What To Do If Your Child Gets a Tick Bite

 

As the weather warms up and summer approaches, many of us are getting excited for weekend family hikes, outdoor BBQs and camping trips. I know I am!

But unfortunately, with the great outdoors, comes the not-so-glamorous reality that there are lots of creepy crawlies out there that can transmit some pretty nasty infections. Yes – I’m talking about TICKS! EEUUWWWW!!! There’s nothing quite as prehistoric-looking and spine-tingling as a tick (except for maybe a cockroach). And the knowledge that the blacklegged deer tick (Ixodes scapularis) – tiny creatures as small as a poppy seed or a sesame seed – can transmit infections such as Lyme disease (Borrelia), Bartonella, Babesia, Erhlichia, Anaplasma, Tularemia, Rocky Mountain spotted fever, relapsing fever, Colorado tick fever, Powassan virus, just to name a few, make them seem somehow even more like something out of a sci-fi horror movie.

The blacklegged deer tick

And if you think that Lyme disease from blacklegged deer ticks is just a concern on the East Coast – think again. A Stanford study in 2014 found that nearly every park in the San Mateo, Santa Clara, Santa Cruz and Mendocino counties that was sampled (these are the parks that I hike with my children!) had ticks that were infected with Borrelia spirochetes (the organism responsible for Lyme disease). Another Stanford study in 2015 sampled additional parks from Sonoma County to Santa Cruz County and confirmed that virtually all of the parks contained ticks that were infected with Borrelia spirochetes, including a newly identified species called Borrelia miyamotoi. And unfortunately, due to the unprecedented rains in the Bay Area this winter, we are expected to have a “banner year” for ticks.

 

Why Worry About a Tick Bite?

The biggest concern with getting a tick bite is the risk of transmission of a tickborne illness. Lyme disease takes the spotlight, with horror stories abounding on the internet, but Babesia and Bartonella can be just as devastating. In children, these infections can become an autoimmune encephalitis called PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome), of which PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) is a subset. Children with PANS/PANDAS develop a sudden-onset of fears, anxiety, OCD behaviors, rages, tics, bedwetting, handwriting regression and brain fog after exposure to certain infections or toxins. An infection like Lyme or strep can trigger an autoimmune, inflammatory reaction in the brain that results in neuropsychiatric symptoms – their brains are literally on fire. PANS/PANDAS and chronic pediatric Lyme disease have become a very large part of my holistic pediatric practice, and while I have been able to thankfully help many of these children recover from this devastating illness using a holistic integrative approach, my preference would be that kids never got it in the first place! And one of the first steps is making sure that we as parents know exactly what to do when our children get bitten by a tick.

(Side note: PANS/PANDAS is such an important issue that I have been interviewed about it to educate other functional medicine practitioners. I will share my interview and blogpost on PANS/PANDAS as soon as it is available, so please stay tuned!)

Prevention is Key

The first and most important step is to try to PREVENT a tick bite in the first place. Prevention includes the following key steps:

  1. Stick to the middle of well-cleared paths. Ticks like to live in tall grassy areas and jump onto your skin as you’re walking by brushing up against the grass, or sitting on a log under a tree to cool down. Make sure that the kids don’t wander into tall grassy or shrubby areas. This is definitely not the time to be going off trail!
  1. Wear the right clothing, in the right way! Ticks can crawl under your shorts or down your shirt to find a nice warm place to take a bite and burrow in. As “uncool” as it may look, be sure to wear long pants and long sleeves and keep your pants tucked into your socks, and your shirt tucked into your pants so there are fewer potential points of entry. Lighter-colored clothing and socks make it easier to spot a tick on your clothes before it finds a way inside, so you can brush it away before it can even take a bite.
  1. Frequently apply a safe and effective insect repellent that works against ticks. I’m not talking about DEET, which I don’t recommend for routine use because of its associated toxicity. You may want to consider permethrin-treated clothing if your child will be spending an extended period of time outdoors in nature (I don’t use this for my kids, and I don’t recommend it for use on the skin directly as there is still toxicity associated with permethrin, especially with excessive use). Several studies have found various essential oils to be effective in repelling and killing ticks. A 2004 study found a lemon eucalyptus extract to be effective in reducing the risk of tick bites. A 2008 study found tansy essential oils to be very effective in repelling ticks by up to 64-72%. Other essential oils that may be effective tick repellents include rose geranium (aka Pelargonium graveolans), clove, lavender, palmarosa, pennyroyal, rose, and sweet myrrh.

If you’re a DIY kinda person, you can certainly make your own essential oil-based sprays, lotions or wipes. Or, if you’re like me and prefer something ready-made, you can try one of the following:

Regardless of which essential oil product you choose to use, the key is to apply frequently, every 2-3 hours or more frequently after sweating or swimming. Remember – essential oils are effective because of their scent. If you can’t smell it, chances are a tick can’t smell it either and won’t be repelled appropriately.

  1. Do frequent tick checks. Ideally, you’ll find a tick crawling on your child’s clothes before it ever has a chance to bite, and just be able to flick it away. But if a tick has bitten, the earlier you find it, the less time it’s had to transmit its saliva that carries the Borrelia spirochetes and other bugs, and the less likely you are to contract Lyme disease and other tickborne infections. Just because a tick carries Borrelia and bites you does NOT mean that you will get Lyme disease. While it’s not entirely clear “how long” a tick needs to be embedded in order to transmit infection, it’s clear that the longer a tick is attached, the higher the risk of transmission. It has previously been thought that the tick must be attached for more than 24 hours to transmit Lyme, but it now seems that just a few hours may be enough – although the risk is much greater if the tick has been attached for over 24 hours. So early tick detection and removal is key to preventing Lyme disease.

While you’re out on the trails, take time to periodically scan their body for ticks. Carefully check behind and in your child’s ears, back of the neck, hairline and run your fingers through your child’s scalp. Look under the collar of their shirt and in  their armpits.  Check their waistline under their pants and any other possible points of entry. You are literally going to be looking for something that looks like a speck of dirt or a new freckle that you hadn’t noticed before. The nymph, the smallest form of the deer tick that is most prevalent in spring/summer, is literally the size of a poppy seed. Until you actually find one embedded, it can be difficult to appreciate just how tiny and difficult to spot they are!

Once you’re back home, take your child’s clothes off and wash in hot water or put in the dryer on high for 30-60 minutes. Take a warm shower IMMEDIATELY to wash away ticks that haven’t fully attached yet, and do another thorough tick check after the bath. Be as thorough as possible because most people with Lyme disease never notice the tick that gave it to them. Ticks love warm, moist, dark areas of the body so check hidden areas especially in or around the ear, hairline and scalp, bellybutton, armpits, groin/genitalia, or areas where clothing was pressed against the skin (waistline, underwear line, neckline).

  1. Check your pets. Pets can carry ticks into your home after being outside. They can also contract Lyme disease, so be sure to do a thorough tick check after you’ve taken your dog for a hike, or if they’ve just romped around your backyard that deer and other animals sometimes frequent.
  1. Check your gear. If possible, wash your backpacks and camping gear, or at the very least do as thorough an inspection as you can and shake everything out. A little tick found its way home from one of our camping trips, and being so tired, I just put away Kenzi’s unworn clothes back into her drawers instead of washing first (I know! What was I thinking?!?!). Of course, the next morning, Kenzi goes to put on some socks before we head out to school, and comes back and asks me what the little bump on her leg is! I knew it had only been attached for possibly 5 minutes, so I didn’t panic (much), and followed the plan outlined below.

What to do if your child gets a tick bite

The first thing to do when you find a tick on your child:

STAY CALM and DON’T PANIC!

The first time I found a tick on my son after we had been swimming in a river in Mendocino County, I thought there was a speck of dirt on his chest. But when I tried to flick it off and it didn’t budge, my heart sank and my stomach churned because I knew exactly what it was. It took everything in me to not freak out and show the panic in my eyes as I was gently pulling it out, all the while holding my breath. The next time I found a sesame seed-size tick was in my daughter’s ear while I was giving her a bath after she had been playing in our front yard. (We live in a suburban town in the Bay Area, but we do have deer that sometimes wander through our yard from the hills, so I’m sure some deer ticks were deposited on our grass as they were passing by – yikes!). Even this second time around, I thought it was a speck of dirt and tried to pick it off with my finger nail. I didn’t feel any less like freaking out, but somehow I managed to keep it together!

The second thing is to REMOVE THE TICK.

How to remove a tick

There are several things you should NOT do when your child has a tick bite, besides not panic.

DO NOT use Vaseline, gasoline, fingernail polish, rubbing alcohol, or any other caustic substance on the tick.

DO NOT put a lit match next to the tick or squeeze or crush it.

Doing any of these can inadvertently cause the tick to regurgitate more of its saliva that carries Borrelia and other infections into your body.

What you SHOULD do:

  1. Have a small Ziploc bag open and ready.
  2. Use fine-tipped tweezers to grasp the tick as close to the skin as possible without crushing it. Pull with gentle steady pressure up away from the skin. BE PATIENT. Keep the pressure steady. This is where you might find yourself holding your breath trying not to scream like I did. Don’t twist or jerk up as this may cause the tick to break off leaving its mouthparts still embedded in the skin.
  3. After a little while, you’ll feel a sudden give as the tick releases its hold. DON’T PANIC and drop your tweezers! Gently put the tick into your Ziploc bag and close it (or if you’re like me, drop the tick, tweezers and all and zip that bag as fast as you can and then breathe because you’ve just been holding your breath for 5 minutes). Place a small moist cotton ball or piece of paper towel in the Ziploc bag so the tick doesn’t dry out before you send it for testing.
  4. If you’ve pulled out the tick but the head and mouthparts are still embedded, don’t dig around and try to get it out. Head to your local urgent care or your doctor to safely remove it completely.
  5. Immediately wash the area with warm water and soap, and apply tea tree oil or any other antiseptic that you have on hand.
  6. Note the site of the tick bite, and draw a circle with a ballpoint pen around the bite site so that you remember where it is.

(There are various tick-removing devices available. I’ve tried a few but I honestly haven’t found any as effective as a pair of good ‘ol-fashioned tweezers)

What To Do After a Tick Bite

Now that the tick is successfully removed, what next? What do you do with that little baggie holding that fear-inducing poppy-sized vermin? Do you give you child antibiotics? Do you just wait and see if your child develops symptoms of Lyme disease?

Remember: The goal is to PREVENT LYME DISEASE. Lyme disease, if caught early and treated appropriately does NOT have to go on to be a devastating chronic illness.

Get the Tick Tested

The first thing I recommend doing immediately once you’re back home is to send the tick to a lab to determine whether or not it even carries Lyme or other tickborne infections. There are various labs that will identify whether the tick is a blacklegged deer tick and if it carries Borrelia burgdorferi or other tickborne microbes. I do recommend checking for co-infections, and not just for Borrelia alone. Ticks can carry and transmit more than one infection, and knowing what symptoms to watch for can be very helpful in early diagnosis. One of my daughter’s ticks tested positive for Ehrlichia which she fortunately did not develop, and I was thankful to know to look for any subsequent symptoms of Ehrlichiosis rather than Lyme disease.

