Lyme Disease

What is Lyme disease?

As kids start spending time outdoors, many parents are concerned about disease, the most common tick-borne disease in the U.S.

In the U.S., Lyme disease is most common in the Northeast and Mid-Atlantic states and the northern Midwest. Although Lyme disease occurs throughout the year, we see the majority of cases between June and October.

When Lyme disease is discovered and treated early, the vast majority of children make a full recovery. But left untreated, the bacteria that cause Lyme can attack many systems of your child's body, including the skin, heart, nerves, and joints. Unfortunately, your child can contract Lyme disease more than once, even if it has been treated before.

Black-legged ticks, also known as deer ticks, are carriers of Lyme disease. 

What causes Lyme disease?

Lyme disease is caused by a bite from one of several types of tiny black-legged ticks, often found on white-footed mice and white-tailed deer that most commonly live in woods and high grass. The bite injects a bacterium into the skin. Lyme disease cannot be spread from person to person.

What are the symptoms of Lyme disease?

A bulls-eye-like rash is one of the symptoms of a tick bite. (Credit: CDC/James Gathany)Most children who develop Lyme disease do not recall having been bitten by a tick. Symptoms can appear a few days to many months after the bite, and can include:

  • a rash in the form of a bulls-eye (single or multiple lesions; see adjacent image from Centers for Disease Control and Prevention)
  • facial palsy, or weakness of the facial muscles
  • headache/meningitis, or swelling of tissues around the brain and spinal cord
  • fainting (in the acute phase)
  • arthritis (in later stages)
  • carditis (inflammation of the heart)

Children with a bulls-eye rash (also called an erythema migrans lesion) may also have systemic symptoms such as fever, fatigue, and joint aches. The rash may not have a classic bull-eye appearance, especially on people with darkly pigmented skin, and can be mistaken for cellulitis, ringworm, or other skin conditions. Children who develop a disseminated infection (with facial palsy, meningitis, or carditis) often have not had a preceding skin rash.

The most common late stage symptom of Lyme disease is arthritis, particularly in the large joints and especially the knee. Typically, the joints will be more swollen and tender than painful, and anti-inflammatory medicine can help.

What can I expect long term if my child has Lyme disease?

If Lyme disease is caught and treated early, most children will make a full recovery. Some children with Lyme disease go on to experience what's called a “post-infectious syndrome” with symptoms that may include feeling fatigue, joint aches and pains, headaches, difficulty sleeping, and problems concentrating. Since the infection itself is gone by this time, doctors generally don't prescribe antibiotics. Each child is different, but it's not uncommon for symptoms of post-infectious syndrome to linger for months, or even years, and they can be made worse by stress or other illness. But most children do make a full recovery.

This graphic shows how adult, nymph, and larva ticks compare in size to sesame and poppy seeds.

Blacklegged, or deer, ticks are very small, so it helps to know what to look for when doing a tick check. Adults are about the size of sesame seeds and in the nymph or larva stage, they can be as tiny as a poppy seeds. (Graphic: Boston Children's Hospital; Images: Adobe Stock)

How we care for Lyme disease

The Division of Infectious Diseases at Boston Children's provides comprehensive care for children and adolescents with Lyme disease and other infections. Our services include consultation, evaluation, treatment, and management of long-term complications of Lyme disease.