What to do if you find a tick on your child

Most physicians are seeing an unusually high number of summer bug bites this year. Mosquito bite rates are higher than expected and there have been some cases of Malaria in Florida.

And some experts think this may be the worst tick season in recent history.

This post is going to focus on ticks. If you’re like most parents and you find one on your child, its easy to panic and start googling.

Don’t.

This post goes over what you need to know if you find a tick bite. If you are more interested in preventing tick-borne illnesses, be sure to check out today’s posts over on instagram and Facebook, which cover 5 easy and high-yield ways to prevent tick-borne illnesses.

For those who want just the summary…

• There are many tick-borne illnesses - most parents know about Lyme, but not about the others. The likelihood of catching one depends a lot on where you’re located, the extent of your exposure, preventive measures used, and luck. But you really do want to do your best to avoid them.

• Tick checks are important. Do them daily (on yourself, your pets, & clothing/shoes/equipment you use outdoors).

• If you find a tick, remove it carefully, being certain not to squeeze it or try to kill it while attached. Your physician will want to know some important things: how long you think it has been attached, whether it is engorged, what kind of tick it is (you can use websites like TickEncounter to help)

• In some cases, such as for Lyme disease, prophylactic antibiotics may be helpful — but even for Lyme, in many cases, watchful waiting is often the right move. Most cases of Lyme disease are a result of missed tick bites. The decision to take preventive antibiotics is a clinical one based on pre-test probability and strict criteria (see below). Your physician can help you navigate the next steps.

• Watch for symptoms. Know what you’re looking for. Trust your gut.

What is a tick-borne illness?

Many (but not all) types of ticks carry disease. And while Lyme is often the most well-known, it is not the only tick-borne illness that can cause problems. There is some seasonal and location variation in the specific ticks and illnesses we worry about, but some examples are:

• Lyme disease

• Anaplasmosis

• Ehrlichiosis

• Rocky Mountain spotted fever

• Alpha Gal Syndrome (which is, weirdly enough, an allergy to red meat)

• There are others too - see the CDC site for more.

What to do if you find a tick on your child

Here is a primer on what to do if you find yourself in this situation.

The most important thing is to remove the tick as soon as possible.We don’t have any excellent data that proves one method of removal is superior to another, but we do know that squeezing the tick or jerking it off abruptly may increase the risk for mouth-parts to break off and remain embedded.

Things to avoid

• Squeezing the body

• Killing it while attached

• Dousing it with any of the random things you see on the internet (essential oils, nail polish, dish soap, vaseline).

• Lighting it on fire (or with a cigarette)

Tick types

Rather than re-invent the wheel, here’s a link to a great visual that can help you understand different types. This website is also a favorite because it allows you to take photos of the tick and send to experts.

Is it worth sending the tick to be tested?

For many parents, the idea of watchful waiting can be very stressful. So given the opportunity to find an answer - often any answer - they’ll take it. But the truth is that sending ticks for testing is expensive and won’t necessarily make much of a difference clinically. Labs that test ticks aren’t necessarily regulated. A tick that tests positive for Lyme can cause a lot of stress — but it doesn’t mean the infection was transmitted to your child.

In general, in a suspicious scenario (where the pre-test probability is high for something like Lyme), we would not want to wait for test results before beginning treatment, since it needs to start within 72h.

Lyme disease: info for parents

Lyme disease is caused by Borrelia burgdorferi, which is a bacteria carried by the Ixodes (or deer) tick.

In general, deer ticks transmit infection after an extensive period of attachment and a long blood meal. Usually, even once a deer tick is attached, it can take hours for it to start feeding.

The blood meal is a necessary element of transmission, which means you need evidence that a blood meal has occurred (ie. tick needs to be engorged). This is because the bacteria is actually dormant in the tick’s gut - it becomes activated by warm blood. Once that happens, it transports itself to the tick’s salivary glands and glides on in. All of this takes hours — in fact, at least 36-48h of feeding is generally required before Lyme transmission can occur.

The Pediatrician Mom Tip: Engorged ticks often look slightly different from unfed ticks. The body may take on a white, light brown or gray hue and will look swollen. This website has a great graphic showing an unfed deer tick and the same tick at different stages of feeding.

What this means for you

If you check your child regularly, then the likelihood of a tick being attached and feasting for that long is quite low.  If you find a deer tick that is not engorged or was not actually attached, it will not transmit Lyme.

Prophylactic antibiotics after a bite

We have some evidence that prophylactic treatment of a high risk case can decrease transmission of Lyme.

In other words: in a situation where there is HIGH pre-test probability that a person actually may have contracted the disease, a single dose of antibiotic (Doxycycline) taken within 72h may decrease the likelihood of progressing to the disease.

How do you figure out if your situation is high risk for Lyme?

We have guidelines from the Infectious Disease Society of America that can help. In general, a patient needs to meet all these criteria in order to give antibiotics:

• confirmed bitten by a deer tick

• bite occurred in an endemic area (ie an area which has Lyme)

• attached for a minimum of 36 hours

• antibiotic can be given within 72h of tick removal

What about the rest of the patients?

For this group, as stressful as uncertainty can be, it is perfectly reasonable to monitor for symptoms.

Keep in mind that most cases of Lyme are actually from tick bites that went unrecognized rather than from known tick bites (because if a tick is found, it is usually removed in ample time).

Symptoms of Lyme

There are 3 main “stages” of Lyme disease, and in today’s post we are going to focus on the first stage (called “early localized disease”) which typically declares itself within 1-4 weeks of the bite. You may notice:

• a flat red rash (erythema migrans). This rash is most often seen on the head, neck or arms/legs, but it can be anywhere. It usually expands in size and can look like a bullseye (but this is not always true).

  • Check out this page for examples of the EM rash on different skin colors and this page for another example on Melanated skin.

    The Pediatrician Mom Tip: For melanated kids, the rash can look different and can actually be very mild (it also doesn’t always look like a target). Unfortunately, these patients are at higher risk for a missed diagnosis — one study found that a third of black patients are diagnosed at later stages of disease.

• joint pain or swelling (arthritis)

• fever

• fatigue

• headache

• neck pain

• body aches

Later stages of Lyme disease (if it is missed) can have more serious long-term heart, neurologic or skin manifestations. These can turn up even several months after the initial bite if the condition was not treated. Here is more information.

What about chronic Lyme?

Unfortunately, many questions remain about this condition - we do not yet have any clear criteria that can help with a diagnosis. Symptoms are usually vague (and have some overlap with other post-infectious conditions, such as long Covid).

More than anything, I caution parents to pay close attention to where they get their information. There are many charlatans out there who make claims and peddle “diagnostic tests” and various supplements, diets, and more to treat this condition without any true peer-reviewed research or safety data to back that up.

Treatment of Lyme in kids

If a child is diagnosed with Lyme disease, which is often a clinical diagnosis early in the course (based on symptom profile rather than bloodwork), then they will be treated with antibiotics.

Treated properly, Lyme disease is curable. With diligent preventive measures, you can decrease the risk of catching a tick-borne illness while still continuing to indoor the outdoors with your family and pets.

For anyone interested in more information about preventing tick-borne illnesses, I have 5 high yield tips on today’s social media post.

It’s important to prevent mosquito and tick bites. For more information on effective bug repellents, click here, and for some of my favorite products here is my Amazon page.