37. Managing Tick Bites in Children in New England

If you find a tick on your child, the first step is to remove it. When removing a tick, use a clean tweezers and grab the tick by the head, as close to the skin as possible. Pull backward firmly and be sure to hold the tweezers horizontally to the skin. Do not to twist or jerk the tick. If the tweezers are pulled vertically to the skin, the tick’s body may break away from the head. Even when using good technique, the tick’s head or mouth parts may break off and remain embedded under your child’s skin. If this occurs, do not attempt to remove the remaining tick parts, as this could be quite painful for the child. The good news about a partially removed tick is that the child’s body will naturally extrude the embedded parts over time. Leaving the head in the child’s skin does not increase the risk of Lyme disease. Once the tick has been removed, cleanse the area with soap and water.

Next, try to determine which type of tick has bitten your child. Deer tick nymphs, the primary vector that transmits Lyme disease, are tiny, about the size of a poppy seed.

See picture below, from the CDC’s website:

While deer ticks can carry Lyme disease, dog ticks in New England do not transmit any diseases to humans (in other parts of the country, dog ticks sometimes transmit Rocky Mountain Spotted Fever). If your child has been bitten by a deer tick, you have the option of dropping the tick off at your local health department. The health department can potentially determine whether the tick is carrying Lyme disease. Keep in mind that in most cases, an attachment period of at least 36-48 hours is required to transmit Lyme disease to humans. Ticks attached to children for very short time periods are unlikely to transmit disease.

Children who have been bitten by a deer tick should be observed for signs of Lyme disease. In the earliest stages, Lyme disease can present with fever, joint pain, and malaise. Many individuals with Lyme will develop a rash at the site of the tick bite, and some will develop the classic “bullseye rash” with multiple expanding lesions on different areas of the body. Later-stage Lyme disease can cause Bell’s palsy, joint swelling, and other systemic problems. At any stage, Lyme disease is treatable with antibiotics.

For children under eight years of age who have been bitten by a deer tick, there is no preventive treatment for Lyme disease. For children age eight and older, a single dose of Doxycycline can be given preventively. Doxycycline generally isn’t given to younger children because it can permanently discolor their adult teeth.