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Here are some frequently asked questions about Lyme disease, prepared by Andrew Nowalk, MD, one of Children's pediatric infectious disease experts.
What is Lyme disease?
Is Lyme disease important in our area?
How is Lyme disease spread?
What are the symptoms of Lyme disease?
What should I do if I think my child has Lyme disease?
How do I keep my children from getting Lyme disease?
What do I do if my child is bitten by a tick?
Where can I get more information about Lyme disease?
Lyme disease is an infection which children get from the bite of an infected tick. The bacteria that cause Lyme disease, called Borrelia burgdorferi, can infect many different mammals, including humans.
The state of Pennsylvania reported more cases of Lyme disease than any other state in 2014. In the past five years, we have seen a dramatic increase in cases in western Pennsylvania. Recent work we have collaborated on has shown that there is a high rate of infected ticks throughout all the counties of western Pennsylvania, so we expect this to continue to worsen.
Lyme disease develops in stages. In the first few week after an infected tick bites a child, the only symptom is a red rash in the shape of a ring. It expands outwards with time – this rash is called erythema migrans. It can be missed by parents when the rash is in the hairline or on the back. If the infection continues, it can spread to other organs. Lyme disease can affect the nervous system, causing facial weakness and eye drooping, as well as meningitis. It also can affect the heart, causing problems with the heart rhythm, and the joints, causing swelling and pain (called arthritis). At any stage, Lyme disease can also appear to be flulike illness, with fever, muscle and joint pains, and fatigue.
Untreated Lyme can last for months to years. The late stages of infection typically cause chronic arthritis, which can last for weeks to months. At any stage, Lyme disease can also appear to be flulike illness, with fever, muscle and joint pains, and fatigue.
If you observe any of the specific symptoms above — rash, joint complaints, facial weakness — and you think your child may have Lyme disease, you should see your primary care provider. If the symptoms are more serious, you should come to the Emergency Department at Children’s Hospital of Pittsburgh of UPMC.
Depending on the timing of the complaint and the symptoms your child is showing, a doctor may decide to have your child’s blood tested. Keep in mind that blood testing is more accurate the longer the child has been infected. Since a blood test for Lyme disease may not appear positive until four to six weeks after the initial tick bite which causes infection, children with only a rash who are in the earliest stages of disease should not have a blood test, but should get antibiotics. If the first test was negative, a doctor may order a later, second test to confirm the diagnosis.
The antibiotics for Lyme disease are safe and effective. You can expect that your child will receive between two to four weeks of antibiotics, depending on their stage of infection. Antibiotics for Lyme disease (including amoxicillin and doxycycline) are safe and effective. Children who are treated are cured – there is no truth to the myth that you always have Lyme disease after infection. Many children actually generate enough immune response to be protected for some time against a repeat infection. When a child has been treated for Lyme disease and years later develops unusual symptoms such as behavioral problems, chronic fatigue, it is never due to Lyme disease.
Since Lyme disease can only be acquired by a tick bite, checking your child for a tick is the best way to prevent infection. Unfortunately, deer ticks are very small (at younger stages, they are smaller than the tip of a pen). If your child is playing outside in warmer weather, try these simple tips or check out the CDC web site:
If you find a tick on your child’s body, remove the attached tick as soon as you notice it by grasping with tweezers, as close to the skin as possible, and pulling it straight out. For detailed information about tick removal, see the CDC’s tick removal page.
Watch for signs of illness such as rash or fever in the days and weeks following the bite, and see a health care provider if these develop. Your risk of acquiring a tick-borne illness depends on many factors, including:
If you become ill after a tick bite, see a health care provider.
In some cases when you are certain that you have been bitten by a deer tick and it was on the body for at least 36 hours, your provider might give you a dose of antibiotic to prevent infection. This is a change from our practice compared to a few years ago, and so we would encourage you to see your PCP or another provider about this preventive antibiotic.
There are a number of websites with accurate and helpful information about Lyme disease.
Children's Hospital's main campus is located in the Lawrenceville neighborhood. Our main hospital address is:
Children’s Hospital of Pittsburgh of UPMC
One Children’s Hospital Way
4401 Penn Ave.
Pittsburgh, PA 15224
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