Tick Bite Prevention for Kids: Protecting Children from Lyme Disease
Tick bites are common in children
Prompt removal and tick checks reduce risk
Early recognition helps prevent Lyme disease and other tick-borne infections
Tick bites in children are common, especially during the spring and summer when families spend more time outdoors. Although most tick bites do not lead to illness, children are at risk for Lyme disease and other tick-borne infections. Prompt tick removal, regular tick checks, and recognizing early symptoms can reduce the risk of complications.
A study published in April 2021 examined emergency department (ED) visits for tick bites across the United States. Marx and colleagues analyzed ED visits between January 2017 and December 2019 by age, sex, region, and season. They found that children younger than 10 years accounted for the largest proportion of ED visits for tick bites.[2]
During the 36-month study period, there were 149,364 emergency department visits for tick bites. The incidence was highest in the Northeast, with the largest seasonal peak occurring during the spring and early summer.
These findings are consistent with earlier surveillance studies showing that young children experience a high number of tick bites and are at increased risk for exposure to tick-borne diseases.
Passive surveillance studies also help identify which tick species most commonly bite children and the pathogens those ticks may carry.
In 2016, more than 3,500 submitted ticks (n=3,551) were analyzed by the University of Massachusetts Laboratory of Medical Zoology. The majority of ticks collected over the seven-year surveillance period were Ixodes scapularis (blacklegged or deer ticks) from Massachusetts (N=2,088).[3]
Why are tick bites more common in children?
Investigators found that children younger than 9 years accounted for the largest proportion of tick bites. According to Xu and colleagues, 39.7% of submitted ticks were nymphs, while 34.6% were adult ticks.
Nearly 200 ticks were collected from children younger than 5 years, another 200 from children aged 5 to 9 years, and nearly 90 from adolescents.
Deer ticks were the most common ticks found on children, accounting for 89% of the 3,551 submitted ticks.
Additionally, 98% of the 1,700 adult ticks submitted were female.
The overall infection rates among human-biting ticks were:
- Borrelia burgdorferi: 29.6%
- Anaplasma phagocytophilum: 4.6%
- Babesia microti: 1.8%
These findings demonstrate that tick bites in children may expose them to more than Lyme disease alone.
The authors also reported ticks harboring multiple infectious agents:
- 1.8% were co-infected with B. burgdorferi and A. phagocytophilum.
- 1.0% were co-infected with B. burgdorferi and B. microti.
- 0.4% were co-infected with A. phagocytophilum and B. microti.
Triple co-infections were identified in 0.3% of submitted ticks.
Note: The investigators did not evaluate other pathogens, including Bartonella henselae or Borrelia miyamotoi.
When do tick bites in children occur?
Tick bites in children occurred most frequently during the spring and fall, when outdoor play, school activities, and sports increase exposure to tick habitats.
According to Xu and colleagues, approximately 1,700 adult ticks displayed two seasonal peaks:
- April through June, representing questing activity of the overwintering adult population.
- October through December, representing the large autumn adult population.
Between April and October, 360 nymphs were submitted, with a clear peak during June.
Where do ticks most commonly attach on children?
Ticks often attach in areas that are difficult to see. Parents should carefully examine the scalp, behind the ears, neck, under the arms, around the waistband, groin, and behind the knees after outdoor activities. Young children may need assistance with thorough tick checks.
How soon should a tick be removed?
A tick should be removed as soon as it is discovered. Although the risk of Lyme disease generally increases the longer a tick remains attached, prompt removal lowers the chance of transmission. Experimental and clinical evidence also suggests that partially fed ticks may occasionally transmit infection more quickly than previously believed.
READ MORE: Have you been bitten by a partially fed tick?
How effective are tick bite prevention methods?
Preventing tick bites remains one of the best ways to reduce the risk of Lyme disease and other tick-borne infections in children. Researchers have evaluated prevention programs by measuring how often ticks remain attached long enough to become engorged, a sign that the tick has been feeding for an extended period.[4]
According to Xu and colleagues, 35.6% of ticks attached to children younger than 9 years were already engorged when they were removed. This finding suggests that many tick bites are not detected promptly despite ongoing public health education.
This is particularly concerning because longer tick attachment generally increases the risk of Lyme disease transmission. Sood notes that an engorged tick is associated with a substantially higher risk of infection than a recently attached tick.[5]
Only 12% of children reported performing regular tick checks.
A school-based intervention involving 1,562 elementary school students examined why children remain vulnerable to tick bites despite educational programs.[6] The results highlight the continued need for parents, schools, and communities to reinforce tick bite prevention strategies.
How often do children check themselves for ticks?
- 56.8% = sometimes
- 25.8% = usually
- 12.0% = always
Who performs most tick checks?
