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.
Pediatric Lyme disease: the growing problem
- Lyme Disease in Kids Is Rising: What’s Behind the Trend?
- Lyme disease in children rising in Pennsylvania: an inside look
- 4 children infected with Lyme disease from one camp in the south
- Only a minority of children with Lyme disease recall a tick bite
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.
Facial palsy, seizures, and neurological cases in children
- Bell’s palsy and Lyme disease
- Treatment varies for Bell’s palsy in children with Lyme disease
- Lyme disease with bilateral facial palsy
- Steroids harmful to patients with Bell’s palsy caused by Lyme disease
- Facial nerve dysfunction after treatment for Lyme disease
- Patient with facial palsy from Lyme disease fails treatment
- Can Bell’s palsy be misdiagnosed in Lyme disease?
- Lyme disease seizures in children
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.
PANS, PANDAS, and psychiatric presentations in children
- Neuropsychiatric Lyme disease
- Psychiatric Lyme disease
- PANS or PANDAS and Lyme disease
- Lyme disease and PANS in teens
- PANDAS and Lyme disease in a 7-year-old child
- 7-year-old girl with PANDAS and Lyme disease
- Oppositional behavior in children with Lyme disease
- Autism symptoms improve with treatment for Lyme disease
- Conversion disorder, Guillain-Barré syndrome, or Lyme disease?
Brain fog and cognitive symptoms in children
- Brain fog and cognitive dysfunction in Lyme disease
- Lyme disease brain fog and anxiety
- What does Lyme disease do to your brain?
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.
Lyme arthritis in children
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.
Diagnosing Lyme disease in children
- Pediatric Lyme Disease: Why Children Are Misdiagnosed
- Pediatric Lyme screening
- Yale study claims children don’t have Lyme disease
- Lyme disease causes a positive test for mononucleosis
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.
Misdiagnosis and dismissal cases in children
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.
Treating Lyme Disease in Children
Treatment decisions in pediatric Lyme require balancing effectiveness with safety. Antibiotic selection, dosing, and duration may differ for children—and families deserve clear guidance when navigating treatment options.
Treatment approaches for children
- Managing Lyme in children: 12 interventions I use
- Doxycycline for children with Lyme disease: pros and cons
- Delaying pediatric Lyme treatment
- Single-dose doxycycline for a tick bite
- Tick bite treatment options
- Importance of a second opinion for tick bite treatment
Lyme Disease in Infants and Newborns
Even the youngest patients can be affected. Infants may contract Lyme disease through tick bites or, in rare cases, through transmission during pregnancy. Diagnosing tick-borne illness in newborns presents unique challenges, as standard testing may not be reliable in immature immune systems.
Infant and newborn cases
- How can Lyme disease affect babies?
- Mother describes challenges in getting treatment for newborn with Lyme disease
- Lyme disease triggers Herxheimer reaction in infant
- Lyme disease and Herxheimer reaction in newborn
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.
School, adolescent, and family impact
- Lyme Disease and Impact in School
- ILADS reminds parents ABCs of Lyme and tick-borne infections
- Lyme Disease: One Teen’s Story of Struggle and Strength
- Lyme symptoms in adolescents
- Children with Lyme disease
- Adolescents and Lyme Disease
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
- Long COVID and Lyme Disease: What Patients Need to Know
- Understanding Lyme Disease Symptoms
- Understanding Lyme Disease Test Accuracy
- Understanding Lyme Disease Coinfections
- Babesia: What Lyme Patients Need to Know
- Post-Treatment Lyme Disease Syndrome (PTLDS)
- Preventing Long-Term Lyme Disease
- Lyme Disease Recovery and Long-Term Outlook
- Ethics, Uncertainty, and Medical Abandonment in Lyme Disease
- Lyme Disease Misconceptions
