From the Guidelines
If you find a tick on your child, remove it promptly using fine-tipped tweezers and administer a single dose of oral doxycycline within 72 hours of tick removal if it's a high-risk bite, as defined by an Ixodes spp. vector species, occurrence in a highly endemic area, and attachment for ≥36 hours 1. When removing the tick, grasp it as close to the skin as possible and pull upward with steady pressure. After removal, clean the bite area with soap and water or alcohol.
Key Considerations
- Monitor the site for 30 days for signs of infection or rash, particularly a bull's-eye pattern which may indicate Lyme disease 1.
- Watch for symptoms like fever, headache, fatigue, or joint pain.
- Not all ticks carry diseases, but prompt removal reduces transmission risk.
- If your child develops a rash larger than 2 inches or experiences fever, headache, or joint pain within several weeks of a tick bite, contact your healthcare provider immediately.
Prevention Measures
- Have children wear long sleeves and pants in wooded areas.
- Use insect repellent containing DEET (10-30% for children, avoiding hands, eyes, and mouth) 1.
- Perform thorough tick checks after outdoor activities, paying special attention to hair, ears, underarms, belly button, waist, and legs.
- Ticks need to be attached for 24-48 hours to transmit most diseases, which is why daily checks and prompt removal are essential protective measures.
Antibiotic Prophylaxis
- For high-risk Ixodes spp. bites in all age groups, a single dose of oral doxycycline within 72 hours of tick removal is recommended over observation (strong recommendation, moderate-quality evidence) 1.
- Doxycycline is given as a single oral dose, 200 mg for adults and 4.4 mg/kg (up to a maximum dose of 200 mg) for children.
From the Research
Tick Bite Guidelines for Children
- Children are at increased risk of Lyme disease, especially those spending extended time outdoors in wooded areas 2
- The disease is transmitted to humans through the bite of the Ixodes tick (Ixodes scapularis and Ixodes pacificus), and typically, the tick must feed for at least 36 hours for transmission of the causative bacterium, Borrelia burgdorferi, to occur 2
- Diagnosis is usually made clinically, and treatment is accomplished with doxycycline or amoxicillin; cefuroxime axetil or erythromycin can be used as an alternative 2
- A network meta-analysis found that oral amoxicillin (1.5 g/day), oral azithromycin (0.5 g/day), injectable ceftriaxone, and injectable cefotaxime were effective for treating Lyme disease, while cefuroxime and penicillin were safe for treating the disease 3
- Amoxicillin was found to be effective for treating erythema migrans, a common manifestation of Lyme disease 3
- Randomized controlled trials have ascertained the efficiency of antibiotics in treating erythema migrans, and oral amoxicillin and doxycycline are first-line treatment options 4
- Ceftriaxone and doxycycline are the 2 most efficient antibiotics, particularly in Lyme arthritis and in neuroborreliosis 4