I recommend tick testing through IgeneX,  the Bay Area Lyme Foundation or TickReport. The turnaround time is unfortunately about 3 weeks for IGeneX and the Bay Area Lyme Foundation. The turnaround time for TickReport is 3 days from receipt of the tick. I trust that their results are accurate and don’t want to have any doubts in my mind. But in the meantime, while you’re waiting for results, you’re still stuck with the question of whether or not to take prophylactic antibiotics.

Should I Give My Child Antibiotics?

To take prophylactic antibiotics or not – that is the question. Prophylactic antibiotics may prevent the development of Lyme disease if given as soon after the tick bite as possible. One study showed that a single 200mg dose of doxycycline given within 72 hours of tick attachment may be effective in preventing the classic erythema migrans rash within 4 weeks of a tick bite; however, the development of a rash is not necessarily a good endpoint as many people with Lyme disease never develop a rash, and this study had no long-term followup to determine if patients went on to develop symptoms of chronic Lyme disease. Most Lyme-literate practitioners do not believe that a single dose of antibiotics is adequate to prevent Lyme disease, and that at least a 3-week course of antibiotics is needed to ensure that you kill the Borrelia in all of its life forms – the free-floating spirochete form, the evasive cell wall-deficient form, and the dormant cyst form. If you stop antibiotics too early, you may not kill the Borrelia that is hiding out in its dormant cyst form and waiting for just the right moment to reactivate and convert to its free-floating spirochete form to cause trouble at a future date.

But antibiotics? Are they really necessary? And especially if your child already has gut issues, or you’ve worked so hard to heal his gut? Well, uh, in this case, I would say “YES!” After caring for too many children and parents with chronic Lyme disease and other tickborne infections, I would rather mop up the after effects of gut dysbiosis and increased intestinal permeability (“leaky gut”) than mop up the after effects of chronic Lyme disease.

The antibiotic chosen may be herbal or pharmaceutical, or a combination of both. But remember – the antibiotic(s) chosen should be taken for a minimum of 3-4 weeks. For adults, a 3-week course of Doxycycline may be recommended. Doxycycline should not be given to children, so Amoxicillin and Azithromycin are typically used instead. Herbal antimicrobials targeted to Lyme and coinfections can also be used alone or in combination with pharmaceutical antibiotics. Just remember, though, that herbal antimicrobials can still disrupt the gut microbiome like antibiotic drugs, and the gut needs to supported just as fully as outlined below. The manufacturers that I recommend for herbal formulas for Lyme and coinfections include BioResource, Researched Nutritionals and Beyond Balance.

Stephen Buhner, a highly regarded Lyme herbalist, recommends the herb Astragalus with adult dosage of 3000mg daily for 30 days after a new tick bite. For prevention, Buhner recommends that adults take Astragalus 1000mg daily during your time in a Lyme-endemic or tick-infested area may be helpful in boosting your immune system and preventing Lyme transmission. This may be a good option for you and your family if you live in a high-Lyme area and don’t want to potentially be on antibiotics for the entire season…

Immediately after a tick bite, Buhner has also found applying a topical paste made of andrographis tincture and green clay to be helpful in preventing infection. Topical 10% azithromycin gel applied 3x/day to the site of attachment for the first 48 hours has been suggested to prevent the transmission of Lyme. However, findings are unclear, so I do not recommend this as sole treatment at the moment.

If you or your child does get bitten by a tick, please discuss what antimicrobial regimen is best with a Lyme-literate practitioner.

Bottom line: I would strongly consider giving your child an antimicrobial medication, pharmaceutical and/or herbal, for at least 3-4 weeks after a tick bite, no matter how long I think the tick was attached.

How do your support your child’s gut with antibiotics?

Kimchi – Korean pickled cabbage

The gut can and should be fully supported while taking antibiotics for Lyme prevention. The goal is to minimize disruption to the gut microbiome and prevent gut dysbiosis and leaky gut. Be sure to give your child probiotics at least 1-2 hours after each antibiotic dose. To help you choose the best probiotic for your child, you can download my Guide to Choosing Your Child’s Probiotic. Load up on awesome fermented foods like sauerkraut, beet kvass, “real” pickles like Bubbies, kimchi, miso soup, kombucha, coconut kefir and yogurt (if you tolerate dairy). Drink bone broth for all that healing glutamine and gelatin to support the small intestinal lining and prevent leaky gut. And be sure to eat a whole foods diet full of variety and color to ensure that your child’s gut gets all the phytonutrients it needs to stay healthy during this time.

Watch for Signs of Lyme Disease

Erythema migrans – the “classic” bullseye rash of Lyme disease

While the above precautions can be very effective in preventing Lyme disease, there may still be occasions where it’s not enough. Watch the site of the tick bite for an expanding bullseye rash, and watch your child for symptoms of acute Lyme disease. Only about 50-60% of patients with Lyme disease ever develop the classic “bullseye rash,” or erythema migrans, with a red ring that expands outward from the site of the bite. The vast majority of people with chronic Lyme disease never recall having a rash, so you want to watch for the other signs and symptoms of Lyme disease to know when to go see your doctor.

Acute Lyme disease can develop anywhere from 3 to 30 days after a tick bite so you’ll want to be on guard for at least a month. Although again, if you’ve taken the above precautions, the chance that your child will develop Lyme disease is significantly lowered and you can breathe a little easier!

Go immediately to your physician if you or your child develops any symptoms of early or late Lyme disease below. The following list can also be found in a convenient Lyme Symptoms Handout from the Bay Area Lyme Foundation. Remember, most people with Lyme disease don’t remember being bitten by a tick, so for some, late-stage Lyme symptoms will be their first sign of Lyme disease.

