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Lyme Disease in Children and Adolescents

As families enjoy time outdoors, the threat of Lyme disease remains a concern to be aware of, with nearly 500 cases reported yearly in Suffolk County alone. Fear not, with the right prevention and early action, the impact of an infected tick bite can be reduced.

Arming yourself with tick safety essentials, from proper removal to repellent use, and knowing how to spot symptoms early on, will reduce the risk of Lyme disease in children and adolescents, so your family can reap the benefits of outdoor play while staying safe.

 What is Lyme Disease?

Lyme disease is a bacterial infection transmitted by the bite of the blacklegged (deer) tick (Ixodes scapularis). Approximately 500 Lyme disease cases are reported in Suffolk County each year, though the true number is likely much higher.

Children and adolescents have similar risk factors for getting Lyme disease as adults, which is based on outdoor exposures in endemic areas. Lyme disease incidence, however, is highest in children ages 5-14 year. This is likely because of common types of activities among children, which occur near tick habitats, forests, and tall grasses.

Most Lyme cases occur in late spring and summer months. The disease in children and adolescents will generally present itself in three stages:

  1. Early presenting 3-30 days after a bite, with a “bull’s-eye” target rash or erythema migrans
  2. Early disseminated disease presenting 3-10 weeks after bite, with multiple erythema migrans lesions, meningitis, carditis, and facial droop)
  3. Late disease presenting 2-12 months after a bite, with arthritis symptoms

 Lyme Disease Symptoms in Children

Sometimes the only specific symptom of Lyme disease is a single erythema migrans, or “bull’s-eye” lesion that causes redness at the site of the bite.

Additional nonspecific symptoms of Lyme disease in children can include:

  • Fever
  • Headache
  • Muscle aches

Not infrequently, the tick and rash may not be noticed and the disease may progress. Some children with Lyme disease will develop multiple erythema migrans lesions and show signs of meningitis, facial droop, or in rare cases, abnormal heart rhythm. A much later manifestation may lead to arthritis, or swelling of the joints that causes pain and stiffness.

 Diagnosing Lyme Disease

Early diagnosis of Lyme disease is key. Early disease with the erythema migrans rash is a clinical diagnosis and no testing is needed.

For the other forms of Lyme disease, a blood test is done for Borrelia burgdorferi (the bacterial species) antibodies. This begins with a screening (or first tier) antibody test. If results are borderline or positive, additional (second tier) antibody testing is performed on the blood sample.

The second tier of tests includes early antibodies (or IgM) and late antibodies (or IgG). This can be a Western blot (traditional testing) or part of the new commercial lab test, the modified two-tier testing (MTTT).

Having clinical features suggesting Lyme disease and a certain combination of IgM or IgG, depending on the stage of the disease, determines if a patient has Lyme disease. Previous history of Lyme disease must be considered when interpreting these results.

 Treating Lyme Disease in Children

Treatment with antibiotics (typically amoxicillin or doxycycline) for Lyme disease is very effective. Early treatment is important, but all stages of Lyme disease can be effectively treated with appropriate antibiotics.

Erythema migrans (both single and multiple lesions), meningitis, carditis, and facial palsy are all treated with 2-3 weeks of antibiotics, depending on the illness.

Arthritis requires four weeks of treatment. Children respond very well to treatment and long-term complications are rare.

 How To Prevent Lyme Disease

Although treatable, it is best to avoid Lyme disease entirely by preventing tick bites.

Preventative measures include:

  • Using insect repellents (20-30% DEET)
  • Staying on trails when hiking
  • Wearing long sleeve shirts, pants and high socks when in grassy areas
  • Doing regular tick checks after being outdoors
  • Removing ticks immediately and properly, with tweezers

Tick identification and time of attachment are also important. It takes at least 24 hours for the Borrelia bacteria to be transmitted, so risk of infection decreases the earlier the tick is removed.

It is important for parents to talk with their child’s doctor about any concerns they have about tick bites and Lyme disease.

For more information on Stony Brook’s Tick-Borne Disease Referral Clinic, click here.

This article is intended to be general and/or educational in nature. Always consult your healthcare professional for help, diagnosis, guidance and treatment.