Tick Bites on Children: Why Prevention Is Failing

Tick bites on children are more common than many parents realize. A 2021 study found that children younger than 9 years old account for the highest number of emergency department visits related to tick bites.

A study published in April 2021 examined emergency department (ED) visits for tick bites in the United States between January 2017 and December 2019. Researchers analyzed visits by age group, sex, region, and seasonal trends.

The authors reported 149,364 ED visits due to tick bites during the 36-month study period. The highest incidence occurred in the Northeast, with the largest peak during the spring and early summer.

Children younger than 9 years accounted for the largest proportion of these visits.

Tick bites on children pose serious dangers

Additional surveillance studies confirm that young children experience a high rate of tick exposure.

In 2016, more than 3,551 ticks were submitted to the University of Massachusetts Laboratory of Medical Zoology as part of a passive surveillance program. Most ticks were Ixodes scapularis, also known as deer ticks or blacklegged ticks.

Investigators found that children younger than age 9 had the highest proportion of tick bites.

According to Xu and colleagues:

• 39.7% of ticks were nymphs
• 34.6% were adult ticks

Nearly 200 ticks were collected from children younger than 5 years old. Another 200 ticks were collected from children ages 5 to 9, while fewer ticks were collected from adolescents.

Deer ticks were the most common ticks found on children

Out of the 3,551 tick submissions, 89% were deer ticks (Ixodes scapularis).

Additionally, 98% of the 1,700 adult ticks submitted were female.

The overall infection rates among ticks biting humans were:

• 29.6% infected with Borrelia burgdorferi (Lyme disease)
• 4.6% infected with Anaplasma phagocytophilum
• 1.8% infected with Babesia microti

Some ticks carried more than one pathogen:

• 1.8% co-infected with B. burgdorferi and A. phagocytophilum
• 1.0% co-infected with B. burgdorferi and B. microti
• 0.4% co-infected with A. phagocytophilum and B. microti

Triple co-infections were identified in 0.3% of ticks.

Note: Investigators did not test ticks for additional infections such as Bartonella henselae or Borrelia miyamotoi.

When do tick bites on children occur?

Tick bites on children occur most frequently during seasons when outdoor activity is highest.

Researchers identified two major peaks among adult ticks:

• April–June (spring activity of overwintering ticks)
• October–December (autumn peak)

Nymphal ticks were most active between April and October, with a peak in June.

These seasonal patterns correspond with outdoor play, school activities, and sports participation.

How effective are tick bite prevention methods?

Several studies suggest current prevention efforts may not be working as well as hoped.

One way researchers evaluate prevention effectiveness is by measuring how many ticks are engorged when discovered. Ticks typically do not become engorged until they have been attached for at least 24 hours.

However, Xu and colleagues found that 35.6% of ticks attached to children younger than 9 were engorged.

This finding is concerning because an engorged tick significantly increases the risk of Lyme disease transmission.

READ MORE: The dangers of being bitten by a partially fed tick

Tick checks are often inconsistent

A school-based educational program involving 1,562 elementary school students examined children’s tick-prevention habits.

When asked how often they checked themselves for ticks:

• 56.8% said sometimes
• 25.8% said usually
• 12.0% said always

When asked who helps them check:

• 77.8% said a grown-up at home
• 14.6% said they checked themselves
• 2.0% said a grown-up at school
• 4.4% said they did not check at all

Why prevention efforts must improve

Researchers emphasize that prevention remains the primary strategy for reducing Lyme disease and other tick-borne infections.

“As long as there are no effective measures for controlling tick populations and no vaccine available, we rely largely on health education and communication efforts to prevent tick bites and Lyme borreliosis,” writes Beaujean.

The authors call for increased research and funding aimed at improving public health interventions for tick bite prevention.

As Benjamin Franklin famously noted, “An ounce of prevention is worth a pound of cure.”

For more on preventing Lyme disease, see Preventing Chronic Lyme Disease: Why Early Care Matters.

Key Point

Children younger than 9 years old experience the highest number of tick bites, highlighting the need for stronger prevention and education efforts.

Clinical Insight

Because deer ticks frequently carry multiple pathogens, a single tick bite on a child may expose them to several infections including Lyme disease, anaplasmosis, and babesiosis.