Early Localized Stage (days to weeks after tick bite)

  • Skin rash, commonly — but not always — a circular or bullseye rash around the bite area
  • Headaches or stiff neck
  • Flu-like ailments, including fever or chills
  • Muscle and joint pain
  • Profound fatigue or lack of energy
  • A small bump or redness at tick bite
  • Swollen lymph nodes

Early Disseminated Stage (weeks to months after tick bite)

  • Expanding skin rash (more or larger rashes covering more parts of the body)
  • Pain or numbness in arms and legs
  • Extreme joint pain
  • Profound fatigue
  • Headaches and lack of energy
  • Fainting
  • Bell’s palsy (facial paralysis)
  • Poor memory or inability to concentrate
  • Heart palpitations

Late-Stage Lyme (months to years after tick bite)

  • Arthritis, particularly in the knee or near the point of infection
  • Nervous system problems including numbness and tingling in hands, feet, or back
  • Severe headaches or migraines
  • Problems with memory, hearing, and vision
  • Stiff neck due to swollen tissues
  • Chronic fatigue
  • Problems with mood or sleep
  • Inflammation of the brain
  • Inflammation of the heart

PLEASE NOTE that in children, symptoms of Lyme may also include behavioral changes (anxiety, depression, fears, OCD behaviors, tantrums/rages), tics, developmental regressions (i.e., deterioration in handwriting), brain fog, slowed cognitive processing, and memory problems.

If your child does develop signs of Lyme disease, please demand that your physician order more specialized Lyme testing through a lab like IGeneX or at the very least order a complete Lyme IgG and IgM Western blot and not simply a Lyme antibody screen with a reflex to Western blot. Unfortunately, the diagnosis of Lyme is highly controversial, but you do NOT want to miss a diagnosis of Lyme disease. Due to the inaccuracy of current testing methods, even the CDC recommends basing the diagnosis of Lyme on clinical symptoms and not on laboratory findings. If your physician will not test appropriately or is not well-versed in Lyme disease, please find a Lyme-literate practitioner near you through ILADS (International Lyme and Associated Diseases Society).

What else can I do to prevent Lyme disease?

I often wonder why it is that some children go on to develop PANS or chronic Lyme disease from a tick bite, and other kids do not? Why do some adults go on to develop chronic Lyme disease with devastating neurologic symptoms, and others develop no symptoms at all?

I believe some of the answers lie in:

  1. Early detection and treatment

These are all the steps that you’ve already taken above! 😊

  1. Supporting any suspected underlying methylation or mitochondrial dysfunction

Many of the kids that I see with chronic illness, including PANS/PANDAS, have subtle red flags that they may have had underlying methylation and mitochondrial dysfunction that predisposed them to a greater risk for complications and long-term effects of certain chronic illnesses. These red flags include low energy, poor endurance, sensory issues, regressions after illness or prolonged recovery time compared with peers. They also include a family history of autoimmune illness, atopic disease (eczema, asthma, allergies), neurodegenerative disorders (autism, Alzheimer’s, Parkinson’s, etc.), mental health disorders, infertility, blood clotting disorders, and early heart disease.

If your body is trying to fight off Borrelia or other tickborne infections, its methylation and mitochondrial stress have increased. If your methylation and mitochondrial function is already impaired, then this added stress can tap out your reserves and be the proverbial “straw that broke the camel’s back,” so that what seems like a sudden development of neuropsychiatric symptoms is really the culmination of a long backstory of previous methylation, mitochondrial, immune, and detoxification stressors.

How do you support your child’s methylation and mitochondrial function? After a tick bite, you can add supportive supplements like methyl-B12, l-methylfolate (or L-MTHF), coQ10, ribose, and L-carnitine.

But we’re talking about true prevention. So even before that tick bite ever occurs, optimize your whole family’s health with the steps below to bolster everyone’s defenses.

  1. Optimizing health

Optimal health begins with the gut and ends with the heart. Optimal health means supporting body, mind, and spirit with the following steps:

  • Ensure a healthy gut microbiome with fermented foods, bone broth, and probiotics.
  • Eat a diet rich in whole, unprocessed, organic foods with a variety of phytonutrients (a rainbow of fruits and vegetables), healthy fats and wild, free-range proteins.
  • Avoid pesticides, heavy metals, and artificial flavors, colors and preservatives.
  • Supplement lacking or insufficient nutrients such as omega-3 essential fatty acids (i.e., fish oil), vitamin D3, zinc, and magnesium.
  • SLOW it down and teach your kids to manage stress through mindfulness and meditation (for tips on how to do this, see my blog post on the Holistic Management of Anxiety.
  • Get outside in nature as often as possible (while watching for ticks!).
  • Get enough sleep! Check out my blog posts on sleep: The 3 Things You Need to Know to Get a Good Night’s Sleep and Eat Yourself to a Good Night’s Sleep.

 

There you have it! All the steps you need to take if you or your child gets a tick bite! Knowledge is power, and armed with the right information, your whole family will enjoy a healthy, happy summer in the great outdoors!


