Lyme Disease in Children

What is Lyme disease in children?

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.

What causes Lyme disease in a child?

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 1 in 100 to more than half of ticks in that area may be infected with Lyme.

Which children are at risk for Lyme disease?

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.

What are the symptoms of Lyme disease in a child?

Symptoms can occur a bit differently in each child. They usually appear within 3 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.

How is Lyme disease diagnosed in a child?

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 1 in 5 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 healthcare provider about which blood tests are recommended to help diagnose Lyme disease.

How is Lyme disease treated in a child?

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 2 to 4 weeks 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.

What are possible complications of Lyme disease in a child?

Some children may develop post-Lyme disease syndrome (PLDS). This means that some symptoms last longer than 6 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.

How can I help prevent Lyme disease in a child?

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 4 to 6 hours for ticks to attach firmly to skin. Showering may help remove any loose ticks.

Use repellents safely. Don't let children handle repellants. Follow all instructions on the product you use. Use only EPA-registered products for children. Ask your child's healthcare provider if you have any questions. Common repellants used against ticks are:

• DEET. This is for skin. It may also be used on clothing. Products that contain DEET repel ticks, but they may not kill the tick and are not 100% effective. Use a children's repellent with the lowest amount of DEET and no more than 30% DEET. Products that contain DEET should not be used on babies younger than 2 months old. Don't put 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.

When should I call my child's healthcare provider?

Call the healthcare provider if your child has:

• Symptoms that don’t get better, or get worse

• New symptoms

Key points about Lyme disease in children

• Lyme disease is an infection caused by bacteria. The bacteria are usually spread by tick bites.

• Lyme disease is a year-round problem, but it peaks during the spring and summer months.

• Ticks live in wooded areas, low-growing grasslands, and yards. A child is more at risk outdoors in these places or around a pet who has been in these areas.

• One of the most common symptoms is a ring-shaped rash that looks like a bulls-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 disease.

• Lyme disease is usually not hard for a healthcare provider to diagnose. Diagnosis is usually based on symptoms, exam, and a history of a tick bite or possible tick exposure. Your child may have blood tests to help diagnose it.

• Lyme disease is usually treated with antibiotic medicine. Early stage Lyme disease is more easily cured with antibiotics than late-stage disease. Repeated courses of antibiotics for post-Lyme disease syndrome don't help.

• There is no vaccine for Lyme disease. But you can help prevent Lyme disease by protecting your child from tick bites.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours, and on weekends and holidays. This is important if your child becomes ill and you have questions or need advice.