Children With Lyme Disease: Symptoms, School, and Long-Term Impact

Children with Lyme disease may struggle academically and socially
Neurologic and cognitive symptoms can interfere with school performance
Delayed diagnosis may worsen long-term outcomes in pediatric Lyme disease

Children with Lyme disease may struggle academically, socially, and physically due to neurologic and cognitive symptoms. In this selection from my book An Expert’s Guide on Navigating Lyme Disease, I discuss how Lyme disease can affect learning, behavior, school performance, and long-term functioning in pediatric patients.

Lyme Disease Can Interfere With Learning

Children with chronic Lyme-related symptoms can suffer both academically and physically.

Neurologic, psychiatric, and cognitive symptoms may impair a child’s ability to learn, concentrate, and participate in school activities.

Adolescents may also struggle socially and become unable to participate in extracurricular activities they once enjoyed.

Tager et al. described 20 children ages 8 to 16 with marked fatigue, headaches, irritability, short-term memory problems, brain fog, insomnia, distractibility, and word-finding difficulties despite antibiotic treatment.¹ Additional discussion can be found in Lyme Disease and School Performance.

Children With Lyme May Need School Accommodations

Children with Lyme disease reported more learning and attention problems, mood symptoms, and feelings of ineffectiveness than controls.²

Another study described adolescents with significant deficits in memory and cognition along with worsening school attendance and grades.³

Some families benefit from accommodations through Section 504 plans and Individualized Education Programs (IEPs), including:

• shorter school days
• untimed tests
• modified home instruction
• quiet testing environments
• reduced workload requirements

Additional discussion is available in Lyme Disease and School Performance.

A Teen’s Path From Martial Arts to a Wheelchair

A healthy athletic 18-year-old female developed a bull’s-eye rash followed by Bell’s palsy and progressive neurologic decline over four years.⁴

Her symptoms included cognitive impairment, orthostatic hypotension, fatigue, headaches, peripheral neuropathy, muscle atrophy, generalized pain, seizures, and difficulty urinating.⁴

Clinicians initially diagnosed her with fibromyalgia, CFS/ME, hypoglycemia, and pseudoseizures rather than Lyme disease.

She was eventually diagnosed with late-stage Lyme borreliosis with multisystem symptoms.⁴

“The patient was subsequently treated and is now physically active, married, and leading a productive life,” the authors reported.⁴ Additional discussion can be found in Psychiatric Lyme Disease.

Doctors Mistakenly Believed Lyme Disease Was Child Abuse

A 4-year-old boy presented with a swollen knee, fracture, and what physicians initially interpreted as bruising.⁵

Because of concerns regarding non-accidental trauma, the child was temporarily placed into foster care.

The rash was later recognized as erythema migrans and Lyme disease testing returned positive.⁵

The investigation was eventually closed after physicians concluded the child had Lyme disease with an unrelated fracture.⁵ Additional discussion is available in Toddler With Lyme Disease Mistakenly Reported as Child Abuse.

Babies and Infants Can Develop Tick-Borne Illness

An otherwise healthy 5-week-old girl from Long Island was diagnosed with Lyme disease and treated for suspected Lyme meningitis with intravenous ceftriaxone.⁶

Another report described premature infants infected with Babesia from a single blood donor.⁷

Researchers have also reported delayed-onset Babesia infection in newborns whose mothers were treated for Lyme disease during pregnancy.⁸ Additional discussion is available in Lyme Disease in a 5-Week-Old Infant.

Children May Be Ill for Years Before Diagnosis

Some children remain symptomatic for months or years before Lyme disease is recognized.

Symptoms may include:

• fatigue
• brain fog
• headaches
• abdominal pain
• joint pain
• mood changes
• school difficulties

It was previously believed that a known tick bite or rash was required for diagnosis. However, fewer than 1 in 5 children with early Lyme disease recalled a tick bite.⁹

Awareness of persistent or unexplained symptoms may help prevent delayed diagnosis. Additional discussion can be found in Only a Minority of Children With Lyme Disease Recall a Tick Bite.

