This is a relatively new infectious illness, first identified in the town of Old Lyme, Connecticut, in 1975. The disease is caused by a bacterium transmitted by the bite of infected ticks. Cases of Lyme disease have been reported throughout the continental United States, but infectious ticks seem to be most active in the Northeast, the upper Midwest and the Pacific Northwest. In the Northeast and Midwest, the tick is carried by deer. In the West, the tick is carried by a mouse. The tiny tick's life cycle makes them most active—and likeliest to bite—in the spring and summer.
Lyme disease is progressive. If antibiotic therapy is given in the early stages, most people respond very well. Unfortunately, Lyme disease is often missed for weeks or months because it is not recognized. Response to treatment begun late may be minimal. Joint manifestations begin one week to two years after the initial illness, lasting for weeks to months and usually recurring for several years. Heart inflammation, meningitis and facial palsy can also develop. Lethargy and fatigue may be constant and incapacitating. These late-stage complications are almost completely avoidable with early treatment.
WHEN SHOULD I SUSPECT LIME DISEASE?
Because deer ticks are so tiny, most people never notice being bitten. If you live in an area where infected ticks are active, be suspicious of any flulike illness that your child develops during the spring, summer or early fall.
The first sign of Lyme disease is often a distinctive, circular rash appearing from several days to two weeks after the tick bit. Beginning like a tiny red pimple, the rash expands to a red circle that may be clear in the center, resembling a bull's eye. Even without treatment, the rash will usually disappear within a few weeks. However, nearly half of all people with Lyme disease never develop the classic rash. Among those who do develop a rash, 50 percent go on to have small red blotches and circles in the thigh or groin within several days. Conjunctivitis may also appear.
The next early sign to watch for is a flulike illness, characterized by a headache, aching muscles, fever, chills, painful joints, a stiff neck or a sore throat. Even without treatment, this illness will usually disappear within a week to ten days, although the accompanying fatigue may persist for weeks or months.
If the disease escapes detection in these early stages, many children go on to develop arthritis, abnormal heart rhythms and nervous system problems.
HOW CAN THE PEDIATRICIAN TELL IF MY CHILD HAS LYME DISEASE?
Diagnosis of Lyme disease is difficult. Your doctor will order blood tests to look for antibodies to the causative bacteria, but such antibodies take time to develop, so they may not appear in the early stages of the illness. Therefore, the diagnosis is usually based on a careful history and examination of the child, the child's symptoms and the activity of ticks in your area.
WHAT TREATMENTS ARE AVAILABLE?
If Lyme disease is suspected, the doctor will prescribe an antibiotic—frequently, amoxicillin. The choice of antibiotic depends on the stage of the disease and the child's age and allergic history. When diagnosed early, Lyme disease usually is treated with oral medication alone. If the child has developed the more serious complications of later Lyme disease, she may need intravenous therapy and may require hospitalization.
CARING FOR A CHILD WITH LYME DISEASE
Beyond antibiotic therapy, no special home care is needed for children with Lyme disease. The following steps will aid in the child's recovery from flulike illness and fever:
• Keep the child at home (and, if necessary, in bed) until the fever passes.
• Give acetaminophen (Tylenol) to ease discomfort.
• Give the child extra fluids (juices and soups) to prevent dehydration.
• Encourage the child to resume as many activities as possible after the acute illness passes. Make sure he or she gets some exercise.
PREVENTING LYME DISEASE
Most people in an infested area cannot avoid all exposure to infected ticks. Follow these steps to reduce the risks:
• Teach the child to stick to paved sidewalks and roads instead of walking through leaves or brushing against shrubbery.
• Dress child in light-colored clothing so ticks will show up more easily.
• Spray clothing with a tick repellent containing the chemical permethrin, if it is available in your area.
• Apply repellents containing DEET with great care to exposed skin, except for the face and hands; follow package directions scrupulously.
• When the child comes indoors, first examine the clothing and then strip the child to check the entire body for ticks. Check the hair carefully.
• Similarly inspect and comb pets who go outdoors.
• If you find a tick attached to the child's skin remove it immediately with pointed tweezers. Removing a tick before it has been attached for more than 24 hours greatly reduces the risk of infection. (Try to save the tick for the physician's examination; do not apply any fluids or chemicals to it.)
• Have your child bathe or shower daily, especially after picnics or romps in the woods.
GETTING HELP
Call your doctor if your child:
• Develops a flulike illness in the spring or summer and you live in an area where Lyme disease is common
• Develops a red, circular rash that does not itch.
