Second Opinion: Tick Talk - All About Ticks and Lyme Disease
Mmmm. Lyme disease. This is a titillating, sometimes terrifying, often oogeying condition. The mere thought of it makes parents search their children's hairlines for the sesame-seed-like arachnid having a meal, and possibly spreading a dreaded plague. (A baby tick, or nymph, is about the size of a poppy seed, not to put you completely off bagels.) Misconceptions abound. Like: Lyme disease occurs only in the spring and summer months (actually, it occurs year-round). Or Lyme disease may cause ADHD (no again, but it can cause long-term problems, such as headaches, in some people). Or that it's contagious (nope). Humans have been living with Lyme disease for generations, and it is partly from our growing awareness that the rates of cases have increased. Happily, awareness has also led to better options for prevention and treatment.
What I Preach
Lyme disease is tricky. The delay from bite to appearance of the illness might leave parents oblivious to the fact that their child was ever bitten. But clues may be found: For up to 75 percent of those infected, a bull's-eye-shaped rash (called erythema migrans) appears and spreads at the site of the bite, usually within a few days to four weeks. In this early phase of the illness, many kids and adults report flu-like symptoms, including headache, fever, chills, swollen glands, and achiness. (Yes, these symptoms could signal nearly every mystery illness, but combined with the bull's-eye rash, they're suspicious.)
Fortunately, for those diagnosed in the early stages, the use of antibiotics for about a month is extremely successful. At present, I'm not aware of any effective alternative therapies, although some approaches, such as acupuncture, might address some of the symptoms of Lyme disease (joint pain, for example).
For those not treated at all, or for whom antibiotics don't work, up to 50 percent may experience further symptoms ranging from the annoying (headaches and fatigue) to the potentially severe but wonderfully less frequent (heart arrhythmias and meningitis). Many of the less serious symptoms resolve without treatment.
"People worry too much about Lyme disease," says a doctor friend of mine, Elinor Mody, a rheumatologist at Brigham and Women's Hospital in Boston. "It's fairly easy to diagnose and to treat. And if a parent is particularly concerned, it's reasonable to ask for a referral to a specialist so further evaluation can be done."
What I Practice
As any finger-wagging pediatrician will tell you, the best strategy for preventing infection is vigilance and awareness. Because it may take up to a few hours for a tick to attach and bite, and they must feed at least 24 hours to transmit the infection, checking daily and removing ticks early can prevent transmission. For all families, but especially for those in higher risk areas (see "By the Numbers"), children should be checked for ticks after outings, particularly in the areas of skin folds, such as the neck, armpits, groin, and along the edge of the scalp. Do my wife and I check our children every day? Not if we've been shopping downtown. But if we go hiking in the woods we check a few times a day. When possible, I have my kids wear socks and pants, but they'd kill me if I made them do this in the summer.
Repellents, such as those containing DEET, ward off ticks to some extent. (Full disclosure: I send my kids off to camp every day with it.) Still, I suggest it be applied sparingly. With little kids, use should be balanced with potential side effects, such as skin irritation or headaches and dizziness (if used more excessively). The American Academy of Pediatrics says you can put bug spray with DEET on infants after 2 months, but I say wait until they're 6 months. Gener ally I avoid topical stuff with the potential for toxicity on small babies. One plant-derived insect repellent, oil of lemon eucalyptus, has gotten recent mention by the Centers for Disease Control as being effective against mosquitoes and possibly ticks, but it is not to be used on children younger than 3 (due to a lack of research).
Parents can also significantly lower tick populations around their homes by simply clearing brush and leaf litter (popular tick hangouts) along the edges of grassy and wooded areas where kids play. A buffer zone can be fashioned with wood chips or gravel between woods and yard.
If you know your child is bitten, call your physician, who, depending on the region and engorgement of the tick, may decide on prophylactic treatment. Watch for the onset of flu-like symptoms or the telling bull's-eye rash within a month of a known (or unknown, in the presence of a rash) bite, and call the doctor if you notice anything suspicious.
The last thing anyone would suggest is that we lock our children in tick-proof chambers. Far from it. So send your kids out to explore, taking precautions when you can. Then, at the end of the day, as they regale you with their adventures in the bathtub, give 'em a look-see. If you find a new beauty mark with arms and legs, you'll know what to do.
By the numbers
- 20,000 — The number of Lyme disease cases that occur annually in the United States.
- ages 5 to 14 — The population with the highest number of new cases of Lyme disease each year.
- 3 — The areas of the U.S. where Lyme disease is most prevalent: the Northeast, the upper Midwest, and the West Coast. (But don't get smug, you folks out there in the Mountain and Southern states. Cases have been reported in nearly all 50 states and abroad.)
- 1975 — The year Lyme disease got its name, when a cluster of rashes and swollen joints found among residents of Lyme, Connecticut, was investigated by a Yale researcher and the CDC.
What to do if you find a tick:
Tell your child that a tick can carry germs, so you need to remove it to keep her healthy. She might feel a pinch, but it won't really hurt. Use tweezers to hold the tick at the head, next to where it joins the skin. Pull firmly and steadily until the tick releases from the skin. Treat the wound with some alcohol, and put the tick in a container filled with alcohol. Don't try using a hot match or petroleum jelly—matches can burn your child (duh) and petroleum jelly doesn't work. If you can't stomach the tweezer method or if part of the tick remains in the skin, see your health care provider. You can even bring the captured tick to your pediatrician (sorry, colleagues!) for inspection.
Notes on Ticks:
- Ticks like to hide in dark, cozy spots, like the back of the neck or hairline.
- Low to the ground and furry, pets are prime tick targets.
About the Author:Jack Maypole is a pediatrician at Boston Medical Center and director of pediatrics at the South End Community Health Center. His family watches for ticks while hiking on Martha's Vineyard.