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Coronavirus Update:What patients and families need to know

Pediatric Lyme Disease

What is Lyme disease?

Lyme disease (LD) is a multi-stage, multi-system bacterial infection caused by the spirochete Borrelia burgdorferi, a spiral shaped bacterium that is most commonly transmitted by a tick bite. The disease takes its name from Lyme, Connecticut where the illness was first identified in the United States in 1975.

According to the Centers for Disease Control and Prevention (CDC), Lyme disease continues to be a rapidly emerging infectious disease, accounting for more than 95 percent of all insect-borne illness in the United States, although it is under reported. The number of annually reported cases has increased 25-fold since national surveillance began in 1982. More than 16,000 infections are reported each year in the United States. The majority (92 percent) of cases are reported in Connecticut, Rhode Island, New York, Pennsylvania, Delaware, New Jersey, Maryland, Massachusetts, and Wisconsin.

Depending on the location, anywhere from less than 1 percent to more than 90 percent of the ticks are infected with spirochetes (bacteria that are usually carried by the tick).

Lyme disease is a year-round problem, although April through October is considered tick season. Cases of LD have been reported in 45 states in this country, with most cases occurring in:

  • The coastal northeast
  • The mid-Atlantic states
  • Wisconsin and Minnesota
  • Northern California

Many cases have also been identified in large areas of Asia and Europe.

What are the symptoms of Lyme disease?

The list of possible symptoms for Lyme disease is non-specific, and symptoms can affect every part of the body. Symptoms usually appear within two to 21 days. The following are the most common symptoms of LD. However, each child may experience symptoms differently.

One of the primary symptoms is often a rash that can be pink in the center and a deeper red on the surrounding skin, but can vary in appearance. The rash can:

  • Appear several days after infection, or not at all
  • Last a few hours or up to several weeks
  • Be very small or very large (up to 12 inches across)
  • Mimic such skin problems as hives, eczema, sunburn, poison ivy, and flea bites
  • Itch or feel hot, or may not be felt at all
  • Disappear and return several weeks later

Several days or weeks after a bite from an infected tick, flu-like symptoms can appear, including the following:

  • Headache
  • Stiff neck
  • Aches and pains in muscles and joints
  • Low-grade fever and chills
  • Fatigue
  • Poor appetite
  • Sore throat
  • Swollen glands

After several months, painful and swollen joints may occur.

Other possible symptoms may include the following:

  • Neurological symptoms
  • Heart problems
  • Skin disorders
  • Eye problems
  • Hepatitis
  • Severe fatigue
  • Weakness
  • Problems with coordination

Symptoms of LD may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is Lyme disease diagnosed?

LD may be difficult to diagnose because the symptoms may resemble other conditions. The primary symptom is a rash, but it may not be present in up to 25 percent of cases. Diagnosis is usually based on symptoms and a history of a tick bite.

Diagnosis of Lyme disease must be made by an experienced physician. Blood and laboratory tests may be performed to rule out other conditions. Research is underway to develop and improve methods for diagnosing LD.


Your child's physician will determine the best treatment plan based on your child's individual situation. Lyme disease is usually treated with antibiotics.Treatment will be considered based on these and other factors:

  • If you are bitten by a tick that tests positive for spirochetes
  • If you are bitten by a tick and have any of the symptoms
  • If you are bitten by a tick and are pregnant
  • If you are bitten by a tick and live in an area where the ticks are known to be infected

How can Lyme disease be prevented?

Humans do not develop an immunity to LD and reinfection is possible. In 1998, the Food and Drug Administration (FDA) had approved a new vaccine against Lyme disease called LYMErix. The vaccine was not 100 percent effective, however, and the FDA still recommended using other preventive measures. In 2002, the manufacturer of LYMErix announced that the vaccine would no longer be available commercially.

Some general guidelines for preventing LD include the following:

Ticks cannot bite through clothing; dress your child and family in:

  • Light-colored clothing
  • Long-sleeved shirts tucked into pants
  • Socks and closed-toe shoes
  • Long pants with legs tucked into socks
Check your family often for ticks, including:
  • All parts of the body that bend: behind the knees, between fingers and toes, underarms, and groin
  • Other areas where ticks are commonly found: belly button, in and behind the ears, neck, hairline, and top of the head
  • Areas of pressure points, including:
    • Where underwear elastic waist band touches the skin
    • Where bands from pants or skirts touch the skin
    • Anywhere else where clothing presses on the skin

Visually check all other areas of the body and hair, and run fingers gently over skin. Run a fine-toothed comb through your child's hair to check for ticks.

Other helpful measures include the following:

  • Walk on cleared paths and pavement through wooded areas and fields when possible.
  • Shower after all outdoor activities are over for the day. It may take up to four to six hours for ticks to attach firmly to skin. Showering will help remove unattached ticks.
  • Use insect repellents safely:
    • Products that contain DEET are tick repellents, but do not kill the tick and are not 100 percent effective. Use a children's insect repellent and check with your child's physician if your child is younger than 1 year of age before using.
    • Treat clothing with a product that contains permethrin, which is known to kill ticks on contact. Do not use permethrin on the skin.
  • Check pets for ticks and treat as needed.


Infectious Diseases

Our Division of Infectious Diseases is the major referral center for infectious diseases in the Washington, D.C., area, helping thousands of patients each year, and actively promoting prevention through community outreach and education.

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