Newsletter

Spring and summer bring fun in the sun, backyard play, hikes, beach trips, and long days at camp. Whether you’re heading upstate, visiting neighboring states, or just exploring nearby wooded and grassy areas, practicing tick safety precautions is always important. While most tick bites will not lead to illness, prevention still matters, and it helps to know what to watch for.

We sat down and spoke with Lizbeth Barba, PNP from our Rahway office in New Jersey, and put together this quick guide to help our families with tick prevention, and understanding what to do if you find a tick on your child. We hope this guide provides information about tick bite prevention to ease any concerns related to tick season.

How concerned should NYC-area parents be about ticks?
If your kids spend time outdoors in grassy or wooded areas, it’s important to follow prevention practices. Lyme disease transmission can happen locally in NYC, especially in Staten Island and the Bronx, though it’s much less common in other boroughs. The majority of cases in our area come from people who have traveled to upstate New York, Long Island, or neighboring states. With that said, tick bites and Lyme disease are things we do see in our practice, particularly in the warmer months.

When are ticks most active?
Ticks are most active between the months of April through October; however, June and July are typically the most high risk months. It’s important to know that ticks can also stay active during mild winters, so tick season isn’t always as predictable as people expect.

How can parents help prevent tick bites?
When kids are spending time in grassy, wooded, or brushy areas, it is important to use the following practices to help prevent a tick bite:
• Wear long sleeve shirts, long pants, and socks. Try to keep all skin areas completely covered.
• Choose light-colored clothing so ticks are easier to spot.
• Apply an age-appropriate insect repellent.
• Stick to the center of trails and stay away from tall grass, brush, and leaf litter.
• Do a thorough skin assessment to check for ticks when coming back inside. Check behind the ears, scalp, armpits, around the waist, behind the knees, and in the groin area.
• Bathe within two hours of coming indoors when possible.
• Put clothes in the dryer on high heat for at least 10 minutes after outdoor time.

What repellents are safe for kids?
Some insect repellents aren’t approved for infants under 2 months, so always check the label and ask your pediatrician if you have questions. The most commonly used insect repellants for kids are:

• DEET: For children under 2, use sparingly, choose a concentration no higher than 30%, this should provide protection for up to 5 hours, and apply only once per day.
• Picaridin: Generally more gentle on skin and less likely to damage synthetic fabrics.
• Permethrin-treated clothing: Useful, but it should never be applied directly to skin. If your child is still putting everything in their mouth, picaridin is probably the better option.

Make sure you wash the child’s skin with water and soap after returning from playing outdoors. Apply spray repellant in an open area to avoid breathing it in. Avoid spraying repellant in children’s hands, especially if they are constantly putting their hands in their mouth.

What should parents do if they find a tick?
Stay calm. Use fine-tipped tweezers to grab the tick as close to the skin as possible and pull upward with slow, steady pressure. Don’t twist, squeeze, burn, or smother it with petroleum jelly. Once it’s out, clean the area with soap and water or rubbing alcohol.

How long does a tick need to be attached to spread Lyme disease?
The risk of Lyme disease transmission increases significantly after a tick has been attached for 36 hours or more. It’s best to have the tick removed as soon as possible, which is why it’s imperative to do a thorough skin assessment after returning from outdoor play.

Should parents save the tick?
Yes, it’s best if you are able to save the tick. This can help with tick identification. We recommend placing the tick in a zip-top bag with a moist cotton ball.

What are the early symptoms of Lyme disease in children?
Early symptoms usually appear between 3 to 32 days after a tick bite. The early symptoms may include: fatigue, fever, headache, muscle aches and/or joint aches. More than 80% of children with Lyme disease also develop a rash. The rash is best described as a bull’s-eye looking rash; however, it doesn’t always look this way.

Is the bull’s-eye rash always present?
No, however, it is important to keep in mind that the absence of a rash doesn’t necessarily rule out Lyme disease; especially if there is a known tick exposure and the child is presenting with any of the symptoms listed above.

Are blood tests always reliable?
Not early on, tests can come back negative the first days or weeks after a tick bite because the body may not have produced enough antibodies yet. If a child has the typical bull’s eye rash and a history of tick exposure in an area where Lyme disease is common, a doctor may treat the symptoms without waiting for the test results.

How is Lyme disease treated in children?
Lyme disease is treated with a course of antibiotics, most commonly amoxicillin or doxycycline. When treated early, it’s typically fully curable and the child may completely recover.

What happens if Lyme disease goes untreated?
If left untreated, Lyme disease can lead to more serious problems over time, including joint swelling, nervous system involvement, and/or heart rhythm issues. These complications are however, less common, and most children recover fully with the right treatment.

Should children ever get antibiotics right after a tick bite?
Not always, a single preventive dose of doxycycline may be recommended if all of the following apply: the tick is confirmed to be a deer tick, the exposure happened in an area where Lyme disease is common, and the tick was attached for 36 hours or more. The treatment can be started within 72 hours of tick removal. Your pediatric provider will determine if treatment is needed for your child.

Do all ticks carry Lyme disease?
No, in the northeastern U.S., Lyme disease is only transmitted by deer ticks, also called blacklegged ticks. Dog ticks and Lone Star ticks can carry other illnesses, but Lyme disease is not one of them.

Common tick myths
Myth: Every tick bite leads to Lyme disease.
Truth: Most don’t result in Lyme disease or any illness at all.

Myth: If there was no visible tick bite, it can’t be Lyme disease
Truth: Lyme disease is often diagnosed without anyone remembering a tick bite. Ticks are small and easy to miss.

Myth: No rash means no Lyme disease.
Truth: Some children never get a rash and sometimes a rash is present but goes unnoticed.

Myth: Lyme disease only happens in rural areas.
Truth: Also seen in suburbs, parks, and parts of NYC, particularly Staten Island and the Bronx.

When to call your pediatrician
Contact your pediatric provider immediately if any of the following symptoms arise after possible tick exposure: you find a tick on your child regardless of how long it’s been attached, develops a bull’s eye rash, fever, fatigue, headache, and/or body aches.

Ticks are most common in the warmer months, but with some basic precautions, families can still enjoy time outdoors without worrying too much.

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.