Pediatric Lyme Disease

Lyme disease is an infection caused by bacteria called Borrelia burgdorferi. The bacteria are spread by tick bites. Lyme disease is a year-round problem, but it peaks during the spring and summer months. It can cause short-term symptoms and may cause long-term problems.

Lyme disease is caused by bacteria that are spread to people by tick bites. The ticks that carry the bacteria are:

• Black-legged deer tick. These are found in the Northeastern, Mid-Atlantic and North-Central U.S.
• Western black-legged tick. These are found on the West Coast of the U.S.

Not all ticks carry the Lyme disease bacteria. Depending on the location, less than one in 100 to more than half of ticks in that area may be infected with Lyme.

A child is more at risk for Lyme disease in certain parts of the U.S. during the spring and summer months, when ticks are more active. Ticks live in wooded areas, low-growing grasslands and yards. A child is more at risk outdoors in these places or around a pet that has been in these areas.

Lyme has been reported in nearly all states. The most cases have been reported in:

• Northeastern states, such as Massachusetts and Connecticut
• Mid-Atlantic states, such as New Jersey and Pennsylvania
• Wisconsin and Minnesota
• Northern California

Many cases have also been reported in Asia and Europe.

Symptoms can occur a bit differently in each child. They usually appear within three to 30 days after a tick bite. Lyme disease has early and late-stage symptoms. Early stage Lyme disease is more easily cured with antibiotics than late-stage disease. Most cases of late-stage disease occur when early stage disease is not treated.

One of the most common symptoms is a ring-shaped rash that looks like a bull's-eye. It may be pink in the center and have a darker red ring around it. The rash does not occur in every case of Lyme. If it does occur, the rash may:

• Appear several days after infection
• Last up to several weeks
• Be very small or very large, up to 12 inches across
• Look like other skin problems such as hives, eczema, sunburn, poison ivy or flea bites
• Itch or feel hot, or not be felt at all
• Go away and come back several weeks later

Several days or weeks after a bite from an infected tick, your child may have multiple ring-shaped rashes on the body and may also develop flu-like symptoms such as:

• Headache
• Stiff neck
• Aches and pains in muscles and joints
• Low fever and chills
• Tiredness
• Loss of appetite
• Swollen glands

Weeks to months after the bite, these symptoms may develop:

• Nervous system symptoms, such as inflammation of the nervous system (meningitis) and weakness and paralysis of the facial muscles (Bell palsy)
• Heart problems, such as inflammation of the heart (myopericarditis) and problems with heart rate
• Eye problems, such as inflammation of the eyes
• Skin disorders
• Severe tiredness
• Weakness

Months to a few years after a bite, these symptoms may occur:

• Inflammation of the joints (arthritis)
• Nervous system symptoms such as numbness in the arms and legs, tingling and pain, and trouble with speech, memory and concentration

The symptoms of Lyme disease can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

The healthcare provider will ask about your child’s symptoms and health history. They will ask about recent tick bites or potential tick exposures. They will also give your child a physical exam.

Lyme disease is usually not hard to diagnose, either by an exam or blood tests. But other conditions may cause similar symptoms. The main symptom is often a rash, but more than one in five people infected with Lyme disease don’t have the rash. In the earliest stage, diagnosis is usually based on symptoms and a history of a tick bite. In later stages, blood testing is very important to make a diagnosis of Lyme disease. Sometimes spinal or joint fluid needs to be tested for the bacteria.

Beware of healthcare providers who believe your child has Lyme disease just based on chronic tiredness or other chronic symptoms that can have many causes. Talk with your child's healthcare provider about which blood tests are recommended to help diagnose Lyme disease.

Lyme disease is usually treated with antibiotic medicine. Early stage Lyme disease is more easily cured with antibiotics than late-stage disease. Your child’s healthcare provider will discuss the best treatment plan with you based on:

• Your child’s symptoms and test results
• If your child had a recent tick bite
• If the tick tests positive for bacteria that cause Lyme disease
• If your child lives in an area where the ticks are known to be infected

Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all medicines.

Lyme disease rarely needs more than a month or two of antibiotics or other treatments. Be wary about advice to treat your child with longer courses of antibiotics or other therapies. They can be harmful and can delay getting the correct diagnosis and treatment for your child's symptoms.

Some children may develop post-Lyme disease syndrome (PLDS). This means that some symptoms last longer than six months. Symptoms can include:

• Ongoing muscle and nerve pain
• Tiredness
• Problems with memory

PLDS does not respond to antibiotics or any other known treatment for Lyme infection. That's because there isn't an active infection anymore. Treatment is aimed at helping to control the symptoms.

There is no vaccine for Lyme disease. A child who has had the disease doesn’t build up immunity and can get it again. But you can help prevent Lyme disease by protecting your child from tick bites.

Ticks can’t bite through clothing, so dress your child and family in:

• Long-sleeved shirts tucked into pants
• Socks and closed-toe shoes
• Long pants with legs tucked into socks

Choose light-colored clothing so that ticks can be easily seen. Check your child often for ticks, including:

• Behind the knees, between fingers and toes, in underarms and in the groin
• In the belly button
• In and behind the ears, on the neck, in the hairline and on top of the head
• Where underwear elastic touches the skin
• Where bands from pants or skirts touch the skin
• Anywhere else clothing presses on the skin
• All other areas of the body and hair

Run fingers gently over the skin. Run a fine-toothed comb through your child's hair to check for ticks.

Other helpful tips include:

• When possible, use cleared or paved paths when walking through wooded areas and fields.
• Shower after outdoor activities are done for the day. It may take up to four to six hours for ticks to attach firmly to skin. Showering may help remove any loose ticks.

Use insect repellents safely. The most common used against ticks are:

• DEET. This is for skin. Products that contain DEET repel ticks but they may not kill the tick and are not 100% effective. Use a children's insect repellent with no more than 30% DEET. Products that contain DEET should not be used on babies less than 2 months old. Don't put insect repellent near your child's mouth, nose, or eyes, or on open cuts or sores. 
• Permethrin. This chemical is for clothing, tents, and other fabric. It is known to kill ticks on contact. Treat fabric with small amounts of a product that contains permethrin. Don't use permethrin on the skin.

Check your pets for ticks. Talk with your pet’s veterinarian about tick repellent medicine.

Call the healthcare provider if your child has:

• Symptoms that don’t get better or get worse
• New symptoms