme disease vaccine is no longer available, the only way to avoid these illnesses is to avoid getting a tick bite or at least finding and removing ticks as soon as possible.
Tips on avoiding ticks include:
- Wear light-colored clothing to allow you to see ticks that are crawling on your clothing.
- Tuck your pants legs into your socks so that ticks cannot crawl up the inside of your pants legs.
- Apply repellents to discourage tick attachment. Repellents containing permethrin can be sprayed on boots and clothing, and will last for several days. Repellents containing DEET (n, n-diethyl-m-toluamide) can be applied to the skin, but will last only a few hours before reapplication is necessary. Use DEET with caution on children. Application of large amounts of DEET on children has been associated with adverse reactions.
- Conduct a body check upon return from potentially tick-infested areas by searching your entire body for ticks. Use a hand-held or full-length mirror to view all parts of your body. Remove any tick you find on your body.
- Parents should check their children for ticks, especially in the hair, when returning from potentially tick-infested areas. Additionally, ticks may be carried into the household on clothing and pets. Both should be examined carefully.
Adapted from information available from the CDC.