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As summer gets into full swing, so do outdoor adventures: hikes, park days, and backyard play are all part of the fun. But for NYC-area parents, that also means thinking about tick bites and the potential risk of Lyme disease. With more families heading upstate, out to Long Island, or even exploring wooded areas closer to home, questions around tick safety become especially important this time of year.

To help parents feel more prepared and informed, we sat down with Dr. Dhara Patel of our Park Slope office to talk all things ticks, from when and where they’re most active, to how to prevent bites, spot early signs of Lyme, and know what to do if you find a tick on your child. We hope this quick Q&A helps make your family’s outdoor time a little safer and a lot more worry-free.

How concerned should NYC-area parents really be about ticks? Are tick bites and Lyme something we see often in practice?
If your kid’s idea of summer fun includes grass, sticks, and anything remotely resembling the woods, yes, you should be vigilant. Local transmission of Lyme in NYC boroughs does occur, especially in Staten Island and Bronx, but it is rare in other boroughs. Most cases are acquired during trips to upstate New York, Long Island, and neighboring states.
Tick bites and Lyme disease are something we do see in practice, especially during the warmer months.

When are ticks most active, and is there a specific “tick season” parents should be aware of?
Ticks love summer break too. Ticks are most active April through October, with peak activity in June and July. However, ticks can also thrive during milder winter climates.

What are the best ways to prevent tick bites in children, especially when they’re outdoors in parks or woods?

• Dress them like it’s 1987! Full sleeves, shirts tucked into pants, pants tucked into long socks, light-colored clothing
• Tick repellants
• Stick to the center of trails and avoid brushing against tall grass or leaf litter
• Doing a full-body tick check when coming indoors. Don’t forget behind ears, scalp, armpits, groin and behind the knees.
• Bathing within 2 hours of outdoor exposure
• Placing clothes in dryer on high heat for at least 10 minutes

Are there any repellents or protective clothing you specifically recommend for kids?
The following are not approved for infants under 2 months of age.

• DEET: For those under 2 years, use sparingly. Choose a concentration no more than 30%, applied only once per day.
• Picaridin: is generally considered more gentle on skin and non-damaging to synthetic materials
• Permethrin-treated clothing: It should not be applied directly to the skin. If your child is still in the “everything goes in the mouth” phase, I recommend using picaridin instead.

If a parent finds a tick on their child, what’s the safest way to remove it at home?
Use fine-tipped tweezers to grasp the tick as close to the skin as possible and pull upward with steady pressure. Don’t twist, burn, or use petroleum jelly. After removal, clean the area with soap and water or rubbing alcohol.

How long does a tick need to be attached to transmit Lyme disease? Is timing really that critical?
Yes, timing matters. The risk of Lyme transmission increases significantly after 36 hours of attachment. The sooner you remove the tick, the lower the risk. That’s why daily tick checks are so important.

Should parents save the tick after removal? And if so, what’s the right way to do that?
Yes! Pop the tick in a ziplock bag with a moist cotton ball. Saving the tick can be helpful for identification.

What are the early symptoms of Lyme disease in children, and how soon might they show up after a bite?
Early signs usually appear 3 to 32 days after a bite and include fatigue, fever, headache, muscle and joint aches, and over 80% will get a skin rash. The rash is often, but not always, the classic bull’s-eye shape.

Is the bull’s-eye rash a reliable sign of Lyme? What if there’s no rash at all?
The bull’s-eye rash is Lyme’s signature move; it’s a strong diagnostic clue, but not everyone gets it, and it can easily go unnoticed. So absence of a rash doesn’t rule out Lyme if there is exposure history and other symptoms are present.

How is Lyme disease diagnosed in kids, are blood tests always reliable in early stages?
Early on blood tests may come back negative because the body hasn’t made enough antibodies yet. So if your child has a classic rash and geographic exposure, we might skip the tests and go straight to treatment.

What’s the treatment protocol for Lyme in children, and how effective is it if caught early?
Children are treated with a course of antibiotics, usually amoxicillin or doxycycline. When treated early, Lyme disease is typically fully curable, and children recover completely.

Are there any lasting effects of Lyme disease in kids if it’s not treated right away?
If untreated, Lyme can cause more serious issues — like joint swelling, nervous system involvement, or heart rhythm problems. These complications are less common and most children recover completely with appropriate care.

Is it ever appropriate to give antibiotics right after a tick bite as a precaution? If so, when?
A single dose of doxycycline can be given as a preventative measure to children who meet all of the following high-risk criteria: (1) the tick is an identified deer tick, (2) the exposure occurred in a highly endemic area, (3) the tick was attached for ≥36 hours, and (4) prophylaxis is initiated within 72 hours of tick removal.

Do all ticks carry Lyme, or only specific ones like deer ticks?
Only deer ticks (also known as blacklegged ticks) transmit Lyme disease in the northeastern U.S. Other ticks, like dog ticks or Lone Star ticks, may carry other diseases, but not Lyme.

What are a few common myths or misunderstandings about ticks or Lyme that you often hear from parents?
Myth: All tick bites lead to Lyme disease.
Truth: Most tick bites do not result in Lyme or any illness.

Myth: If there is no known tick bite, it can’t be Lyme.
Truth: Lyme is often diagnosed without a known tick bite. Ticks can be sneaky.

Myth: No rash means no Lyme.
Truth: Many kids never develop a rash, or it’s missed.

Myth: Lyme only happens in rural areas
Truth: It’s also common in suburbs and parks, especially in areas like Staten Island and the Bronx.

If you’re unsure about anything related to your children’s health, ticks, Lyme, and anything in between, it’s always best to ask your pediatrician. We’re happy to help.

Resources for Parents

NYC Health: Ticks and Lyme Disease
Local guidance on ticks, Lyme risk by borough, and prevention tips from the NYC Department of Health.

New York State Dept. of Health: Tick Safety Guide
A detailed overview of tick types, removal techniques, and Lyme disease prevention across NY State.

HealthyChildren.org Symptom Checker: Tick Bite
A trusted tool from the American Academy of Pediatrics to help you know what to watch for and when to call your pediatrician.