Lyme Disease
Robert P. Lindeman, MD, PhD
Natick Pediatrics, PC

We’ve survived an exceedingly long winter, and we are all looking forward to a well-deserved New England summer. Unfortunately, our friends the ticks have also survived the winter lying dormant beneath the snow and ice, and now they are ready us. And with the ticks comes Lyme disease.

Lyme disease is a problem because, left untreated, it develops into a painful arthritis, and sometimes progresses to involve the nervous system as well.

Lyme disease is not caused by the bite of the tick itself, but by a bacterium that is carried by the deer tick (Ixodes species). These ticks are smaller than the familiar dog ticks and are harder to find on your child. Somewhere between 2-20% of deer ticks carry the bacterium that causes Lyme, so not everybody who is bitten is at risk of getting sick. If the tick is found early, infection is also less likely. The bacterium passes from the tick to human only after being attached for 24 to 72 hours.

The most reliable sign of early Lyme disease is the appearance of a circular or oval "bull's-eye rash", usually 1-2 weeks after the tick bite. It appears either as a red expanding rash, or as a central red spot surrounded by clear skin that is ringed by an expanding red rash. Usually, this rash is so characteristic that a doctor will not need any additional testing to diagnose Lyme disease. But the rash can disappear, so you should take a picture of a suspicious rash on your child if you are unable to see the child's doctor the day you notice it.

In some cases, the bull's-eye rash never forms. In the absence of the rash, doctors pay attention to other symptoms, such as swollen lymph glands near the tick bite, general aches, joint pain, headache, sore throat, and fever. In such cases, your child’s doctor may want to perform a blood test to detect exposure to Lyme disease.

Doctors try to be careful not to mis-diagnose Lyme disease. The temptation to treat all unusual joint pains or nerve conditions with antibiotics (on the assumption that they are the result of Lyme disease) may lead a doctor to overlook other serious conditions, such as childhood arthritis. Not only is there the possibility of subjecting a patient to unnecessary or incorrect treatment, but also prolonged treatment with antibiotics puts a patient at risk for unwelcome side effects.

Preventing Lyme Disease
The key to prevention is tick-avoidance. To the greatest extent possible, you should avoid contact with soil, leaves, and vegetation, especially during May, June, and July, when ticks have not yet matured and are harder to find on skin and in hair. If you or your child must go to these places, the following tips might be helpful:

• Wear closed shoes and boots (no sandals), long-sleeved shirts, and long pants. Tuck pants into boots or shoes to prevent ticks from crawling up legs.
• Wear light-colored clothing to help make the ticks more visible.
• Keep long hair tied back and wear a hat.
• When outside, avoid sitting on the ground.
• While outdoors, check yourself and your child frequently for ticks.
• After each outing, check yourself, your child, and your pet for ticks. Ticks can bite anywhere, but they seem to like the area behind the ears, the back of the neck, the armpits, the groin, and the area behind the knees.
• Wash all clothes after leaving tick-infested areas, and bathe and shampoo your child thoroughly to eliminate any unseen ticks. It might not be a bad idea to shampoo the dog frequently as well.
• Keep lawns mowed and trimmed.
• Keep your yard free of underbrush, lawn trimmings, and litter. Stack your woodpile off the ground.
• Have a licensed professional spray your yard with insecticide in May and September.
• Use insect repellents containing no more than 10% DEET. Use repellents sparingly on children, and never use them on infants. At best insect repellent has limited usefulness in preventing tick bites.

When to Call Your Child's Doctor
If you find a tick on your child, call your child's doctor. He or she may want to examine the tick after removal. Use tweezers to grasp the tick firmly at its head or mouth, next to your child's skin. Pull firmly and steadily on the tick until it lets go, then swab the bite site with rubbing alcohol and place the tick in a small jar of the same alcohol. Never use petroleum jelly or a lit match to kill a tick.

If your child was bitten by a tick and has a bull's-eye rash or other Lyme disease symptoms, such as swollen lymph glands near the tick bite, general aches, headache, sore throat, or fever, call your child's doctor right away.

For more information about Natick Pediatrics, or to talk to the doctor, please call the office at (508) 655-9699.

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Medical Office Building
MetroWest Medical Center
Leonard Morse Campus
67 Union Street, Suite 305
South Natick, MA 01760

(508) 655-9699
(508) 655-2984 fax

Posted: November 15, 2002