Symptoms Of Lyme Disease In Children And Its Prevention

Lyme disease in children is caused by the bite of tiny (the size of a poppy seed) black-legged ticks (Black-legged deer tick and Western black-legged tick) (1). These ticks are found on white-footed mice or white-tailed deer that mostly live in woods and high grass. The tick bite transmits a bacterium called Borrelia burgdorferi into the skin, responsible for this multisystem disease (2) (3).

Lyme disease got its name from Old Lyme, a place in the US, where there was a first reported case in 1977. The disease is commonly found in the northeast and mid-Atlantic states, the north-central states of Wisconsin and Minnesota, and Northern California. The disease mostly occurs from June to October, and sometimes during the rest of the year too (2) (3).

Read about the causes, symptoms, complications, diagnosis, treatment, and prevention of Lyme disease in kids.

How Common Is Lyme Disease, And How Does It Spread?

Lyme disease most commonly occurs in children between five and nine years and adults between 55 and 59 years (4). It is estimated that there are 300,000 cases of Lyme disease every year in the US (5).

All ticks do not cause Lyme disease as they do not carry the bacterium Borrelia burgdorferi. Based on the location, less than 1% to more than 50% of the ticks are infected by the bacteria (5). These infected ticks generally attach to hard-to-see places in the body such as the groin, scalp, and armpits. If they remain attached for around 36 to 48 hours, they transmit the bacteria (3).

Most diseases are transmitted by nymph ticks (immature ticks less than 2 millimeters long), which feed during the summer and spring. However, they may sometimes be transmitted by adult ticks during the cooler months (3).

What Are The Symptoms Of Lyme Disease In Children?

After being infected by the bacterium, children develop several non-specific symptoms that make the diagnosis of Lyme disease difficult. The disease usually has three stages. Children who are treated early recover well and never get the late stages of the disease.

These are the symptoms experienced in the different stages of the disease.

Early-stage (the first 30 days after the tick bite)

• Around 70% of children develop a red or pink, circular, expanding bull’s eye rash called erythema migrans at the tick bite site (6) (3).

The rash

• May be small or large (up to 12 inches across)
• Generally develops three to 30 days after the bite
• Is usually painless
• May itch or feel hot
• Lasts for several weeks
• May mimic other skin issues, such as sunburn, hives, eczema, flea bites, and poison ivy
• May disappear and develop again after several weeks

The symptoms experienced by children at this time are (6) (3):

• Fever and chills
• Discomfort
• Headache
• Mild stiffness in the neck
• Pain in muscle or joint
• Fatigue
• Swollen glands

At this stage, blood testing for Lyme disease is usually negative. So, if children develop a rash that resembles erythema migrans, healthcare providers may start treating them with antibiotics. Even if children do not develop a rash but have symptoms similar to Lyme disease, you should consult a healthcare provider.

Second stage (bacteria spread to the body)

Several weeks or months after the bite, these symptoms occur (6) (7):

• Multiple erythema migrans appear
• Inflammation of the nervous system (meningitis) that leads to fever, headache, and stiff neck
• Bell’s palsy, characterized by weakness and paralysis of facial muscles of one side of the face or both sides (seen as an uneven smile)
• Heart diseases, such as myopericarditis (heart inflammation) and problems with heart rate
• Inflammation of eyes
• Skin issues
• Fatigue

Last stage

If the disease is not recognized and treated in the earlier stages, these symptoms occur several months or a few years after the tick bite (6) (7).

• Arthritis, characterized by inflammation in the knees and larger joints. Generally, only one knee is affected, and the swelling may be intermittent.
• Neurological diseases include numbness, tingling, pain in limbs, and difficulty with memory, concentration, and speech.

What Are The Complications Of Lyme Disease In Children?

Post-Lyme disease syndrome (PLDS) may develop in a few children, where some symptoms stay even after the treatment is over (6).
These symptoms are (7):

• Muscle and nerve pain
• Fatigue
• Memory problems

This condition does not respond to any treatment because there is no infection in the body. Therefore, in the case of PLDS, doctors aim to provide relief by treating the symptoms.

What Are The Risk Factors Of Lyme Disease?

Anyone may get Lyme disease; however, the risk factors that increase the chance of contracting the disease are (8):

• Living in a tick-infested region
• Being outdoors in warmer months when ticks are the most active
• Spending a lot of time outdoors (gardening, hiking, camping, or hunting)
• Living near or visiting wet, woody, or brushy areas

How Is Lyme Disease Diagnosed In Children?

The following steps can help diagnose Lyme disease (3).

1. Healthcare providers may perform physical examinations to check the symptoms of Lyme disease. They may also inquire about the history of exposure to ticks.
2. If children do not have any rash on their bodies but show other Lyme disease symptoms, blood tests may be advised to find if the body is producing antibodies against the bacteria. These blood tests are helpful when done two to six weeks after the tick bite because by then, the immune system gets enough time to react with the bacteria.
3. Other tests may be performed if the disease has spread beyond the skin.

• Electrocardiography (in the case of Lyme carditis, or heart involvement)
• Magnetic resonance imaging of the brain and lumbar puncture (in the case of Lyme meningitis, or infection of the nerves)

How Is Lyme Disease Treated In Children?

Lyme disease responds well to antibiotic treatment, so the early stages may be completely resolved without causing any permanent damage. Oral antibiotics that work well are doxycycline, amoxicillin, and cefuroxime. These are mostly given for a two- or four-week period depending on the severity of the condition. However, if the symptoms do not resolve with the first course of antibiotics, a second course is given.

Children with neurologic or cardiac problems may need intravenous antibiotics. In addition, those who have been severely affected by the disease and have cardiac, brain, or joint issues may need regular follow-up (3).

How To Prevent Lyme Disease In Children?

It is important to prevent Lyme disease because there are no vaccines available. Moreover, people cannot develop immunity against the disease, so they may get infected more than once.

To prevent Lyme disease, children should (5) (9)

• Wear light-colored clothes covering the entire body, socks, and closed-toe shoes.
• Wear a hat to prevent ticks from entering the scalp.
• Avoid moist and shaded places where tick infestation is possible.
• Always stay on a clear trail where there are no shrubs or branches.
• Use insect repellents. Products with DEET are safe on the skin and can repel ticks. However, they may not be able to kill them. Look for repellents that have not more than 30% DEET, as large amounts are unsafe for children. Ensure that children wash off the DEET after returning indoors.
• Use products with permethrin only on the clothing and not on skin.
• Check and remove the ticks after returning indoors. The ticks may be hiding behind the knees, underarms, between fingers and toes, belly button, neck, in and behind the ears.

Ticks may also be found in your backyard, so keeping it clean by removing leaves and cutting tall grass is important. Pest control may also be done to reduce ticks in your garden.

How To Remove Ticks From The Skin?

If you find a tick on your child’s skin, follow these steps to remove it from the skin (5).

• Do not touch the tick. Use a pair of tweezers to hold it gently as close to the skin as possible and remove it.
• Do not try to crush the tick or kill it by using solvents, knives, or fire.
• Place the tick in a plastic container so it may be tested for infection.
• Wash the bitten area with an antiseptic solution and apply an ointment.

References

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