Tick Bites and Lyme Disease in Kids: What Every Parent Needs to Know

Tick season is here, and if you've ever found a tick on your child, your pet, or even yourself, you've probably wondered: How worried should I be?

In this episode of MomDoc Talk, pediatrician and mom Dr. Kristen Cook breaks down everything parents need to know about ticks, Lyme disease, tick bite prevention, and when it's time to seek medical care.

You'll learn how Lyme disease is transmitted, how to safely remove a tick, why timing matters, what symptoms to watch for, and why diagnosing Lyme disease isn't always straightforward. Dr. Cook also shares practical prevention tips to help keep your family and pets safe during outdoor adventures.

Most importantly, you'll leave feeling informed, empowered, and prepared instead of fearful.

What You'll Learn

• What causes Lyme disease
• Which ticks carry Lyme disease in the United States
• How ticks transmit disease
• Why prompt tick removal matters
• How to safely remove a tick
• What an engorged tick looks like
• When preventive antibiotics may be considered
• Early symptoms of Lyme disease
• The classic Lyme disease rash and what it looks like
• Late complications of untreated Lyme disease
• Why Lyme disease testing can be complicated
• Treatment options for Lyme disease
• What post-treatment Lyme disease syndrome is
• Signs of Lyme disease in dogs and pets
• Practical ways to prevent tick bites

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Podcast Disclaimer

The information presented in this podcast is for educational and informational purposes only. It is not a substitution for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider for medical concerns. All of the opinions are of Dr. Kristen Cook and do not reflect the opinions of her employer nor the hospitals she is affiliated with. The authors and publishers of this podcast do not assume any responsibility for errors, omissions, or consequences of using the information provided.

