From the Guidelines
For a child with a recent tick bite in New Mexico, the primary recommendation is to remove the tick promptly and carefully, then monitor for symptoms, and do not routinely prescribe prophylactic antibiotics, unless the tick bite meets specific high-risk criteria, as outlined in the 2021 guidelines by the Infectious Diseases Society of America, American Academy of Neurology, and American College of Rheumatology 1. To remove the tick:
- Use fine-tipped tweezers to grasp the tick as close to the skin's surface as possible.
- Pull upward with steady, even pressure. Don't twist or jerk the tick.
- After removal, clean the bite area and your hands with rubbing alcohol or soap and water. Monitor the child for 30 days for symptoms such as fever, rash, headache, joint pain, or muscle aches. If these occur, seek medical attention immediately. Prophylactic antibiotics are not recommended because:
- The risk of tick-borne diseases in New Mexico is relatively low.
- Most tick-borne illnesses are effectively treated if caught early.
- Unnecessary antibiotic use can lead to resistance and side effects. According to the 2021 guidelines, a tick bite is considered high-risk only if it meets the following criteria: the tick bite was from an identified Ixodes spp. vector species, it occurred in a highly endemic area, and the tick was attached for ≥36 hours 1. If a rash or flu-like symptoms develop, doxycycline is the first-line treatment for most tick-borne diseases, but for children under 8, amoxicillin may be used instead, as doxycycline is relatively contraindicated in this age group 1. Prevent future bites by using insect repellents containing DEET, wearing long sleeves and pants in tick-prone areas, and checking for ticks after outdoor activities. The 2024 American Heart Association and American Red Cross guidelines for first aid also emphasize the importance of early tick removal to prevent disease transmission, and recommend antibiotic prophylaxis for Lyme disease when a tick bite occurs in a highly endemic region and tick attachment is estimated to have been ≥36 hours 1.
From the Research
Management of Tick Bites in Children
The management of a child with a recent tick bite in New Mexico involves several steps:
- Removing the tick as early as possible with fine tweezers, taking the tick's head with the forceps 2
- Inspecting the tick bite area for 1 month for signs of infection, such as erythema migrans or Lyme borreliosis 2
- Considering the risk of tick-borne illnesses, such as ehrlichiosis, tularemia, rickettsiosis, and babesiosis, and seeking medical attention if symptoms develop 3, 4, 5
- Not generally recommending antibiotic prophylactic therapy after a tick bite, unless specific circumstances warrant it 2
Diagnosis and Treatment
Diagnosis and treatment of tick-borne illnesses depend on a high index of suspicion and recognition of clinical features, such as erythema migrans in Lyme disease or spotted rash in a spotted fever group disease 4
- Considering ehrlichiosis in the differential diagnosis of any patient with recent fever, pancytopenia, hepatosplenomegaly, and history of tick exposure 5
- Using polymerase chain reaction or serum antibody titers to confirm the diagnosis of ehrlichiosis 5
- Treating ehrlichiosis with doxycycline, which can lead to rapid clinical improvement if the diagnosis is made early 5
Prevention
Preventing tick bites by covering the body as much as possible, applying repellents to the body, and using permethrin on clothes can reduce the risk of tick-borne illnesses 2