Tick Bite

What is it?

Ticks are small insect-like creatures that live by sucking blood from an animal or human host. They are not actually insects, but are more closely related to spiders, centipedes, and crabs. Most ticks live outdoors, where they breed, lay eggs, and develop into larvae (babies) and then adults. Ticks generally feed on the blood of a different kind of host in each life stage. This makes it possible for ticks to transmit diseases from animals to people.

The ticks that bite humans belong to several different families, but they all make their living the same way. The tick climbs a stalk of grass or weed, and waits there for a passing animal or person. Once they get onto the host, they start to crawl upward until they find a place where they are not likely to be found, like in a fold of skin (armpit, groin, etc). The tick then slowly breaks through the host’s skin (this is almost always painless). Like mosquitoes, ticks then inject their saliva, which contains a mixture of chemicals that increase blood flow to the area and prevent blood from clotting. This helps them get the biggest meal they can. Once securely attached to a host, most ticks feed for several days, and then drop off, unless the host finds them first. Tick bites almost never hurt at first, which means that a person with a tick may not find it for quite some time, unless the person is careful to check him or herself.

Tick bites themselves aren’t dangerous or even very uncomfortable at first, though almost everyone who gets bitten by a tick is disgusted by it. Some kinds of ticks can carry a variety of infections, though these are fairly rare. Infections that ticks can give to humans include Rocky Mountain spotted fever and Lyme disease, which are the best known. Ticks can also carry still rarer diseases such as "ehrlichiosis" (air-lick-ee-oh-siss), "tularemia" (tool-ah-ream-ee-ah), "babesiosis" (babb-easy-oh-siss), and infections and fevers. Tick bites can also cause a temporary form of weakness or paralysis called "tick paralysis," which is most common in younger children. Scientists believe that some of the chemicals in the tick’s saliva cause tick paralysis. Some people may also develop an allergic reaction to the tick bite, especially if they have had tick bites before. Children can develop infections of their skin at the site of the bite, especially if their skin itches and they scratch it open. Finally, if parts of the tick remain in the skin after removal, the person’s body can form a permanent bump, or "granuloma," around the material. With the exception of allergic reactions, people can prevent these problems by removing the tick as soon as they find it. Ticks have to remain on the body for 24 – 48 hours in order to transmit infections, so early removal easily prevents the diseases.

Once you discover that a tick is on your child, it is important to remove it as soon as possible. It is also important, though, to do this carefully so as not to leave parts of the tick in the skin. First, please be sure the tick is actually biting your child – if you catch it early enough it may still be trying to find a place to bite. If you can see the tick moving along the skin, just try to brush it off gently. If it is biting, it will stay tightly attached to the skin. The very best method of removing a biting tick is to grasp it by the head as close to the skin as possible, and then slowly but steadily pull it out. Your doctor will have the very fine forceps that can do this job the best. If you can’t get to your doctor, you can remove the tick yourself using the finest pair of forceps or tweezers you can find. Push down on the skin around the tick’s head gently before closing the forceps, then grasp the head firmly and pull slowly backwards. Don’t let go until you have pulled the tick all the way out. Try not to pull the tick’s body out and leave the head behind.

Please do not try to kill the tick while it is on the skin, using alcohol, lotions, grease or heat. These things don’t work and can make the actual removal harder.

Removing the tick is the most important step in preventing any of the other diseases we mentioned above. So long as your child does not develop any symptoms of these diseases, there is no need for antibiotics or other medicines, and these will not help to prevent an infection. Doctors use antibiotics to treat people who do develop symptoms of infections.

Once you have removed the tick, you have reduced most of the risk of infection. If you were able to remove the tick within the first two days of the bite, your child almost certainly will not develop an infection. Here are some things to look out for that would raise concerns about infection or other illnesses:

• Fever
• "Influenza"-like symptoms such as sore throat, aching muscles and joints, cough
• Rash of any kind, but especially rash on the palms and soles (suggests Rocky Mountain spotted fever) or a spreading red circular or oval patch with normal skin in the center (suggests Lyme disease)
• Headache
• Weakness of legs
• Unsteady gait (walking)
• Lethargy (extreme tiredness)
• Difficulty swallowing, talking, or breathing

Of course the best way to prevent diseases that ticks can cause is to prevent the bite in the first place. There are three main ways to do this:

1. Recognize places where ticks are likely to live. This includes tall grass and weeds. Ticks need lots of moisture to live, so they are more common in lush, green environments than very dry areas. If your child has been playing or walking through such areas, please be sure to give him or her a thorough "tick check" at the end of each day. Go over your child’s skin carefully, paying special attention to skin folds and hidden areas. Don’t forget the scalp, though – ticks can sometimes end up on the head, especially in a small child.
2. If you can’t avoid areas where ticks are likely, try to have your child wear protective clothing like long-sleeved shirts, long pants, and socks. This is often hard to do when it is hot outside. It is still important to do the "tick check" at the end of the day, of course.
3. You can use insect repellents to prevent ticks. The chemical called "DEET" is the most effective. DEET can be dangerous in very high concentrations in smaller children, so please read the label carefully. In general, DEET products with a concentration of 30 – 35% DEET provide the maximum protection without major risk, even in small children. Some products contain "extended duration," or "ED" DEET. These can provide longer-lasting protection and may reduce the amount of DEET that your child absorbs through the skin. Please avoid the very high concentrations of DEET that contain up to 100% DEET – these are fine for adults, but are too concentrated for children. There is no scientific evidence that products containing DEET and sunscreen together in one product are useful. In fact, DEET reduces the effectiveness of sunscreen by up to 34%. In some cases you may need to apply both a sunscreen product and a DEET product, to protect your child from sunburn and from ticks. In that case, please apply the sunscreen first, and give it 20 minutes to get into the skin, and then apply the DEET. Remember that you should use sunscreen frequently and in large amounts, but you should use only just enough DEET to work, and apply it as infrequently as possible.

You may also want to read our Aftercare Instruction on Insect Bites and Stings.

While it is normal to worry about the infections that ticks can carry, please remember that treatment with antibiotics is not useful in preventing the infections. Your doctor will not want to start your child on an antibiotic just because of the bite. This is why it is so important to watch for symptoms.

There aren’t many biting creatures that look like a tick and stay stuck onto the body for as long as ticks do, so if you think it’s a tick, it probably is. The diseases that ticks can cause are a different matter, though. There are a number of other kinds of infections and conditions that resemble tick-borne diseases. Many of these can be serious themselves, so if your child develops any unusual rash, especially with a headache and a fever, please be sure to get in touch with your doctor right away.