Tick Bites in Children May Transmit Multiple Infections

Children account for approximately 25% of reported Lyme disease cases in the United States.

Human-biting ticks may also carry Babesia and Anaplasma in addition to Lyme disease.¹⁰

Some ticks in pediatric studies were co-infected with multiple pathogens simultaneously.¹⁰

For a broader overview, visit our Lyme Coinfections hub.

Frequently Asked Questions

What are common symptoms of Lyme disease in children?

Symptoms may include fatigue, headaches, brain fog, mood changes, joint pain, sleep problems, abdominal pain, and school difficulties.

Can Lyme disease affect school performance?

Yes. Cognitive and neurologic symptoms may interfere with concentration, attendance, memory, and academic performance.

Can children have Lyme disease without a known tick bite?

Yes. Many children diagnosed with Lyme disease do not remember a tick bite.

Can Lyme disease cause behavioral or mood changes in children?

Some children with Lyme disease experience irritability, anxiety, depression, and social withdrawal.

Can children develop chronic symptoms after Lyme disease?

Some children continue to experience fatigue, pain, cognitive symptoms, or neurologic complaints after treatment.

Can infants get Lyme disease?

Yes. Lyme disease and Babesia have both been reported in infants and newborns.

Clinical Takeaway

Children with Lyme disease may experience neurologic, cognitive, psychiatric, and physical symptoms that interfere with learning and development.

Delayed diagnosis may worsen educational, emotional, and social outcomes.

Persistent unexplained symptoms in children should prompt consideration of Lyme disease and associated co-infections.

Related Articles

These related articles explore pediatric Lyme disease, neurologic symptoms, delayed diagnosis, and persistent symptoms in children.

Neurologic Lyme Disease
Delayed Lyme Disease Diagnosis
Clinical Judgment Leads to Successful Lyme Disease Treatment in a Child
Post-Treatment Lyme Disease Syndrome
Lyme Disease Symptoms Guide

References

1. Tager FA, Fallon BA, Keilp JG, Rissenberg M, Jones CR, Liebowitz MR. A controlled study of cognitive deficits in children with chronic Lyme disease. J Neuropsychiatry Clin Neurosci. 2001 Fall;13(4):500-507.
2. McAuliffe P, Brassard MR, Fallon BA. Memory and neuropsychological deficits in adolescents with post-treatment Lyme disease. Appl Neuropsychol. 2008;15(3):208-219.
3. Bransfield RC, Friedman KJ. Differentiating psychogenic nonepileptic from epileptic seizures in adolescents with Lyme disease and associated complex illnesses. Healthcare (Basel). 2019;7(2):66.
4. Pan Z, et al. Lyme disease mimicking child abuse. Clin Pediatr (Phila). 2021.
5. Handel AS, Hellman H, Hymes SR. Lyme disease in a 5-week-old infant. Pediatr Infect Dis J. 2019 Sep;38(9):e215-e217.
6. Glanternik J, et al. Transfusion-transmitted babesiosis in premature infants. Pediatr Infect Dis J. 2017.
7. Hoversten P, Bartlett AH. Delayed onset congenital babesiosis. Pediatr Infect Dis J. 2018.
8. Nigrovic LE, Thompson AD, Fine AM, Kimia AA. Clinical predictors of Lyme disease among children with peripheral facial palsy in a Lyme disease-endemic area. Pediatrics. 2008;122(5):e1080-e1085.
9. Gaudet T, et al. Experiences of parents whose children developed Lyme disease: a qualitative study. Chronic Illn. 2019.
10. Wormser GP. Doxycycline for young children? Updated recommendations for Lyme disease. Pediatr Infect Dis J. 2019.
11. Eisen, L. (2022). Tick species infesting humans in the United States. Ticks and Tick-Borne Diseases, 13(6), 102025.
12. Tout K, et al. Surgical management and outcomes in pediatric Lyme arthritis. J Pediatr Orthop. 2021.
13. DeLong AK, Blossom B, Maloney EL, Phillips SE. Estimated frequency and burden of persistent symptoms after treatment for Lyme disease in the United States. BMC Infect Dis. 2019;19:605.

---

Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention