Lyme disease in children explained

Lyme disease is caused by a bite from a tick that is infected with a corkscrew-shaped bacterium called Borrelia. The disease is prevalent in woodland and heathland areas, but infected ticks can also be found in urban parks and gardens.
 

Ticks are part of the arachnid family, related to spiders. Like spiders, they’re eight-legged, and they are parasites, surviving by sucking blood from a host animal or person.
 
Ticks can be difficult to spot. ‘They can be as small as a poppy seed, but when they’re fully fed, they can grow to the size of a baked bean,’ Julia explains. They also become darker in colour as they feed and grow. They then drop off, often unnoticed.
 
Ticks are also easy to miss because their bites are painless. ‘They have a substance in their saliva that acts like a local anaesthetic, so people are often unaware that they have been bitten,’ says Julia.
 
For this reason, if you’ve been out walking or playing in the natural environment, it’s important to check your child (and yourself) for ticks when you get home.

Firstly, don’t panic. ‘It’s important to remember than not all ticks carry the bacteria that can cause Lyme disease, so a tick bite doesn’t always mean you will be infected,’ Julia reassures.
 
Nevertheless, if you see a tick on your child, it’s important to remove it correctly and as soon as possible, as follows:
 

• Never pull off a tick with your fingers, normal tweezers or any other tool not designed for the job. You should only remove it with a tick remover (widely available from pharmacies, vets, pet shops and online) or a very fine-tipped pair of tweezers.
• Do not smother the tick in oil, Vaseline or any other creams, gels or lotions.
• If you’re using a tick remover, follow the instructions for use. If you’re using fine-tipped tweezers, grasp the tick as close to the skin as possible, then gently pull upwards.
• Take care not to squeeze or crush the tick, and make sure all parts of the tick are removed. ‘If the mouth parts are left behind, the body will expel them naturally, but you should monitor the skin for signs of local infection,’ Julia says.
• Clean the area with soap and water or an antiseptic.
• Try to save the tick as it can be tested for infection.

The most obvious sign of Lyme disease is a rash called an Erythema Migrans (or EM) rash. This is a circular rash that develops around the site of the tick bite. It usually takes between three days and four weeks to appear, but it can take as long as three months before it develops.
 
The rash is often described as a bull’s-eye rash, as it often has a round centre with a circular outer rim, like the bull’s-eye on a dartboard. However, not all EM rashes look like this.
 
Some don’t have a defined centre, or they may have a blister at the centre rather than an area of redness. Equally, they may appear blotchy rather than circular or oval, solid, or look like a bruise.
 
EM rashes are often red, but they may also be blue or purple, and sometimes a yellow colour. They’re not usually itchy, hot or painful, and they don’t normally respond to antihistamines or anti-fungal creams. On some occasions, a person may have multiple rashes across the body, even if they were only bitten once.
 
EM rashes grow outwards as they progress, and can end up as much as a metre wide. It’s a good idea to draw around the outer edge with a biro each day, so you can see how much it’s growing.

It’s estimated that a third of people who have been infected with Lyme disease don’t get an EM rash, so it’s important to be aware of other possible symptoms in your child. These include:
 

• Flu-like symptoms such as a headache, stiff neck, general aches and pains, and sore muscles and joints.
• A high temperature, or feeling hot and shivery.
• Swollen glands.
• Tiredness, loss of energy and difficulty concentrating.
• Bell’s Palsy: a condition that causes one side of the face to droop and not work properly. This is more likely in children than adults and can be alarming, but it usually gets better although it can take some time. 

‘Younger children often can’t articulate how they feel, so look out for other signs that they are feeling unwell, such as changes in behaviour or sleep patterns and general irritability,’ Julia adds.

Whether or not your child has an EM rash, it’s important to see their GP if they have the above symptoms and they have been bitten by a tick or visited an area where ticks are found (such as forests and grassland) in the past month.
 
If your child does have an EM rash, your doctor should diagnose Lyme disease on the spot. They should start treating them with oral antibiotics; the type and dose will depend on your child’s age and weight, and they’re stronger than the antibiotics that are prescribed for milder infections like ear and chest infections. They are likely to need to take these for around three to four weeks.
 
If your child doesn’t have a rash but has other symptoms of Lyme disease and your GP suspects they might have it – for example if you’ve seen a tick on them, or they’ve spent time in high-risk areas – they may decide to give them antibiotics as a precaution.
 
There is a blood test called an ELISA test that your GP can arrange if they suspect your child has Lyme disease. However, a Lyme infection may not show up in the blood until four to six weeks after a tick bite, so a negative result in the early stages may not be accurate. For this reason, the doctor may advise starting antibiotic treatment while awaiting the results, and repeat the test at a later date.

Most people with Lyme disease get better with antibiotics, although the symptoms may last for some time, even once treatment has finished.
 
How long your child’s symptoms last is variable. ‘As with other illnesses, some children bounce back quickly, but others need much longer to get better,’ Julia explains. ‘Some children will be able to go to school while they recover, but some can’t. Lyme disease is a serious infection and the antibiotic doses are high, so plenty of rest is needed.’
 
If, however, your child’s symptoms haven’t improved by the time they finish their antibiotics, or have worsened, they may be given a second course of a different antibiotic.
 
Beyond this point, your child might be referred to a specialist for more blood tests and advice. Bear in mind, though, that symptoms may take a while to resolve.

The best way to deal with Lyme disease is to do everything you can to prevent tick bites, so follow these steps if you’re out and about in the garden, parks or countryside with your child.
 

• Apply insect repellent during outdoor activities. ‘There are lots of repellents, such as those containing citriodol, that are very effective and gentle enough for children’s skin,’ Julia says. Your local pharmacy can offer advice on what to use.
• Dress your child in long sleeves and long trousers.
• Wear light coloured clothing as this makes ticks easier to spot, and brush off any visible ticks when you get home.
• Avoid walking through long grass and stick to pathways if you can. If you do need to walk in long grass, tuck trousers into socks.
• Consider treating outdoor clothing with a spray containing permethrin: a chemical that kills ticks and other insects.
• Shower your child and check for ticks when you get home. ‘They particularly like warm places on the body, so make sure you check your child’s armpits, behind their knees, their groin and hairline,’ Julia advises.
• Keep a tick remover handy in case your child does get a tick bite.
• Although it’s unlikely that ticks will pass from pets to humans, keep pets up to date with their tick protection and check them regularly for ticks, too. 

If you’re following this advice, there’s no need to let the fear of Lyme disease spoil your enjoyment of the great outdoors.
 
‘Be aware of ticks and what they carry, but don’t let the threat of Lyme disease get in the way of allowing your child to enjoy and explore nature,’ Julia says. 

Lyme Disease UK has created an awareness pack specifically designed for children of various ages.