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Transcript

0:33

Welcome to Mom Doc Talk with Dr. Kristen Cook, where real-life parenting meets medical expertise. I'm your host, a pediatrician with over a decade of experience, and just like you, a parent navigating the ups and downs of raising good human beings. With stories from my own experience as a mom, lessons in child development, and insights based on scientific evidence, I'm here to share practical strategies that work. Let's dive into this journey together and make parenting feel a little more peaceful and a lot more rewarding. Hi, and welcome back to Mom Doc Talk. I'm your host, Dr. Kristen Cook. I'm a pediatrician, a mom, and your partner in creating more peaceful and effective parenting journeys. Today, I'm talking about something that seems to become more relevant every single year. Ticks and tick-borne illnesses. If you've ever found a tick on your child, your dog, yourself, or even just heard stories about Lyme disease and wondered how worried you should be, this episode is for you. Today, I'm focusing on the ticks that cause Lyme disease, what they look like, how they spread disease to humans and pets, how to safely remove a tick, when you should seek medical care, how testing for Lyme disease works, why the diagnosis can sometimes be challenging, and what can happen if these illnesses go untreated. And gosh, that sounds like a lot of information. I want to begin by acknowledging that not every tick bite causes infection. In fact, most tick bites cause no medical issues whatsoever. My first experience with a tick occurred when I was with my now-husband in a hotel in Nebraska, when my mother-in-law pulled out a lighter and burned a tick out of my father-in-law's neck. I was horrified, but everyone else acted like it was no different than killing a spider. By the way, this is not the recommended way to remove a tick, which I will discuss soon. My goal today is not to scare you. My goal is to give you practical, evidence-based information so you know exactly what to watch for and when to act. Let's dive in. Ticks are tiny parasites that feed on blood. They don't jump. They don't fly. Instead, they wait on grass, in trees, on bushes, shrubs, or leaf litter, and latch onto animals or people as they pass by. This behavior is called questing. Over the past several decades, tick populations have expanded dramatically across the United States. Researchers believe that several factors contribute to this, including warmer temperatures, milder winters, expanding deer populations, increasing suburban development, and more human interaction with wooded environments. The CDC estimates hundreds of thousands of Americans are treated for tick-borne illnesses each year. The spotlight tends to be on Lyme's disease, especially where my medical practice is located. Let's meet the major players. Lyme's disease is an infection caused by a bacteria called Borrelia burgdorferi. This bacteria lives and reproduces in two specific types of ticks. The most common vector, which is an organism that transmits a disease to other organisms, is carried primarily by the black-legged tick, also called a deer tick. This tick is located in the eastern and midwestern United States. Another tick that causes Lyme's disease is the western black-legged tick, which is located on the west coast. Female eastern black-legged ticks are about the size of a sesame seed. They have a reddish-orange body, dark black legs, and a dark shield near their head. Adult males are smaller and are dark brown or black. Finally, young nymphs are about the size of a poppy seed and extremely difficult to see. Eastern black-legged ticks are primarily found in the northeast United States, mid-Atlantic region, and upper Midwest. Female western black-legged ticks are also about the size of a sesame seed. They have a reddish-orange body, dark black legs, and a dark shield near their head, making them very similar in appearance to the eastern black-legged tick. Adult males are slightly smaller and are dark brown to black in color. And as with the deer tick, young nymphs are about the size of a poppy seed and again are extremely difficult to see, which is one of the reasons that they are responsible for many tick-borne infections. Western black-legged ticks are found primarily along the Pacific coast, especially in California, but also can be found in parts of Oregon, Washington, and Nevada. Research suggests that transmission of Lyme disease is unlikely during the first 24 hours of attachment and becomes increasingly more likely after 36 to 48 hours. The bacteria that cause Lyme disease typically live in the tick's midgut. Once the tick begins feeding on human blood, the bacteria must activate and multiply, migrate from the tick's gut to its salivary glands, and enter the human host through saliva. This process usually takes time. For this reason, prompt tick removal significantly reduces Lyme disease risk. If you find a tick on yourself or on your child, please stay calm. But it is important to get that tick out as soon as possible. If you can, save the tick so it can be identified. How should you successfully remove a tick? Use a pair of fine-tipped tweezers to grab the tick where it meets the skin's surface. Gently but firmly pull the tick upwards. Do so steadily without twisting or jerking it. Do your best to remove the whole tick at once, including the mouth parts. If the mouth parts of the tick break off when the body of the tick is removed, remove them separately. Place the tick in a closed container if possible. Once the tick has been removed, clean the skin thoroughly with soap and water or rubbing alcohol. Studies have demonstrated that transmission can occur occasionally before 36 hours under certain circumstances. Factors that may increase this risk include a partially fed tick. If a tick had already fed on another host and then reattaches to a human, transmission may occur more quickly. Another risk factor is a highly infected tick. These are ticks that carry larger numbers of bacteria and thus may potentially transmit infection sooner. Finally, errors in estimating attachment time can increase risk. Oftentimes people don't know when the tick attached. A parent may discover a tick during a bath and assume it attached that day when it may have actually attached two days earlier. One of the best clues to transmission risk is how engorged the tick appears. Engorgement refers to a tick that has fed on human blood and appears swollen as a result. An unfed tick appears flat, small, and thin. A partially engorged tick looks slightly swollen with a semi-round body. A fully engorged tick looks significantly enlarged. They have a grayish or tan coloring and a balloon-like appearance. A fully engorged deer tick may have been feeding for several days. This is the situation associated with the highest risk for Lyme disease transmission. While not perfect, clinicians often estimate duration using engorgement. A flat tick has likely been engorged for less than 24 hours. A slightly engorged tick has likely been attached for 24 to 36 hours. And a fully engorged tick has likely been attached for several days. A common misconception is that a big tick equals a dangerous tick. This is not necessarily the case. Adult deer ticks are naturally larger than nymphs. The nymph stage is responsible for many Lyme infections because of their relatively small size. They