What to do if you find a tick on your child

Finding a tick on your child could make even the most seasoned parents panic. But this post will cover everything you need to know to handle that situation like a pro!

First step: Don’t start googling!

Second step: Make sure you download my FREE “what to do if you find a tick” guide.

Just the summary

• There are many tick-borne illnesses - most parents know about Lyme, but not about the others. The likelihood of catching one depends a lot on where you’re located, the extent of your exposure, preventive measures used, and luck.

• Do want to do your best to avoid tick bites: use an effective, safe insect repellent (more here) and check for ticks if you’ve been outdoors.

• If you find a tick, remove it carefully, being certain not to squeeze it or try to kill it while attached. Your physician will want to know some important things: how long you think it has been attached, whether it is engorged, what kind of tick it is (you can use websites like TickEncounter to help).

  • See my guide page for a step-by-step cheat sheet.

• In some cases, such as for Lyme disease, prophylactic antibiotics may be helpful — but even for Lyme, in many cases, watchful waiting may be the right move. Most cases of Lyme disease are a result of missed tick bites. The decision to take preventive antibiotics is a clinical one based on pre-test probability and strict criteria (see below). Your physician can help you navigate the next steps. My next blog post covers this is in more detail.

• Watch for symptoms. Know what you’re looking for. Trust your gut.

What is a tick-borne illness?

Many (but not all) types of ticks carry disease. And while Lyme is the most well-known, it is not the only tick-borne illness that can cause problems. There is some seasonal and location variation in the specific ticks and illnesses we worry about, but some examples are:

• Lyme disease

• Anaplasmosis

• Ehrlichiosis

• Rocky Mountain spotted fever

• Alpha Gal Syndrome (which is, weirdly enough, an allergy to red meat)

• There are others too - see the CDC site for more.

What to do if you find a tick

REMOVE IT.

Using a fine-tipped tweezer or a specific tick-removal tool (such as this one), grasp the head of the tick (not the body) and pull up confidently with steady pressure.

We don’t have any excellent data that proves one method of removal is superior to another, but be aware that squeezing the tick or jerking it off abruptly can increase the risk for mouth-parts to break off and remain embedded. If any mouth parts remain, leave them alone. Digging into the skin can traumatize it further.

DO NOT:

• Squeeze the body

• Kill it while attached

• Douse it with any of the random things you see on the internet (essential oils, nail polish, dish soap, vaseline).

• Light it on fire (or with a cigarette)

PRACTICE GOOD WOUND CARE.

Wash the area with soap and water - and wash your hands.

TAKE A PHOTO.

Try to identify the tick. Things to note include size, color, identifying features, and whether it is engorged or swollen (usually will look white or light brown). You can also send a photo to Tickspotters which is a great free resource run by the University of Rhode Island.

TRY TO FIGURE OUT HOW LONG IT WAS ATTACHED.

This can sometimes be challenging, and it may involve back-calculating to the last time your child was outdoors or checked.

SAVE IT.

Afterwards, you can immerse the tick in rubbing alcohol or wrap in tape to kill it, but save in a ziplock with the date in case it needs to be ID'd in the future.

Tick types

Rather than re-invent the wheel, here’s a link to a great visual that can help you understand different species of ticks.

Is it worth sending the tick to be tested?

For many parents, the idea of watchful waiting can be very stressful. So given the opportunity to find an answer - often any answer - they’ll take it. But the truth is that sending ticks for testing is expensive and won’t necessarily make much of a difference clinically. Labs that test ticks aren’t necessarily regulated, and a tick that tests positive for Lyme can cause a lot of stress — but it doesn’t mean the infection was transmitted to your child.

In general, here’s my take: if there is a higher risk scenario, we would want to start antibiotic treatments within 72 hours. So I wouldn’t want to wait for test results to be back before a patient reached out to me.

Okay, so what constitutes a “higher risk” scenario for Lyme?

We have guidelines from the Infectious Disease Society of America that can help. In general, a patient needs to meet all these criteria in order to give antibiotics, because the “pre-test probability” of Lyme disease transmission is higher.

