Children With Lyme Disease: Symptoms and School Impact

Children with Lyme disease can develop neurological, psychiatric, and cognitive symptoms that interfere with learning, social development, and daily functioning. While many children recover with early treatment, others experience persistent or complex symptoms that affect school performance, mood, and physical health.

Lyme disease in children may present differently than in adults. Instead of joint pain or fatigue alone, children may develop learning problems, behavioral changes, headaches, sleep disruption, dizziness, or sensory sensitivities. These symptoms may evolve gradually and are sometimes mistaken for anxiety disorders, attention difficulties, or other childhood conditions.

Children ages 5–14 represent one of the highest incidence groups for Lyme disease in the United States.

For a broader overview, see the Pediatric Lyme Disease guide.

Common symptoms in children with Lyme disease may include:

• Headaches
• Brain fog
• Memory problems
• Sleep disturbances
• Dizziness or autonomic dysfunction
• Behavioral changes
• Light or sound sensitivity

Some children also develop neurologic findings such as facial nerve palsy (Bell’s palsy), which may be one of the earliest recognizable neurologic signs of Lyme disease. Others may develop Lyme arthritis, most commonly presenting as swelling of a knee or another large joint.

Many of these symptoms are discussed in the Lyme disease symptoms guide.

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How Lyme Disease Affects Learning in Children

Children with chronic Lyme symptoms may struggle both academically and physically. Neurological, psychiatric, and cognitive symptoms can significantly impair a child’s ability to learn and participate in the classroom.

Adolescents may also face social challenges if fatigue, pain, or cognitive slowing prevents them from participating in activities they previously enjoyed.

Symptoms may also fluctuate over time, which can make Lyme disease difficult to recognize early in children.

Tager et al. (2001) described 20 children ages 8 to 16 with persistent Lyme symptoms despite antibiotic treatment. Reported symptoms included marked fatigue (100%), arthralgias (100%), severe headaches (100%), irritability or depression (94%), short-term memory problems (94%), deterioration in school performance (94%), myalgias (88%), brain fog (88%), neck pain (88%), insomnia (82%), distractibility (82%), word-finding problems (82%), and sensory sensitivity to sound (58%) or light (74%).

Read more.

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Warning Signs in School

Teachers or parents may notice changes in school performance before Lyme disease is recognized. Warning signs may include:

• sudden decline in grades
• difficulty concentrating
• memory problems
• slower reading or processing
• headaches during school
• fatigue by midday
• irritability or mood changes

When these symptoms appear in children living in tick-endemic areas, Lyme disease should be considered as part of the evaluation.

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Educational Accommodations May Be Needed

Children with Lyme disease have reported higher rates of learning difficulties, attention problems, and mood disturbances compared with controls (Tager et al., 2001).

Another study described adolescents with significant deficits in cognition, including short-term visual memory, delayed verbal memory, and recognition memory. These adolescents also had worse school attendance and grades than controls (McAuliffe et al., 2008).

Educational accommodations may help some children maintain academic progress. Programs such as the Individualized Education Program (IEP) and Section 504 plans may allow adjustments such as shortened school days, untimed tests, modified assignments, quieter testing environments, and temporary home instruction programs.

Read more.

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Why Lyme Disease May Be Missed in Children

Lyme disease in children may be overlooked because symptoms can develop gradually and may resemble other childhood conditions. In many cases:

• a tick bite was never noticed
• a rash may have been absent or unrecognized
• symptoms appear weeks or months after infection
• behavioral or cognitive symptoms are attributed to other diagnoses

Because of these factors, Lyme disease may not always be considered early in the evaluation.

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Case Examples of Lyme Disease in Children

A teen’s path from martial arts to being in a wheelchair

A healthy, athletic 18-year-old female skilled in Taekwondo developed a bull’s-eye rash followed by Bell’s palsy. Over the next four years she became progressively disabled, eventually requiring a wheelchair and experiencing seizures.

Her symptoms included cognitive impairments affecting attention, memory, processing speed, and executive functioning, as well as tactile hypersensitivity, sun sensitivity, orthostatic hypotension, fatigue, non-restorative sleep, headaches, peripheral neuropathy, muscle atrophy, cervical radiculopathy, hair loss, joint instability, and generalized pain.

Clinicians initially diagnosed fibromyalgia, chronic fatigue syndrome, hypoglycemia, and “pseudoseizures” rather than Lyme disease.

She was later diagnosed with late-stage Lyme borreliosis with multisystem symptoms along with porphyria and Ehlers-Danlos-related instability (Bransfield and Friedman, 2019).

“The patient was subsequently treated and is now physically active, married, and leading a productive life.”

Read more.

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Doctors mistakenly believed Lyme was child abuse

A 4-year-old boy was evaluated after an unwitnessed fall while playing in the yard. He had a swollen knee, a tender forearm fracture, and a large bruise-like mark on the buttock.

The pediatrician reported the case to child protective services for possible non-accidental trauma.

The child was temporarily placed into foster care. Later evaluation revealed the “bruise” was actually a bull’s-eye rash consistent with Lyme disease.

Laboratory testing confirmed Lyme infection, and the child was treated with oral amoxicillin.

Read more.

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A Lyme rash initially dismissed

A 6-year-old girl developed a circular rash on her face that was initially diagnosed as allergic dermatitis.

After treatment with oral cefuroxime, laboratory testing confirmed Lyme disease.

Read more.

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Clinical Perspective

In my practice, children with Lyme disease often present with symptoms affecting multiple systems—including neurologic, cognitive, and autonomic functions. Because these symptoms may resemble other childhood conditions, Lyme disease may not always be considered early in the evaluation.

Many children improve significantly with appropriate treatment, although recovery may take time when symptoms have been present for months.

Recognizing symptoms early may help prevent prolonged illness and allow children to receive appropriate medical care and educational support.