Concord Pediatrics, P.A.
248 Pleasant St. Suite 1700
Concord, NH 03301

Phone: (603) 224-1929
Fax: 
(603)228-7114 

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Choosing a pediatrician is an important and personal decision and we want you to feel at ease with the care you and your child will receive.

My child has a tick attached to their skin! What should I do?

If you find a tick attached to you or your child's skin, there's no need to panic.  Read through the information below. If you have additional concerns or questions, please call our office. (There are 5 Steps noted here!)

1. Remove the tick.

There are several tick removal devices on the market, but a plain set of fine-tipped tweezers will remove a tick quite effectively.

  1. Use fine-tipped tweezers to grasp the tick as close to the skin's surface as possible.

  2. Pull upward with steady, even pressure. (See image here and here.)  Don't twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. The goal is to remove the tick in one piece quickly.

    • If pieces of the tick remain in the skin, gently try to remove them with clean tweezers. If you are unable to easily remove the pieces easily with tweezers then leave them.  Do not worry; this does not increase the risk of Lyme Disease. Wash the site, and apply Bacitracin or Polysporin antibiotic ointment (over-the-counter) daily for 1 to 3 days- the body will naturally push the remaining pieces out as the skin heals. Monitor the site and call our office if you are concerned your child might have a local skin infection (if the bite area becomes red, swollen, or painful).

  3. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol or soap and water.

  4. Dispose of a live tick by submersing it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet. Never crush a tick with your fingers.

Avoid folklore remedies such as "painting" the tick with nail polish or petroleum jelly, or using heat to make the tick detach from the skin. Your goal is to remove the tick as quickly as possible–not to wait for it to detach.

2. After you remove the tick:

  1. Wash the bite area gently and apply Bacitracin or Polysporin antibiotic ointment (over-the-counter) to the bite area daily for a few days while it heals. Monitor the site and call our office if you are concerned your child might have a local skin infection (if the bite area becomes red, swollen, or painful).

  2. Please note: A small (1 to 2 inch) red or purple area at the tick site in the first 24 hours is a typical local reaction and does not mean a person has Lyme Disease. If that reddish area continues to expand or becomes painful after the first 48-72 hours, please make an appointment for you child so we can evaluate the rash. Click here to see a photo of a typical bite reaction- this is not the Lyme rash.

  3. In some cases a single prophylactic or prevention dose of doxycycline (an antibiotic) may be appropriate after a tick bite. Our office follows guidance from the CDC, AAP, and NH DHHS, based upon the evidence based guidelines from the Infectious Disease Society of America.  A dose of Doxycycline given to try to prevent Lyme Disease may be appropriate if your child had an engorged  (very swollen/full of blood) deer tick attached to their skin. This medication is only effective for "prevention of Lyme" if given within 72 hours of removal of the tick.  Please call our office at (603) 224-1929 to make an appointment or with any concerns or questions.  Currently there is limited safety data on the use of Doxycline for children under 8 years of age.  Based on 2018 guidelines Doxyclycline may be considered for both prophylaxis and treatment in patients of any age, including those under 8.  Your provider can discuss the best clinical course for your child.  There are several effective antibiotic treatments (with options for children with antibiotic allergies) for children in all age groups if Lyme Disease is diagnosed.

  4. Monitor your child (winter, spring, summer, and fall!) for signs and symptoms of Lyme Disease.  If your child develops a rash (anywhere on the body- not just at a bite site), a painful, red, or swollen joint, a prolonged fever, facial droop (Bell's palsy), or a headache that persists, see your doctor.  We will follow the latest, most up-to-date CDC and AAP guidelines for treatment.

3. Should I get the tick tested?

People who have removed a tick often wonder if they should have it tested.  

You can read more about tick testing at the NH Department of Health and Human ServicesThe New Hampshire Department of Agriculture, Markets and Food offers free tick identification to New Hampshire residents. The intent is to monitor the distribution of tick species in NH. Ticks submitted there will not be tested for disease-causing pathogens.

There are other labs that can test ticks (often for a fee), but in general, testing of individual ticks is not useful because:

  • If the test shows that the tick contained disease-causing organisms (and chances are, a deer tick in NH will!), that does not necessarily mean that you have been infected. We do not treat a person based on tick testing.