• confirmed bitten by a deer tick

• bite occurred in an endemic area (ie an area which has Lyme)

• attached for a minimum of 36 hours

• antibiotic can be given within 72h of tick removal

Info about Lyme Disease in kids

Lyme disease is caused by Borrelia burgdorferi, which is a bacteria carried by the Ixodes (or deer) tick.

In general, deer ticks transmit infection after an extensive period of attachment and a long blood meal. Usually, even once a deer tick is attached, it can take hours for it to start feeding.

The blood meal is a necessary element of transmission, which means you need evidence that a blood meal has occurred (ie. tick needs to be engorged). This is because the bacteria is actually dormant in the tick’s gut - it becomes activated by warm blood. Once that happens, it transports itself to the tick’s salivary glands and glides on in. All of this takes hours — in fact, at least 36-48h of feeding is generally required before Lyme transmission can occur.

The Pediatrician Mom Tip: Engorged ticks often look slightly different from unfed ticks. The body may take on a white, light brown or gray hue and will look swollen.

This website has a great graphic showing an unfed deer tick and the same tick at different stages of feeding.

What this means for you

If you check your child regularly, then the likelihood of a tick being attached and feasting for that long is quite low.  If you find a deer tick that is not engorged or was not actually attached, it will not transmit Lyme.

Prophylactic antibiotics after a bite

We have some evidence that prophylactic treatment of a high risk case can decrease transmission of Lyme.

In other words: in a situation where there is HIGH pre-test probability that a person actually may have contracted the disease, a single dose of antibiotic (Doxycycline) taken within 72h may decrease the likelihood of developing Lyme.

What about the rest of the patients?

For this group, as stressful as uncertainty can be, it is perfectly reasonable to monitor for symptoms. Its worth knowing that most cases of Lyme are actually from tick bites that went unrecognized rather than from known tick bites (because if a tick is found, it is usually removed in ample time).

Symptoms of Lyme

There are 3 main “stages” of Lyme disease, and in today’s post we are going to focus on the first stage (called “early localized disease”) which typically declares itself within 1-4 weeks of the bite. You may notice:

• a flat red rash (erythema migrans). This rash is most often seen on the head, neck or arms/legs, but it can be anywhere. It usually expands in size and can look like a bullseye (but this is not always true).

  • Check out this page for examples of the EM rash on different skin colors and this page for another example on Melanated skin.

    The Pediatrician Mom Tip: For melanated kids, the rash can look different and can actually be very mild (it also doesn’t always look like a target). Unfortunately, these patients are at higher risk for a missed diagnosis — one study found that a third of black patients are diagnosed at later stages of disease.

• joint pain or swelling (arthritis)

• fever

• fatigue

• headache

• neck pain

• body aches

Later stages of Lyme disease (if it is missed) can have more serious long-term heart, neurologic or skin manifestations. These can turn up even several months after the initial bite if the condition was not treated. Here is more information.

What about chronic Lyme?

Unfortunately, many questions remain about this condition - we do not yet have any clear criteria that can help with a diagnosis. Symptoms are usually vague (and have some overlap with other post-infectious conditions, such as long Covid).

More than anything, I caution parents to pay close attention to where they get their information. There are many charlatans out there who claim expertise and recommend random (often expensive) “diagnostic” tests, supplements, diets, and more to treat this condition - and take advantage of anxious families who are desperate. Although there are certainly experts on Lyme disease out there, many of these interventions have zero true peer-reviewed research or safety data.

Treatment of Lyme in kids

If a child is diagnosed with Lyme disease, which is often a clinical diagnosis early in the course (based on symptom profile rather than bloodwork), then they will be treated with antibiotics.

Treated properly, Lyme disease is curable. With diligent preventive measures, you can decrease the risk of catching a tick-borne illness while still continuing to indoor the outdoors with your family and pets.

It’s important to prevent mosquito and tick bites. For more information on effective bug repellents, click here, and for some of my favorite products here is my Amazon page.