- 77.8% = a grown-up at home
- 14.6% = the child
- 2.0% = a grown-up at school
- 4.4% = no tick checks performed
How can parents help prevent tick bites in children?
No prevention strategy is perfect, but combining several measures can reduce the risk of tick bites.
- Perform a thorough tick check after outdoor activities.
- Pay particular attention to the scalp, behind the ears, neck, armpits, waistband, groin, and behind the knees.
- Remove attached ticks promptly using fine-tipped tweezers.
- Wear long sleeves and long pants in wooded or grassy areas.
- Use EPA-registered tick repellents according to age recommendations.
- Shower soon after coming indoors when practical.
As Beaujean and colleagues emphasized, education continues to play an important role in preventing tick bites and Lyme borreliosis. Today, prevention also includes prompt tick removal, personal protective measures, landscape management, and continued research into improved preventive strategies.[7]
Frequently Asked Questions
Can a child get Lyme disease from one tick bite?
Yes. A single tick bite can transmit Lyme disease if the tick is infected with Borrelia burgdorferi. However, not every tick carries Lyme disease, and not every tick bite results in infection. Prompt removal lowers the risk.
What should I do after removing a tick from my child?
Clean the bite area with soap and water or an antiseptic, monitor your child for a rash or flu-like symptoms over the next several weeks, and contact your healthcare provider if symptoms develop.
Are toddlers more likely to get tick bites?
Yes. Surveillance studies found that children younger than 10 years account for the highest number of emergency department visits for tick bites, likely because of frequent outdoor play and difficulty detecting attached ticks.
Where should I check my child for ticks?
Carefully inspect the scalp, behind the ears, neck, under the arms, groin, waistband, behind the knees, and other skin folds after spending time outdoors.
Can tick bites transmit diseases other than Lyme disease?
Yes. Depending on the region, ticks may also carry organisms that cause anaplasmosis, babesiosis, Powassan virus disease, and several other tick-borne infections.
Clinical Takeaway
Tick bites in children are common, especially during the spring and summer. Most tick bites do not lead to illness, but children are at risk for Lyme disease and other tick-borne infections. Knowing how to remove a tick, when to monitor for symptoms, and when to seek medical care can help reduce the risk of complications.
Parents who perform consistent tick checks and remove attached ticks promptly can significantly reduce the likelihood of delayed diagnosis and improve early recognition of Lyme disease and other tick-borne infections.
Related Articles
Early Lyme disease symptoms
Have you been bitten by a partially fed tick?
Powassan virus infection causes polio-like illness
Prevalence of Borrelia infections and Powassan virus in Maine
Maine woman dies from deer tick virus
References:
- Bacon RM, Kugeler KJ, Mead PS. Surveillance for Lyme disease—United States, 1992–2006. MMWR Surveill Summ. 2008;57(10):1-9.
- Marx GE, Spillane M, Beck A, Stein Z, Powell AK, Hinckley AF. Emergency Department Visits for Tick Bites — United States, January 2017–December 2019. MMWR Morb Mortal Wkly Rep. 2021;70(17):612-616.
- Xu G, Mather TN, Hollingsworth CS, Rich SM. Passive Surveillance of Ixodes scapularis (Say), Their Biting Activity, and Associated Pathogens in Massachusetts. Vector Borne Zoonotic Dis. 2016;16(8):520-527.
- Falco RC, Fish D, Piesman J. Duration of Tick Bites in a Lyme Disease-Endemic Area. Am J Epidemiol. 1996;143(2):187-192.
- Sood SK. Lyme Disease in Children. Infect Dis Clin North Am. 2015;29(2):281-294.
- Shadick NA, Zibit MJ, Nardone E, DeMaria A Jr., Iannaccone CK, Cui J. A School-Based Intervention to Increase Lyme Disease Preventive Measures Among Elementary School-Aged Children. Vector Borne Zoonotic Dis. 2016;16(8):507-515.
- Beaujean D, Crutzen R, Kengen C, van Steenbergen J, Ruwaard D. Increase in Ticks and Lyme Borreliosis, Yet Research into Its Prevention on the Wane. Vector Borne Zoonotic Dis. 2016;16(5):349-351.
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
More attention should be paid to pre treatment of play areas and yards with pesticides that control tick populations. Befenthrin is most effective and easily applied by home owners.
I can’t go feedback on Bifenthrin. It has been classified as a “possible human carcinogen” based on an increased incidence of urinary bladder tumors in mice.” per fda at https://www.federalregister.gov/documents/2012/09/14/2012-22772/bifenthrin-pesticide-tolerances#:~:text=Bifenthrin%20is%20classified%20as%20a,urinary%20bladder%20tumors%20in%20mice