Lyme Disease in Children

What is Lyme disease?

Lyme disease (LD) is a multistage, multisystem bacterial infection caused by Borrelia burgdorferi bacteria. These are usually transmitted by tick bites. The disease takes its name from Lyme, Connecticut, where the illness was first identified in the United States in 1975.

Lyme disease continues to be a rapidly emerging infectious disease. It is the leading cause of all insect-borne illness in the U.S. LD cases more than doubled during the surveillance period of 1992 to 2006. In 2010, there were nearly 23,000 confirmed cases and more than 7,000 probable cases of LD. 

Lyme disease is a year-round problem, although April through October is considered tick season. The chance of encountering a tick infected with the bacteria is more likely during this time. Cases of LD have been reported in nearly all 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 nonspecific. Symptoms can affect every part of the body. Symptoms usually appear within 3 to 30 days after a tick bite. The following are the most common symptoms of LD. However, each child may experience symptoms differently.

One of the primary symptoms is often a circular-shaped rash that can be pink in the center and a deeper red on the surrounding skin. It resembles a bulls-eye pattern. The rash:

• Can appear several days after infection, or not at all.

• Can last up to several weeks.

• Can be very small or very large (up to 12 inches across).

• Can mimic such skin problems as hives, eczema, sunburn, poison ivy, and flea bites.

• Can itch or feel hot, or may not be felt at all.

• Can 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

• 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 health care provider for a diagnosis. It is possible that your child may be one of the 10% to 20% of people with LD who have posttreatment Lyme disease syndrome. This means that symptoms linger after 6 months.

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 more than 20% 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 health care provider. Blood and laboratory tests may be performed to help diagnose LD and to rule out other conditions.

Research is under way to develop and improve methods for diagnosing LD.

What is the treatment for Lyme disease?

Your health care provider will determine the best treatment plan, based on your individual situation. Lyme disease is usually treated with antibiotics.

Treatment will be considered based on these and other factors:

• Your symptoms and test results.

• 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 live in an area where the ticks are known to be infected.

How can Lyme disease be prevented?

• 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 waistbands touch 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 daily.

• 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 4 to 6 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 always kill the tick and are not 100 percent effective. Use a children's insect repellent (10% to 30% DEET) for your child. Do not use repellent for infants younger than age 2 months. Do not apply to the area around your child's nose, mouth, and eyes. Do not apply over any cuts or open sores. 

    • Treat clothing with a product that contains permethrin. This is known to kill ticks on contact. Do not use permethrin on the skin.

  • Check pets for ticks and treat as needed.