Thank you so much for taking the time to read this very important blog post on how to prevent and treat tick bites and hopefully prevent chronic Lyme disease. Please share with any family who loves spending time outdoors in nature, so we can all do our best to keep our children healthy and happy for a lifetime!

xo Holistic mama doc – Elisa  Song, MD

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50 Comments
  1. Thank you for this article. My son had a tick at the back of the neck. He was away with his father and complained of a sore neck Friday evening Howe we it was Sunday lunch before I saw him and discovered the tick. We removed it and had it tested, and it was Lyme carriage. We had gone straight to urgent care and started antibiotics immediately for the course of 2 weeks I think. After the tick results came in we blood tested my child and he had no antibodies of exposure. Should I still be worried? It’s been almost two years

    • Hi Shae,

      Remember, not everyone who gets a tick bite will get Lyme, even if the tick has been attached for a long time. If your son is healthy and developing normally and thriving, then I wouldn’t worry and just do your best to keep him as healthy as possible!
      xo Elisa

  2. Thank you, Elisa, for this really balanced and comprehensive article. Here in the French Alps tick-borne diseases are endemic but there is surprisingly little awareness of them, let alone prevention. As a result, even in our village, I know of several people trying to cope with chronic Lyme, which is not always recognized as such by the medical establishment. A few years ago I developed an erythema migrans rash but immediately knew what it was and got 4 weeks of antibiotics resulting in no further symptoms. Your focus on knowledge and prevention is certainly the key. I don’t have young children at home now but always find your articles interesting and informative.

    • Hi Mary – Thanks so much for your kinds words! Yes – knowledge is power so hopefully more and more people become Lyme-aware…
      xo Elisa

  3. OMG! Get the tick repellant that is not toxic and works! From Montana Farmacy also on Etsy, or make it yourself with essential oils. The recipe is in the book “HEALING LYME”.
    If you get bitten, use andrographis tincture and bentonite clay on the bite. Be prepared, have it on hand. Take 1-2 grams Astragalus everyday to prevent Lyme and other infections. Throw it in juice or a smoothie, or take it by the spoon or capsule.

    • Thank you for your thoughtful comment!
      🙂 Elisa

  4. Thanks for this. Another acupuncturist momma told me she gives her kids ledum homeopathy after they get tickS. Would you do this too? If so, what dose and for how long?We check ourselves throughout the day and every night. I’ve already found 5 ticks bites in my 21mo son this year. (One was in his scalp which I found by chance… I don’t even know how to check the scalp so I just look through it whenever I get a chance.) anyway, if I followed the antibiotic recommendation then he would have been on them for several months already. Luckily we do many healthy practices and I think he is ok. Ooh- such a rich topic… I could go on….

    • Hi Rachel,

      Ledum may be helpful in preventing insect and tick bites, but I don’t know that it would prevent Lyme transmission after a tick bite. However, to use it preventatively, many people will take Ledum 9C or 30C 3 pellets 2x/day when going in a mosquito or tick area. I do like Steve Buhner’s recommendation for astragalus when in a Lyme-endemic area for a prolonged time, because yes – for many kids they would potentially be on antibiotics year-round! Best of luck! There are no clear dosage guideliness of astragalus for kids. But it generally is considered safe, although I would use caution if you have an autoimmune illness. Best of luck!
      Elisa

      • Thanks! Found another one on him again today, ugh. What form is easiest to give astragalus to kids? is there a glycerin tincture? could i put it in his morning oats?
        thanks again.

        • Hi Rachel! Herb Lore (www.herblore.com) makes a great glycerin-based astragalus tincture. Herbs for Kids makes one as well. I’ll put a post soon on different strategies to get supplements into kids :-), but yes – in oatmeal, a little bit of smoothie, or apple sauce are all options!

          xo Elisa

  5. Do you do treatment for kids with Pandas? Both mine have been diagnosed and have been on ABX almost a year with only small improvements in their streph titres.

    • Hi D’Anne. Yes, my partner Dr. Trolan and I both treat kids with PANDAS. I’m so sorry for your struggles! PANDAS can be so devastating. I wish you and your children the best. If you would like to consult with our practice, Dr. Trolan practices in the very same was as I do and is currently accepting patients. You can go to http://www.wholefamilywellness.org for our practice information. Best of luck!
      xo Elisa

  6. Thank you Elisa, such a great and informative post. Just a question though, you are most likely to be outdoors when you have a tick bite – so any tick removing advice for when you are outdoors? (When you won’t have access to tweezers or zip doc bag)?

    • Hi Vivian! You know, when I’m going to be hiking or outdoors, now I actually always carry a baggie and tweezers with me… Otherwise, if you don’t have access to supplies and won’t be back home within an hour or two, I would pull the tick out as carefully as possible with your fingers if you can and then watch closely for symptoms of Lyme or coinfections. Take care!
      Elisa

  7. Great article! Thanks so much for this thorough article. You can get the tick tested through UMASS. I had my complete results from my test within six days of mailing my tick. I live in San Francisco and sent the tick with Priority Mail. The cost for a complete test (with additional tick-born diseases besides lyme) and turn around are much better than any other company I researched.

    • Thx, Daniela! Leaving off Tick Report was my oversight. Thx for reminding me! I added them in as a resource, as well as a reminder to check for co-infections.
      🙂 Elisa

  8. Hi, My family and I were camping over Memorial Day near Manteca CA(Friday to Monday). The Mosquitoes were fierce so we kept well covered and used bug spray… no showers for 4 days. On Tuesday AM I saw a bit on my almost 9-year-old’s shoulder that looked different from the rest. It was very symmetrical and about the size of a quarter. It wasn’t raised much or puffy like the rest. My son said it didn’t itch like the rest. I watched it fade for a week with little alarm (but took picture along the way). Yesterday my son woke up with a larger, darker bullseye beyond the original boundary. We went to his pediatrician that day. The pediatrician insisted we would have seen the tick. No tick, no Lyme he said. He’s certain it is just a secondary infection from scratching. I did mention that all his bites were scratched to the point of bleeding and wondered if he could have scratched the tick out himself. He said no way. He does still have other inflamed bites that are quarter sized but they are raised, not symmetrical, and still itch. This one doesn’t itch and hasn’t been itching. He thinks the bite behaves different from the rest because it was a spider and the rest were mosquitoes.
    He explained that Doxycycline would not be given to my son because of he age. I asked about Amoxicillin and Azithromycin. He said studies say they don’t work. The doctor is sending pictures to the infectious disease department of Kaiser. My son was given a 10 day course of Cehphalexin to fight the bacterial infection and topical Hydrochrtisone. He told me to watch for flu symptoms.
    Should I follow his directions or get a second opinion? I found you because you are the pediatrician to my friend’s family and she suffers from Lyme’s Disease herself.

