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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.

Lyme Disease | Treatments & Prevention

How is Lyme disease diagnosed?

Most tests for Lyme disease look for antibodies the body makes in response to infection. Since it takes time for the immune system to produce these antibodies, an early test may come back negative, but your child could still have Lyme disease. Also, if your child has had Lyme disease in the past, the test may remain positive.

While currently available tests work in most cases, a clinical evaluation should take into account exposure to ticks, as well as the timing and nature of symptoms in making a diagnosis of Lyme disease.

Research is underway to develop and improve methods for diagnosing Lyme disease. Learn more.

How is Lyme disease treated?

Lyme disease is most often treated with antibiotics such as doxycycline, amoxicillin, or cefuroxime for several weeks. Please complete the full course of antibiotics as prescribed, even if your child is feeling better, in order to kill all the bacteria.

If your child doesn't respond to oral antibiotics, or if the Lyme disease is affecting the central nervous system, antibiotics may need to be given intravenously (through an IV). This usually doesn’t require your child to be hospitalized. In many cases, a nurse can come to your home to administer the IV or teach you or another family member how to do it.

Anti-inflammatory medicine may be prescribed for children who are experiencing pain from arthritis.

How can Lyme disease be prevented?

Unfortunately, there is currently no vaccine for Lyme disease. But you can avoid Lyme disease by avoiding tick bites, checking for ticks, and removing ticks promptly, before they become lodged in the skin. Some tips:

Avoid tick “playgrounds”: Ticks like low-level shrubs and grasses, particularly at the edges of wooded areas. If you’re hiking, try to stay in the center of the trail and avoid bushwhacking. Walk on cleared paths or pavement through wooded areas and fields when possible.

Dress appropriately: Long pants with legs tucked into socks and closed-toed shoes will help keep ticks away from skin. Light-colored clothing helps make ticks visible.

Insect repellant: Products that contain DEET repel ticks but do not kill them and are not 100 percent effective. Use a brand of insect repellent that is designated as child-safe if your child is 1 year or older. For infants, check with your pediatrician about what brands are safe to use. You can also treat clothing with a product that contains permethrin, which is known to kill ticks on contact.

Shower after outdoor activities are done for the day. It may take four to six hours for ticks to attach firmly to skin. Showering will help remove unattached ticks.

Check yourself and your family frequently for ticks, especially if you’re in an area where the ticks are common — even if you’ve only been out in your yard. Black-legged ticks can be extremely tiny, measuring less than one millimeter across, so make sure you search your child’s clothing and body very thoroughly. You or your child should perform one thorough tick check per day. Visually inspect all areas of the body 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
  • anywhere clothing presses on the skin

What should I do if I find a tick on my child?

Don't panic. First Lyme disease is spread by the black-legged tick, not by the larger and more-common dog tick. The risk of developing Lyme disease after a black-legged tick bite is low, especially if the tick has been attached for a short time.

If you find a tick on your child, remove it using a fine-tipped pair of tweezers. Grasp the body of the tick and pull in an upward motion until the tick comes out. Do not squeeze or twist the tick’s body. Take note of the tick’s size and color, and how long you think it has been attached to your child.

If your child has been bitten by a black-legged tick that has been attached for more than 24 hours and you are in a Lyme disease endemic area, consult with your pediatrician. In some cases, your child may be prescribed antibiotics to prevent Lyme disease from developing.

Lyme Disease | Programs & Services