  • If you have been infected, you could develop symptoms before results of the tick test are available. You should not wait for tick testing results before beginning appropriate treatment.

  • Negative results can lead to false assurance. For example, you may have been unknowingly bitten by a different tick that was infected. We treat based on a person's symptoms, not tick testing.

However, you may want to learn to identify various ticks. Different ticks live in different parts of the country and transmit different diseases.

4. Should I get my child tested for Lyme Disease?

Many parents wonder about testing their child for Lyme Disease, especially after a tick bite. 

Testing for Lyme disease should not be performed for children without symptoms or signs suggestive of Lyme disease. That means that after a tick bite, (no matter if a child was given a prevention dose of antibiotic or not) we should monitor for signs and symptoms of Lyme Disease. 

Our office follows the 2-Step Laboratory Testing Process as recommended by the CDC and the American Academy of Pediatrics.  You will need to discuss the need for testing with your doctor.  In areas with endemic Lyme disease (like NH!), it is expected that the vast majority of erythema migrans (the "bull's eye rash") is attributable to B burgdorferi  (Lyme) infection, and antibiotic treatment is appropriate without testing.  In many cases (because of where we live), treatment will also be started before testing for children who have suspected Lyme arthritis (big swollen, painful joint) or Bell's Palsy.  

Please note, per The Red Book (The Authority on Pediatric Infectious Diseases from the American Academy of Pediatrics)

  • Development of antibodies (evidence that your body's immune system fought an infection) in patients treated for early Lyme disease does not indicate lack of cure or presence of persistent infection. Ongoing infection without development of antibodies (“seronegative Lyme”) has not been demonstrated. Once antibodies develop to Lyme Disease, the antibodies may persist for many years. So, tests for antibodies should not be used to check for the success of treatment.  
  • Occasionally there is a concern for Lyme Disease in a child who does not have the classic rash, arthritis (swollen joint), or Bell's Palsy.  We will need to discuss testing using the 2-Step Testing Process for a child with a prolonged fever, body aches, headache, or fatigue.  Patients with Lyme disease almost always have classic signs of infection (eg, erythema migrans, facial nerve palsy, or arthritis). Those more generalized symptoms (fever, fatigue, headache, body aches) commonly accompany these specific signs but almost never are the only evidence of Lyme disease. Serologic testing for Lyme disease should not be performed for children without symptoms or signs suggestive of Lyme disease and plausible geographic exposure.   

You may also be interested in checking out the following links:

 

5. Learn about tick bite prevention, then go back outside and enjoy nature in New Hampshire!

Read more about ticks and Lyme Disease online at the CDC and Check out this Tick Bite Fact Sheet from the NH DHHS.

Some tips for avoiding tick bites:

  • Stay on trails outdoors; avoid areas of overgrown brush and tall grasses.

  • Wear light-colored clothing so ticks can be easily seen.

  • Wear long pants, a long-sleeved shirt, closed toe shoes with socks, and a hat. Tuck your pants into your socks and your shirt into your pants.

  • Check yourself, your children, and your pets often for ticks (at bedtime and in the morning!), shower after returning indoors.

  • Use insect repellent containing DEET or permethrin (always follow directions). More info here!

  • After returning indoors, run clothes in the dryer on high heat to kill any ticks that may be on the clothing.

Create a Tick-safe Zone to Reduce Ticks in the Yard

The Connecticut Agricultural Experiment Station has developed a comprehensive Tick Management Handbook[PDF – 8.53 MB] for preventing tick bites. Here are some simple landscaping techniques that can help reduce tick populations:

  • Remove leaf litter.

  • Clear tall grasses and brush around homes and at the edge of lawns.

  • Place a 3-ft wide barrier of wood chips or gravel between lawns and wooded areas to restrict tick migration into recreational areas.

  • Mow the lawn frequently.

  • Stack wood neatly and in a dry area (discourages rodents).

  • Keep playground equipment, decks, and patios away from yard edges and trees.

  • Discourage unwelcome animals (such as deer, raccoons, and stray dogs) from entering your yard by constructing fences.

  • Remove old furniture, mattresses, or trash from the yard that may give ticks a place to hide.

Questions or Comments?
We encourage you to contact us whenever you have an interest about our services.

Call (603) 224-1929

248 Pleasant St. Suite 1700
Concord, NH 03301