    • Oh my goodness, Laura – what a quandary. Most infectious disease doctors would say if there is a bullseye, that is “pathognomonic” for Lyme disease (meaning not really anything else does that), and would go ahead and treat. The difficulty is that there is conflict between ILADS (Lyme-literate docs) and IDSA (conventional ID docs) about how to diagnose and treat Lyme disease. If it really does look like a bullseye, however, I would take my child in for a second opinion. The Bay Area Lyme Foundation has great resources, including this link to an article on their page http://www.bayarealyme.org/lyme-disease-prevention/protect-yourself-your-family/ which points out that most people DON’T notice a tick bite. Click on the link on their page that reads: “See this article from the California Lyme Disease Association and Sonoma Mosquito & Vector Control”.

      Best of luck!!!
      Elisa

      • Thank you for your comprehensive article and for responding to my reply so quickly. Please thank your staff for me as well. I called them today, and they were very helpful in giving me the names of Lyme specialist in the area. I have a second opinion scheduled for early next week with a Lyme specialist. Who knows where this will go. It just feels good to know I’m doing all I can to help my son stay healthy. Really, thank you!

    • Definitely seek out a Lyme literate doctor. My daughter had a homogeneously red circular rash (not bull’s eye and not expanding and also did not itch). I went to multiple doctors within Kaiser, and they all refused to treat with antibiotics, thinking that it was not Lyme. Along with their ignorance of diagnosing Lyme, they also were not knowledgeable at treating Lyme and its co-infections. I contacted ILADS and took her to a Lyme literate doctor. It turned out that she had 3 co-infections, along with Lyme. Infectious disease doctors do not treat long enough to typically treat the infection. Also, multiple medications may be needed to treat various co-infections. My daughter is on three antibiotics, one anti-malarial med. and one herbal (along with good pro-biotics) and has been for many months. After 9 months of treatment, she has just recently lost most of her symptoms. They were subtle and difficult for us to detect. Please seek out a Lyme specialist to make sure you treat your son accordingly now. Godd luck!

      • Yes yes yes, Penny! So important to work with a Lyme-literate doctor who is familiar with the ILADS approach… Thank you!
        xo Elisa

  9. My mother will take our almost 12 yr old son for a 10 day sailing trip around Santa Cruz Island off the coast of Southern CA in July. They anchor, hike, Snorkel, etc…. although there are trails-they often do get overgrown as less and less people do this anymore… and with the rain I am a little concerned about ticks.
    I have Hashimotos and my husband has MTHFR gene mutation -so we are familiar with autoimmunity and hope to help our son prevent this…. but while my mom will give token concern to ticks- I don’t think she is vigilant at all….
    so my concern is that I won’t be able to check my son til after about 12 days from his first exposure.

    If my mom actually finds a tick…. but we can’t get medicine for 12 days… how bad is this?
    I am wondering if I should try to get a Dr to give us a dose of Antibiotics-for them to take with them just in case?

    The island is 25 miles of the coast- it is a 6 hr sail on average -with only Coast guard radio -ship to shore communications… no cell service.
    Any feedback you might have would be great!

    • Hi Shannon,

      What an amazing adventure for your son! But yes, ticks could be a concern. Your son can definitely be involved in doing his own tick checks so you can practice that even while you hike before he leaves. It may be challenging to find a doc who is willing to write a prescription for prophylactic antibiotics… I know for my daughter who will be at outdoor Girl Scout camp for 2 weeks, I am planning to give her astragalus 500mg daily… I also will have a ziploc bag and tweezers in her backpack at all times.

      Best of luck!
      Elisa

  10. This is a fantastic article. Thank you!

    You mention deer as the primary culprit for transporting ticks, but my understanding is that they hitchhike on mice and chipmunks more frequently, which is why ticks and ticknorne illnesses are an increasingly suburban phenomenon. One theory suggests that the tick population is cyclical and this year’s numbers are so high (in our area, at least) because the rodent population thrived last year because we had such a bumper crop of acorns, etc. the year before that. Any thoughts on the validity of these ideas?

    • Hi Amanda,

      Thanks for your message! I’m not sure that rodent are the primary carrier, but you are absolutely right that they can carry the Ixodes tick and are absolutely contributing to the tick/Lyme problem we are having. The trails around me have rodent traps for that very reason!

      Sincerely,
      Elisa

  11. Back in November I had the classic bullseye rash on my righ calf. It took a full month to go away. No other symptoms have developed. I went to the doctor, she did a test where one marker came back positive but nothing else. She sent it for western blot, nothing. No antibiotics was prescribed. Do you think this is something I should look out for in the future? I found it interesting that I have had no symptoms other than the rash.

    • Hi there – that is very interesting. Many doctors would treat a bullseye rash without even checking a western blot as it’s pathognomonic for Lyme disease. But, if your immune system is strong, it’s very possible that your body can deal with Lyme or other infections effectively even without antibiotics. That would be awesome, and I hope that’s the case for you! I just would be aware that if unusual symptoms develop in the future, it may be nothing, but I personally would want to get tested for Lyme just in case a reactivation occurs.

      Best to you!
      Elisa

  12. Thanks for a great article! I’m going to share this with my community.

    I know this article is more about prevention and what to do right after a bite but because you’re so knowledgeable on this topic I’m curious what you feel about the new testing that Dr Klinghart is talking about for chronic Lyme detection and treatment (developed with radiologists Dr. Marco Ruggiero). I heard him share this on the upcoming Chronic Lyme Summit II: “we have set up a certain sequence of using ultrasound on the brain, on the thymus, on the spleen, on the vagus nerve, and on the brain stem. We drive out the microbes, and then we collect the urine and find the microbes. This is by far the best test we use – the PCR testing – looking for whole strands of DNA of the bugs in the urine.”

    In this same interview he says “Most of my patients with severe, persistent Lyme disease have never had a tick bite. They had a spider bite or a flea bite or a bite from a stinging fly. So these are insect-borne diseases but not tick-borne diseases.” This is a scary thought and I’d love to hear your thoughts and what you see with patients.

    I don’t work with clients to address their Lyme disease but refer out instead. However I do like to be well informed so they can get them the best help there is. While they are working with a Lyme literate doctor I am supporting their Lyme anxiety with GABA, theanine and tryptophan and diet so SSRIS and benzodiazepines don’t have to be added into the mix.

    Thanks!

    • Hi Trudy,

      I’m not sure that I agree that most patients have never had a tick bite. Mosquitoes have been found to be vectors, so I’m sure that other insects could be vectors as well, although I haven’t seen any confirmation of this in the literature. On the other hand, most people have no recollection of a tick bite because they are so small and often go undetected, and many never develop the classic bullseye rash. I think Dr. Klinghardt is brilliant, though, and his detection methods for chronic infections is absolutely cutting edge and beyond what most practitioners can do or are even aware of. It will be fascinating to see if his ultrasound provocation method will help us to identify the likely thousands of patients who have Lyme and other chronic infections that are going undiagnosed. And in the meantime, for patients who are suffering without or without a diagnosis, targeted amino acid therapy and dietary interventions that you do with clients is absolutely critical to restoring balance and harmony to their systems so that they can more effectively handle the psycho emotional stress of their illness AND their immune systems can more effectively fight their infections. So grateful for the work you do!

      Sincerely,
      Elisa

      • Thanks for the feedback and good point about the size of the ticks and no bulls-eye rash

        I have 2 follow on questions
        1) I appreciate that you are opposed to DEET and recommend essential oils but you do mention permethrin-treated clothing too. Do you have any concerns about toxicity?

        2)I know you are assessing for and treating pyroluria (a social anxiety condition for readers here who may not be familiar with it.) Dr Klinghardt feels Lyme disease cannot be successfully treated until pyroluria is addressed. I’m curious if you’ve seen a connection?

        • Hi Trudy! I do have concerns about permethrin toxicity, but if you’ll be in a tick-infested area for a prolonged period, I think that wearing a light t-shirt and then having a permethrin-treated outer layer may be reasonable. And yes, I definitely see a connection with pyroluria and not just Lyme but any infection that can cause PANDAS/PANS. I don’t know what comes first though – if a chronic infection triggers metabolic imbalance with subsequent pyroluria, if or pyroluria sets the stage for immmune imbalance and subsequent chronic infection. But yes, both need to be treated simultaneously if present…

          Take care!
          Elisa

  13. I loved your article THANK YOU! I am having a difficult Mom moment. I am working with LLMD’s as I’m recovering from Lyme, Bartonella and a parasitic infection. I’ve been almost bedridden for 6 months.
    My almost 15-year-old only child went to Boy Scout camp this week in an area of Oklahoma where my husband and I were a bit repeatedly by ticks 18 years ago. There are so many there! I’m trying to be a good mom and not to deprive him of his childhood or make him absorb my paranoia. We armed him with all the right tweezers, tape rollers, alcohol, Ziploc baggies and powerful sprays to keep them at bay. He called home today homesick and after four days of backpacking in the mountains there he told us he had been bitten by at least 10 or more that had attached. They were small. Too small to save he said as they were squished when he pulled them out. He found them the same day and checked as diligently as any 14-year-old boy would. He will be home Saturday for two weeks before he takes a two week backpacking trip in the mountains of New Mexico with my husband that is a lifelong dream of his. I was prepared for a bite but not this many! He is not having any symptoms or illness but I feel the need to treat regardless for 3 to 4 weeks. The question is what with? I don’t want him sick for his New Mexico trip and I’m not sure what is the best thing to treat him with? Can you treat teenagers with Doxy? Does it cause sun sensitivity? None of my LLMD’s take insurance and all are hugely expensive. I could make a “antibiotic” of essential oil in a vegetarian capsule? I’m trying not to have a nervous breakdown. Thanks in advance for any advice.

    • Oh Shari – what a difficult place to be in! I totally hear where you’re at, and I would definitely be flipping out a bit, too! I guess it really depends on how healthy your son is at baseline, because not everyone who gets bitten by a tick that carries Lyme will actually get Lyme. But I know it’s especially frightening for you because you are experiencing the horrors of chronic Lyme disease firsthand. While I can’t give you specific medical advice for your son, if he were my child, I would give Amox and Azithromycin for 3 weeks and watch closely for any suspicious symptoms. I would not give my child Doxy because of the sun sensitization. Best wishes to you and your son, and I hope that you find recovery and healing soon!
      xo Elisa

  14. My son was bitten by a tick about a year ago and his lymph nodes in his armpit swelled up immediately. I gave him Biocidin for a month and after one dose his lymph nodes returned to normal. He exhibited no other symptoms so that was all we did. Then a few months later he said his arms hurt. I immediately thought Lyme and took him to a naturopath who found a whole list of coinfections along with Lyme which she is treating with Dragon Pearls formula. My question is when does the window close on giving antibiotics. Would it be too late now? He is not exhibiting any symptoms so I’m hesitant to go that route.
    Thanks!

