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Should Your Child See a Doctor?

Tick Bite

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Definition

  • A tick (small brown bug) is attached to the skin
  • A tick recently was removed from the skin

Symptoms 

  • The bite is painless and doesn't itch; so ticks may go unnoticed for a few days.
  • After feeding on blood, ticks become quite swollen and easy to see.
  • Ticks eventually fall off on their own after sucking blood for 3 to 6 days.

Causes 

  • The wood tick (dog tick) is the size of a watermelon seed and can sometimes transmit Rocky Mountain spotted fever and Colorado tick fever.
  • The deer tick is between the size of a poppy seed (pin head) and an apple seed, and can sometimes transmit Lyme disease.

Lyme Disease 

  • The risk of Lyme disease following a recognized deer tick bite in a high risk area is estimated to be only 1.4%.
  • Almost all infections start with a bull's eye rash (erythema migrans) at the site of the tick bite.
  • Antibiotics can be given at this time.
  • The routine use of antibiotics following tick bites to prevent Lyme disease is not recommended.

When to Call Your Doctor for Tick Bite

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • You can't remove the tick after trying topic advice
  • You can't remove tick's head that broke off in the skin after trying topic advice (Note: if the removed tick is moving, it was completely removed).
  • Widespread rash occurs 2 to 14 days following the bite
  • Fever or severe headache occurs 2 to 14 days following the bite
  • Bite looks infected (red streaking from the bite area, yellow drainage) (Note: infection doesn't start until at least 24-48 hours after the bite.)
 

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • Red-ring or bull's eye rash occurs around a deer tick bite (Lyme disease rash begins 3 to 30 days after the bite)
  • Weak, droopy face or crooked smile
 

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
 

Parent Care at Home If

  • Tick bite with no complications and you don't think your child needs to be seen
 

Home Care for Tick Bites

Treating Tick Bites

  1. Reassurance: Most tick bites are harmless. The spread of disease by ticks is rare. If the tick is still attached to the skin, it will need to be removed. Covering the tick with petroleum jelly, nail polish or rubbing alcohol doesn't work. Neither does touching the tick with a hot or cold object. Try one of the following techniques:
  2. Wood Tick Removal: Soapy Cotton Ball – Try First
    • Apply liquid soap to a cotton ball until it's soaked.
    • Cover the tick with the soap-soaked cotton ball.
    • Let it stay on the tick for 30 seconds.
    • The tick will usually be stuck to the cotton ball when you lift it away.
    • Source: Dr. Charles Crutchfield, dermatologist, Minneapolis, Minn.
     
  3. Wood Tick Removal: Tweezers: Try Second
    • Use tweezers and grasp the tick close to the skin (on its head).
    • Pull the wood tick straight upward without twisting or crushing it.
    • Maintain a steady pressure until it releases its grip.
    • If tweezers aren't available, use fingers, a loop of thread around the jaws or a needle between the jaws for traction.
  4. Deer Tick Removal: Tiny deer ticks need to be scraped off with a finger nail or credit card edge.
  5. Tick's Head: If the wood tick's head breaks off in the skin, remove it.
    • Clean the skin with rubbing alcohol. Use a sterile needle to uncover the head and lift it out.
    • If a small piece of the head remains, the skin will eventually shed it.
    • If most of the head is left, call your doctor.
  6. Antibiotic Ointment: Wash the wound and your hands with soap and water after removal to prevent catching any tick disease. Apply antibiotic ointment such as Polysporin to the bite once (no prescription needed).
  7. Expected Course: Tick bites normally don't itch or hurt. That's why they often go unnoticed.
  8. Call Your Doctor If:
    • You can't remove the tick or the tick's head
    • Fever or rash in the next 2 weeks
    • Bite begins to look infected
    • Your child becomes worse

Preventing Tick Bites

  1. Prevention:
    • When hiking in tick-infested areas, wear long clothing and tuck the ends of pants into socks. Apply an insect repellent to shoes and socks.
    • Permethrin products applied to clothing are more effective than DEET products against ticks.
     
  2. Tick Repellent for Skin - DEET:
    • DEET is an effective tick repellent.
    • Use 30% DEET for children and adolescents (AAP recommendation 2003) (30% DEET protects for 6 hours)
     
  3. Tick Repellent for Clothing - Permethrin:
    • Permethrin-containing products (eg, Duranon, Permanone, and Congo Creek Tick Spray) are highly effective tick repellents.
    • An advantage over using DEET is that they are applied to and left on clothing instead of skin. Apply it to clothes, especially pants cuffs, socks and shoes. You can also put it on other outdoor items (mosquito screen, sleeping bags).
    • Do not apply Permethrin to skin (Reason: it's rapidly degraded on contact with skin)
       
     

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.


References

  1. Buckingham SC, Marshal GS, Schutze GE, et al. Clinical and laboratory features, hospital course, and outcome of Rocky Mountain Spotted Fever in children. J Pediatr. 2007;150:180-184.
  2. Christy C and Siegel. Lyme disease-what it is, what it isn't. Contemp Pediatr. 1995;12(7):64-86.
  3. Doan-Wiggins L. Tick-borne diseases. Emerg Med Clin North Am. 1991; 9:303-325.
  4. Howard J, Loiselle J. A clinician’s guide to safe and effective tick removal. Contemp Pediatr. 2006;23(5):36-41.
  5. Marshall GS (editor). Tick-borne disease in children. Pediatr Ann. 2002;31:154-208 (entire issue).
  6. Moskowitz H and Meissner HC. Tick-borne diseases: Warm weather worry. Contemp Pediatr. 1997;14(8):33-49.
  7. Rim JY, Eppes S. Tick-borne diseases. Pediatr Ann.2007;36(7):390-402.
  8. Shapiro ED, Gerber MA. Lyme disease: Fact versus fiction. Pediatr Ann. 2002;31:170-177.
  9. Shapiro ED. Lyme disease. Pediatr Rev. 1998;19:147-154.
  10. Tibbles CD, Edlow JA. Does this patient have erythema migrans? JAMA. 2007;297:2617-2627.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 9/23/2010

Copyright 1994-2011 Barton D. Schmitt, M.D.

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