Lyme disease is an infection which affects many children that is often misunderstood by many parents.
One reason for some of the confusion about Lyme disease is that the incidence of Lyme disease varies so widely from state to state. So while awareness of Lyme disease might be high in Connecticut, New Jersey, New York, Pennsylvania, and the other states that get a thousands of cases each year, it is likely low in states like Arkansas or Lousiana, that may only have one or two cases each year.
Understanding more about Lyme disease can help you recognize and prevent an infection in your child and may also help you avoid confusing Lyme disease with other more common childhood infections.
Lyme Disease Symptoms
The first symptom of Lyme disease is the classic rash that most people are familiar with which is known as erythema migrans. This circular rash occurs at the site of the tick bite, about 7 to 14 days after the tick bite, although it may begin as early as 3 days or as late as 32 days after the tick bite.
This erythema migrans rash is usually described as:
- looking like a target or bull's eye, with a central red spot, an area of clear skin, and a red border
- being itchy, warm, and sometimes painful
- gradually expanding to a size of 7 to 14 inches
- lingering for about 2 weeks
In addition to the rash, other Lyme disease symptoms that some children have resemble flu-like symptoms and can include fever, myalgia (muscle aches), chills, headache, fatigue, and joint pain (arthralgia).
Without treatment, children with Lyme disease can also develop:
- early disseminated Lyme disease symptoms, which can occur about 3 to 10 weeks after the initial tick bite and can include multiple secondary erythema migrans lesions, fever, headache, fatigue, conjunctivitis (pink eye), lymphadenopathy (swollen glands), aseptic meningitis, facial nerve palsy (Bell's palsy), and more rarely, and carditis (inflammation of the heart muscle) with heart block.
- late disseminated Lyme disease symptoms, which can occur several months after the initial tick bite, and includes arthritis that most often affects large joints, like a child's knees, and more rarely, chronic neurological symptoms, including numbness and tingling in their hands and feet, shooting pains (radiculoneuritis), and concentration problems.
Lyme Disease Diagnosis
Although tests are available to help confirm or make the diagnosis of Lyme disease, it is usually recommended that children be diagnosed with Lyme disease because they have:
- symptoms of Lyme disease
- physical signs of Lyme disease, such as the classic Lyme disease rash -- erythema migrans
- a recent history of a tick bite or possible tick bite
It is important to keep in mind that not all children have the erythema migrans rash and not everyone remembers having a tick bite, which can sometimes make the diagnosis of Lyme disease difficult.
When Lyme disease testing is done, an ELISA (enzyme-linked immunoassay) or IFA (immunofluorescent assay) antibody test is usually done first. If one of those tests is positive (which can be a false positive) or equivocal, a Western blot test for IgM and/or IgG Lyme disease antibodies is performed next.
Keep in mind that the CDC does not usually recommend that any other kinds of Lyme disease testing be done and does not usually think that the testing of individual ticks is useful.
Lyme Disease Treatments
Antibiotics are the main treatment for children with early Lyme disease and they may include:
- Doxycyline for 10 days
- Amoxicillin (Amoxil) for 14 days
- Cerufoxime axetil (Ceftin) for 14 days
- Macrolide antibiotics, such as azithromycin (Zithromax), clarithromyin (Biaxin), or erythromycin
Doxycycline should not be taken by children who are under eight years old though.
Macrolide antibiotics, such as azithromycin, clarithromyin, or erythromycin, are considered second-line treatment for Lyme disease and are only used when doxycyline, amoxicillin, or cefuroxime can't be used. Because they may not be as effective as first-line antibiotics, experts usually recommend that children with Lyme disease be closely followed to make sure their symptoms go away if are being treated with a macrolide antibiotic.
Children with early or late disseminated Lyme disease may need to take antibiotics for 21 to 28 days.