Understanding Pediatric Lyme Disease

A parent’s guide to recognizing and treating Lyme disease in children

What this page covers
This page explains how Lyme disease presents in children, why pediatric cases are often missed, and where to find detailed information on diagnosis, treatment, and recovery.

Lyme disease in children often looks different than it does in adults. Kids may not report symptoms clearly, may be dismissed as anxious or attention-seeking, and may present with behavioral or cognitive changes before physical complaints emerge.

For parents, the challenge is knowing when something is truly wrong—and finding a clinician who will listen. Too often, Lyme disease misconceptions lead to delayed diagnosis and prolonged suffering in children who deserve better.

Why Lyme Disease in Children Is Often Missed

Children are not small adults. They experience and express illness differently. A child with Lyme disease may not complain of joint pain—they may simply stop running. A teenager may not mention fatigue—they may just start failing classes.

Common reasons pediatric Lyme goes unrecognized:

No recalled tick bite or rash
Symptoms attributed to growing pains, stress, or school avoidance
Behavioral changes mistaken for ADHD, anxiety, or depression
Clinician unfamiliarity with atypical pediatric presentations
Reliance on tests with known limitations (see Understanding Lyme Disease Test Accuracy)

When doctors don’t think of Lyme, they don’t test for it. And when they do test, false negatives can provide false reassurance.

How Lyme Disease Presents in Children

Pediatric Lyme disease can affect virtually any organ system. Symptoms may be subtle at first and worsen over time—or appear suddenly and severely.

Early Symptoms

Erythema migrans (EM) rash — may appear anywhere on the body, not always a “bull’s-eye”
Fever
Fatigue
Headache
Neck stiffness
Muscle and joint aches

Many children never develop a rash—or the rash appears in a hidden location like the scalp or behind the knee.

Neurological Symptoms

Lyme disease frequently affects the nervous system in children:

Facial palsy (Bell’s palsy) — sudden drooping on one or both sides
Headaches — often severe and persistent
Meningitis symptoms — neck pain, light sensitivity
Brain fog — difficulty concentrating, memory problems
Numbness and tingling
Balance problems

Neurologic Lyme in children requires prompt recognition and treatment.

Behavioral and Cognitive Changes

Some of the most overlooked Lyme symptoms in children are behavioral:

Irritability and mood swings
Anxiety or panic attacks
Depression
School avoidance or declining grades
Personality changes
Sleep disturbances
Rage episodes

These symptoms are frequently misdiagnosed as psychiatric conditions. When Lyme is the underlying cause, psychiatric medications may provide little relief—while appropriate treatment of the infection often leads to improvement.

This pattern of psychiatric misdiagnosis reflects broader ethical challenges in Lyme disease care.

Musculoskeletal Symptoms

Joint pain — often migratory, moving from joint to joint
Lyme arthritis — typically large joints like the knee
Limping or refusing to walk (in young children)
Muscle aches

Parents sometimes notice that a previously active child suddenly becomes sedentary—not because they’re lazy, but because movement hurts.

Autonomic Symptoms

Children can develop autonomic dysfunction just as adults do:

Dizziness when standing
Racing heart
Temperature sensitivity
Nausea or abdominal pain
Fatigue that worsens with activity

These symptoms often go unexplained when routine tests return normal.

Fatigue

Fatigue in children with Lyme is not ordinary tiredness:

Sleeping 10–12 hours and still exhausted
Unable to complete a school day
Needing rest after minimal activity
Worsening fatigue despite adequate sleep

This is not laziness. It reflects ongoing illness that deserves investigation.

The Diagnostic Challenge in Pediatric Lyme

Diagnosing Lyme disease in children requires clinical suspicion, careful history-taking, and recognition that tests have limitations.

Key challenges include:

Children may not articulate symptoms clearly
Parents may be dismissed as overanxious
Symptoms overlap with many common childhood conditions
Testing may be negative early in infection or after partial treatment

For more on testing limitations, see Understanding Lyme Disease Test Accuracy.

When Children Are Dismissed

One of the most painful experiences for families is being told nothing is wrong—when they can see their child suffering.

Children with Lyme disease have been misdiagnosed with:

Anxiety disorder
Depression
ADHD
Conversion disorder
School refusal
Chronic fatigue syndrome
Fibromyalgia
Growing pains

In some cases, parents have been accused of Munchausen by proxy for advocating for their sick children. This represents a profound failure of the medical system.

These patterns reflect how deeply Lyme disease misconceptions can harm the most vulnerable patients.

Co-infections in Children

Children can acquire the same tick-borne co-infections as adults:

Babesia — can cause sweats, air hunger, fatigue
Bartonella — may cause rashes, irritability, neuropsychiatric symptoms
Ehrlichia/Anaplasma — can cause fever, headache, low blood counts

Co-infections may explain why some children don’t respond to standard Lyme treatment alone.

When Symptoms Persist After Treatment

Some children continue to experience symptoms after completing antibiotic therapy. This may reflect Post-Treatment Lyme Disease Syndrome (PTLDS) or persistent illness requiring further evaluation.

Research by Kalish and colleagues found that approximately 25% of children treated for Lyme disease experienced symptoms lasting longer than six months, including fatigue, joint pain, and cognitive changes.

For guidance on long-term outcomes, see Lyme Disease Recovery and Long-Term Outlook.

Children who remain ill deserve continued care—not dismissal. For a broader perspective on preventing progression, see Preventing Long-Term Lyme Disease.

What Parents Can Do

If you suspect your child has Lyme disease:

Document symptoms — Keep a log of what you observe, when it started, and how it fluctuates
Trust your instincts — You know your child better than anyone
Seek a knowledgeable clinician — Find a physician experienced with pediatric tick-borne illness
Don’t accept dismissal — If something is wrong, keep advocating
Consider co-infections — Ask about testing for Babesia, Bartonella, and other tick-borne pathogens

Your child’s health is worth fighting for.

Frequently Asked Questions

Can Lyme disease cause behavioral changes in children?
Yes. Lyme disease can cause irritability, mood swings, anxiety, depression, rage, and personality changes. These symptoms often improve when the underlying infection is treated.

Why was my child diagnosed with anxiety instead of Lyme?
Lyme disease symptoms often overlap with psychiatric conditions. Without clinical suspicion and appropriate testing, the infection may be missed entirely.

Can children recover fully from Lyme disease?
Many children recover fully, especially with early diagnosis and treatment. Some experience persistent symptoms requiring ongoing care and support.

What if my child’s Lyme test is negative?
Lyme tests have known limitations. A negative test does not rule out infection, particularly in early or late-stage disease. Clinical judgment should guide diagnosis.

Should I worry about co-infections in my child?
Co-infections are common and can complicate recovery. If your child isn’t improving with Lyme treatment alone, co-infection testing may be warranted.

Related Resources

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**Links included:**
– ✅ All 8 other hubs
– ✅ Autonomic Dysfunction (major spoke)
– ✅ Brain Fog
– ✅ PTLDS
– ✅ Coinfections

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Learn how Lyme disease presents in children, why pediatric cases are missed, and what parents can do. Expert guidance from a 37-year Lyme specialist.

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