    • Hi Angela,

      Tough question. There really isn’t a window that closes for using antibiotics. But if a child doesn’t have symptoms and is doing well, then making sure to keep the immune system and gut strong and healthy is really the best way to make sure that whatever infections are present remain in remission.

      Good luck!
      Elisa

  15. Appreciate the call-out of Oil of Lemon Eucalyptus repellent products as a deet-free alternative. Healthy non-toxic tick & mosquito repellents safe for kids and pets – good tip to re-apply often. Our Cape Cod All Natural products are available at the National Seashore Store and registered with the CDC and select retailers and farmers markets and now Online.
    capecodnaturals.com

  16. An excellent and thorough article! My son contracted Lyme seven years ago when he was ten. His Lyme-literate doctor put him on doxycycline for three weeks. In your article you say that “Doxycycline should not be given to children…”. I don’t dispute that. New information comes in all the time and seven years was quite awhile ago! My question is why? What did it do to his little body and are the effects lasting? Thank you for your time.

    • Hi Tami,

      Thanks so much! So, doxy theoretically shouldn’t be given to kids under 8 years of age because of the possible effects on cartilage and permanent teeth staining. But you’re absolutely right – there’s always new knowledge, and it looks as though those concerns are largely theoretical and I have fewer concerns about using doxy than I used to, even at younger ages!

      xo Elisa

  17. I’m not sure I agree with the use of antibiotics since, in my understanding, the bacteria bind together in a bundle and are untouchable by antibiotics.
    Also, I’m not sure using store-bought, canned, fermented foods are of any use because they have killed all the beneficial bacteria through the canning.

    • Hi Theresa,

      For chronic Lyme, the organisms often live in biofilms and promote immune system activation of the coagulation cascade, so a biofilm and clot-busting protocol needs to be in place in order for any antimicrobial, whether pharmaceutical or herbal, to reach the spirochetes. For a recent tick bite, though, there should not really be a biofilm or hypercoagulability issue, so antimicrobials alone should be effective. And yes, home-fermented foods would be awesome ideally. But in the meantime, there are several companies that are now making great store-bought fermented options.

      Thanks so much for your thoughtful comments!
      Elisa

  18. Hello, I am amazed that you take the time to reply to everyone. Thank you for that! My 3 year old was just bit and we lost the tick while wrestling him to get it out (he was not happy!). I don’t know what kind it was. Either way his pediatrician won’t give him antibiotics. I was planning to do that for him as well as ledum and arsenicum album. Then I was told on a Lyme Facebook group that ledum can damage the organs of children. Do you know this to be true. It’s so hard to know who to believe and what resources to trust! Thanks for your help.

    • Hi Bailey,

      You’re so welcome! Homeopathic medicines, if appropriately dilute, should cause no damage on the organs. For instance, if I were to give my child Ledum 30C and Arsenicum album 30C after a tick bite, I would feel totally comfortable that there would be no side effects. If it were my child, I would also look into the herbal protocols by Stephen Buhner, which do not require a physician’s prescription.

      Best to you and your 3-year old!
      xo Elisa

  19. My kid got bit Sunday.. we think and it is Tuesday night.. we just saw the bulls eye on his shin..
    Is this an immediate doctor visit in the morning ? does this mean the Tick is in him?
    What do we need to do?

    • Hi Josh. While I can’t give specific medical advice on what to do, yes! I would bring your son if to his doctor immediately. If it were my son, thn my approach would be to get on some sort of antimicrobial regimen ASAP – early treatment can absolutely prevent the progression to chronic Lyme disease. Best of luck to your son!
      xo Elisa

  20. My son is 7 years old (so too young for Doxycycline), weighs 25kg, and was prescribed amoxicillin, at a dose of 1200 mg/day (400 mg, 3 times a day), for 21 days. He had a bulls-eye rash, but no other symptoms that I have noticed. He began the antibiotics the day after I noticed the bulls-eye rash. His rash is fading, and looks like a small bump now.

    I wanted to know if 3 weeks of antibiotics is long enough? Or does he need longer treatment?

    At the end of antibiotic treatment, does he need to be seen by a doctor?

    • Hi Dianna – I’m so sorry for my late reply. I would absolutely have your son seen by a Lyme-literate doctor to ensure that he has been adequately treated, but for acute Lyme like what you’re describing, 3 weeks of Doxy should be fine!

  21. Thank you Dr. Song for your thoughtful sharing of knowledge. My 5 year old daughter and I camped in our Pacific Northwest old growth woods 14 days ago. I was not informed about ticks, at all, and only burned mosquito coils at our campsite. I knew of ticks growing up in the sage brush desserts of Eastern Washington but didn’t realize they were a problem, literally in our deer friendly back yard. My girl spent the day crawling under little branch forts left behind by other campers. The next day she had a deer tick attached to her hair line. I removed it, applied iodine and was happy to see the small lesion heal up, but relieved when I read on the CDC site, that only 2% of tick bites result in Lyme. Tonight when putting her to bed my husband and I both noticed a 2 cm solid dark red spot at the bite site. I’ve been scouring the web for hours for information but am disheartened by the indication of Lyme if a spot or rash appears days or weeks after the bite. I am so thankful that her doc is a pediatric ND in Portland. I will share with her your site before seeing her ASAP. I hope for a complete eradication of the disease following her treatment plan which I’m sure will involve antibiotics + supporting medicines. I will be following your recommended diet instructions to balance her gut with the long course of antibiotics that seems inevitable.

    • I’m so sorry for my late reply! I’m hoping for the best for your daughter! You’re rapid action has most certainly helped her to thrive and be well! 🙂

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