are difficult to see, and they often remain attached unnoticed for days. In some circumstances, a physician may prescribe a single dose of an antibiotic called doxycycline after a deer tick bite. The purpose of this is to try to prevent Lyme disease. Generally, this approach is considered when the tick is identified as a deer tick. The time of attachment was 36 hours or more. The tick was removed within 72 hours of attachment. Lyme disease is common in that particular geographic area, and the patient has no contraindications to doxycycline. Current guidelines allow doxycycline prophylaxis for children of all ages when the benefits outweigh the risks. I'll be honest, I work in a county that is Lyme endemic, so I err on the side of caution. If a parent is not sure how long a tick was attached to their child and the child has no symptoms, I tend to prescribe prophylactic doxycycline. I may not follow the prophylaxis guidelines to the latter, but again, guidelines are just that. They're not law. The signs and symptoms of Lyme disease vary based on the stage of infection. Early signs and symptoms occur 3 to 30 days after a tick bite. They include fever, chills, headache, muscle aches, fatigue, and swollen lymph nodes. In at least 70% of cases, a classic rash called erythema migraines develops. It appears at the site of the tick bite and initially looks like a pink circle or oval. It expands over several weeks, and once it does, it may look like the target logo. Months after the initial tick bite, severe headaches, neck stiffness, and single joint swelling can occur. The joint most affected is the knee. If Lyme disease affects the heart, palpitations or irregular heart rhythms may occur. Neurological issues are common. Weakness or paralysis of the facial muscles, an infection of the brain called meningitis, and nerve damage that causes shooting pain, numbness, or tingling may occur. Finally, late complications of untreated Lyme disease include memory problems and confusion. Several years ago, I saw a teenage patient for knee swelling. He had already seen an orthopedic surgeon who had drained some fluid from his knee, sent it to the lab, only for the test and he come back inconclusive. By the time that I saw him, the swelling had been persistent for months. I asked my usual questions. Was there a known injury? No. Did he have any recent fevers? No. Does the family like to camp? Well, yes, they spent a lot of time in northern Wisconsin. I immediately ordered testing for Lyme disease, and guess what? This teen had Lyme disease. I treated him and he recovered fully. Am I trying to toot my own horn? Of course not. I am simply sending a call to action. If your child has a medical condition, please consider reaching out to your pediatrician first before you seek the advice of a specialist. Specialists very appropriately focus on conditions related to their medical specialty. Pediatricians, family medicine practitioners, and internal medicine providers tend to look at the big picture first. How do we test for Lyme disease? I wish it was as simple as testing for strep throat. It's actually more complicated than people realize. It involves a two-step blood test. These tests look for antibodies against the bacteria that causes Lyme disease. If a person is infected with the bacteria that causes Lyme disease, the human body starts producing cells to try to kill that bacteria. This is where it gets complicated. It takes several weeks after a tick bite for those antibodies to begin to develop. Many people infected with Lyme disease will test negative for four to six weeks after the initial tick bite or the development of symptoms. Furthermore, if a person has been successfully treated for Lyme disease, those antibodies will linger for months to years. Which means that if a person with a case of Lyme disease has been successfully treated and tested again later, that test may falsely determine that they have an active Lyme disease infection. Personally, if I see a patient with a known tick bite that has a rash consistent with erythema migraines, I don't even test for Lyme disease. I just treat. Lyme disease is treated with antibiotics. The exact medication, as well as the duration of treatment, depends on the symptoms that are present. Early Lyme disease is typically treated with doxycycline for 10 to 21 days if the patient is over eight years old. Children younger than that and pregnant women may be treated with a 10 to 21 day course of amoxicillin instead. If there are cardiac or neurological symptoms, the treatment course is usually 14 to 21 days. If the symptoms are severe, IV antibiotics such as ceftriaxone may be required. The great majority of people who are diagnosed with Lyme disease and successfully treated will fully recover from this infection. About 5 to 30 percent of people will experience something called post-treatment Lyme disease syndrome. Persistent joint pain, fatigue, and brain fog are the most common symptoms. This condition is much more common if Lyme disease is not diagnosed and treated until the late stage symptoms have already presented themselves. The treatment of post-treatment Lyme disease syndrome is largely supportive. Physical therapy can help with arthritis. Cognitive rehabilitation can assist with brain fog. And something called energy pacing can be helpful for fatigue. One of the most important things a parent should know is that many children diagnosed with Lyme disease never recall a tick bite at all, particularly when the bite comes from a tiny nymph tick. So please, if you or your child was diagnosed with Lyme disease, it is not your fault. Do not blame yourself. I know that I focus on parenting, but I am also a dog mom, and I want pet owners to pay attention here. Dogs are particularly vulnerable to Lyme disease. Signs and symptoms include limping, fever, lethargy, and swollen joints. Cats can be affected by ticks too, but disease transmission is less common. Cats only develop Lyme disease if they sustain a tick bite from a tick that has already been infected with Lyme disease. If your cat develops fever, sudden lethargy, or difficulty walking, please contact your veterinarian. Finally, here are some tips to prevent tick bites. Wear long-sleeved shirts and pants, and tuck your socks into your pants. Try to avoid areas that are prone to ticks. Use tick repellent that contains 0.5% permethrin or 20% DEET to skin and clothing. After outdoor activities in tick-prone areas, check yourself, your children, and your pets for ticks. Take a shower immediately if possible. Lyme disease creates a lot of fear in many communities, especially in areas that are endemic to Lyme disease. We need to be mindful of ticks and tick-borne illnesses. If this episode resonated with you, please share it with a friend. Knowledge is power. At the same time, I want to remind you that the content of Mom Doc Talk with Dr. Kristen Cook is for informational purposes only. It is not meant to diagnose or treat any medical condition. Always consult the advice of your personal healthcare providers. Thanks for listening to Mom Doc Talk, where we explore the world of parenting with a little bit of science and a whole lot of heart. If this episode resonated with you, please consider sharing it with a friend. Don't forget to subscribe and review this episode as it helps me reach more parents like you. I'd love to connect on social media. You can find me at momdoctalk_kcmd.