Spring and summer are upon us and our patients are hopefully going to be outdoors more and more.
We have begun to get many phone calls, like we do every spring, about tick bites. Tick bites generate a lot of anxiety among parents because of the fear of Lyme disease and other infections spread via ticks.
The small blacklegged deer ticks are the ones that cause all the trouble in humans.
The deer tick’s success as a species depends on white-tailed deer that are prevalent in the northeastern United States. We know from people who study tick life cycles that nymph deer ticks are at their peak activity from May through July.
What do you do if you see a tick on your child? There are some simple steps to remove a tick. The most effective strategy is manual removal. Strategies that attempt to suffocate the tick are not recommended, and this includes applying things like petroleum jelly, gasoline, nail polish and rubbing alcohol. Strategies that attempt to irritate a tick are also not recommended. This includes using a match, hot nail or knife.
The best method is as follows:
- Using blunt, angled forceps (splinter tweezers are pretty good too), grasp the tick by its head as close to the skin as possible. Do not apply pressure to or puncture the tick’s body, which could cause the tick to regurgitate material into the wound.
- Apply slow and steady traction to the tick on a perpendicular axis from the skin (imagine taking an arrow out of the ground).
- Inspect the skin for retained mouthparts, and if present attempt to remove.
It is unnecessary to preserve the tick for analysis because the value of tick analysis is unclear and not clinically useful—we don’t send ticks to be analyzed because it doesn’t help us in making decisions.
We also don’t routinely recommend starting antibiotics if a child had a tick removed just to “play it safe” in an effort to prevent Lyme disease. The first reason is that the vast majority of tick bites will not lead to an infection even when the tick is infected. An infected tick typically requires at least 48 hours to transmit the infection. The second reason is there are risks of adverse effects from doxycycline that can only be used in children over 8 years old, and other antibiotics like amoxicillin in children under 8 years old have unproven efficacy.
We also don’t encourage automatically obtaining blood work after a tick bite because drawing blood is traumatic, there are many false positive results and nearly all cases of Lyme disease can be recognized clinically. If a tick was known to be present for less than 48 hours and a rash never developed then you should not worry.
The key to avoiding Lyme and other tick-borne diseases is avoidance.
Wear long pants in areas where tick exposure is likely, and tuck pant legs into socks to ward off the immature ticks on the ground and on low growth.
Inspect the skin, especially the armpit, groin areas and nape of the neck immediately after outdoor activities to detect and remove ticks before transmission can occur.
If skin exposure is unavoidable, apply an appropriate insect repellent to the skin or clothing to protect against tick bites.
The last part of this article will briefly describe the clinical symptoms of Lyme disease. For a more complete description go to the CDC website. We do not recommend browsing the internet to gather information on Lyme disease because it has been proven to give incorrect information.
Early localized disease is the most recognizable as it is characterized by a distinctive rash called erythema migrans at the site of the tick bite. The rash develops one to two weeks after the tick bite and is a direct result of the infectious organism, called Borrelia burgdorferi, spreading in the skin. This causes an enlarging flat, red area that may clear up over time in the central area, giving it a bull’s-eye appearance. It is important to stress that the rash is usually present for one to two weeks and expands to an average size of 6 inches. Any rash that is never larger than a quarter almost never represents Lyme disease. We know that, 90 percent of the time, if a person is infected they will develop the rash, which makes the diagnosis easy. If an infected person does not develop the erythema migrans rash or no one recognized the rash as something to be addressed it is possible to develop other symptoms weeks to months later. These other symptoms include carditis, facial nerve palsy, meningitis and arthritis. The good news is that, regardless of when the infection is treated, antibiotics are curative. There is public misconception that children can have long-lasting affects of Lyme disease. All of the good research that is available shows clearly that after appropriate diagnosis and treatment there are no long-term concerns.
By Dr. Darren Saks, Tenafly Pediatrics
