Recognizing the characteristic rash of Lyme disease is the key to diagnosing this infection early on in the course. Although it can initially look like ringworm or an insect bite, the size and rapid spread of the rash is a tip-off to Lyme disease. For the minority of infected children who don’t show an early rash, diagnosis can be tricky, since other symptoms such as headache or fatigue are vague and non-specific. Diagnosis by blood tests looking for antibodies to the organism causing Lyme disease isn’t very helpful in the early stages. Those tests are often still negative early on, or, if positive, may only show past exposure to the disease but not active infection. Catching and identifying the tick responsible is helpful when it doesn’t turn out to be a deer tick, but testing the tick itself for the Lyme organism isn’t of value. The best advice for diagnosis centers around removal of ticks, speaking with a health care provider and vigilance for any symptoms, particularly a rash. Fortunately, Lyme disease is treatable, especially if caught early, with safe and common antibiotics, and (as of 1998 data), no long-term brain or personality effects in children have been demonstrated.
Prevention & Treatment
Of course the best approach to Lyme Disease is preventing it. During tick season, which usually begins in April, some basic strategies can cut down on the chance of a tick bite. If possible, have children avoid heavily tick-infested woods or grasslands. Have them wear long sleeves and long pants, light colored to make spotting a dark tick easier. Tuck pants into light-colored socks. Ticks cannot fly, so instead drop down from grasses or branches or crawl onto their prey. Judicious use (< 30 percent DEET for children) of insect repellent is helpful, on clothes or skin. (When used on the skin of children, avoid the face and hands and any damaged skin areas, and wash the repellent off after the child comes inside). After children have been playing outside, they should be inspected nightly for ticks, especially in hidden areas like the groin, nape of the neck and behind the ears.
To remove a tick, grasp it firmly with tweezers, forceps or fingers covered with a tissue as close to the skin and by the mouth parts as possible. Pull it out with even traction and either kill it or bottle it for identification. For some high risk individuals, there is a vaccine, but this is not approved for children under 15 years of age.
Though this extra effort makes sense in the high risk areas of our country, paranoia about Lyme disease isn’t necessary. Remember only one to two percent of tick bites end in illness, and a treatable one at that. Currently, physicians are advised by infectious disease experts not to treat this illness on suspicion alone. It is often unnecessary and can lead to the development of hardier germs that become resistant to our antibiotics. Neither are early blood tests recommended, as they rarely provide a firm answer. If a child has been bitten by a tick, remove it as soon as it is noticed. Alerting a health care professional and working with him or her to identify the earliest signs or symptoms of Lyme disease is the best way of striking the balance between over-treatment and appropriate treatment.
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