If You Find A Tick On Your Child: Make Sure You Know These Guidelines
Finding a tick on your child can be scary, but I want you to know that with the right approach, you can handle this situation calmly and effectively. As a pediatrician, I've walked countless parents through tick removal, and I'm here to give you a clear, step-by-step guide that will help you feel confident in managing this common occurrence.
Step 1: Stay Calm and Get Your Supplies
Take a deep breath. Most tick bites do not result in illness, and prompt, proper removal significantly reduces any risk of disease transmission. Here's what you'll need:
Fine-tipped tweezers or a tick removal tool
Rubbing alcohol or antiseptic wipes
A small container or ziplock bag
Magnifying glass
Gloves
Step 2: Examine the Tick Carefully
Before removal, take a moment to look at the tick. Note its size, color, and how long it appears to have been attached. If possible, try to identify whether it's engorged (swollen with blood), which can indicate it's been attached for longer. Don't worry if you can't identify the species right now—we'll address that later.
Step 3: Remove the Tick Properly
This is the most important step, and I want you to do it right:
Using tweezers:
Grasp the tick as close to your child's skin as possible - lay the tweezer flat against the skin for optimal removal.
Pull upward with steady, even pressure—don't twist or jerk
Don't squeeze the tick's body, as this can push infected fluids into the bite site
If mouth parts break off and remain in the skin, remove them with tweezers if you can grasp them easily
Using a tick removal tool:
Follow the manufacturer's instructions
These tools are designed to slide under the tick and lift it out
What NOT to do:
Don't use petroleum jelly, nail polish, or heat to try to make the tick detach
Don't use your fingers to pull out the tick
Don't twist or crush the tick during removal
Step 4: Clean the Area Thoroughly
After successful removal:
Clean the bite site with rubbing alcohol or soap and water
Wash your hands thoroughly with soap and water
Apply a small amount of topical antibiotic ointment to the bite site if desired
If part of the tick remains, don’t dig in after it. Chat with your care team about next steps.
Step 5: Preserve the Tick
Place the tick in a small container or ziplock bag with the date and location where the bite occurred. While we don't typically test ticks for disease, having the tick available can help with species identification if needed.
Step 6: Monitor the Bite Site
Keep an eye on the bite area for the next several weeks. It's normal to see some redness and swelling immediately after removal, but watch for:
Expanding redness or rash
Rash that develops a "bull's-eye" appearance
Fever
Flu-like symptoms
Joint pain or swelling
Any questions or concerns
When to Consider Antibiotic Prophylaxis
Now, let's talk about when we might consider preventive antibiotics, specifically for Lyme disease. Based on current guidelines from the American Academy of Pediatrics, the Infectious Diseases Society of America, and the CDC, we consider single-dose doxycycline prophylaxis (4.4mg/kg/dose one time) when the following criteria are met:
The tick bite occurred in an area where Lyme disease is common (this includes our Philadelphia/TriState area). You can check your area here if you aren’t sure.
The tick is identified as an Ixodes species tick (also called deer tick or blacklegged tick)
The tick was attached for more than 36 hours
Doxycycline can be started within 72 hours of tick removal
If even one of these criteria isn't met, the recommendation for healthy, asymptomatic children is simply to monitor for symptoms without preventive treatment and watch for any symptoms (see below).
Important Notes About Prophylaxis
We typically recommend a single dose of the antibiotic doxycycline — this is considered even in younger children under 12. While past guidance avoided doxycycline in young kids, we now know a single dose is safe and effective when used properly (AAP Red Book; 2020 Lyme Guidelines).
It's crucial to understand that no alternative antibiotics are recommended for prophylaxis—doxycycline is the only option that has been proven effective for this purpose.
Also, while we have effective prophylaxis for Lyme disease, there are currently no clinical data supporting antibiotic prophylaxis for other tick-borne illnesses like anaplasmosis, ehrlichiosis, babesiosis, or Rocky Mountain spotted fever - other tick-borne illnesses.
About Tick Testing
I often get asked about testing the tick itself for infections. Current guidelines tell us that tick testing for spirochete infections like Lyme is not generally recommended because the results don't always correlate well with actual infection outcomes. However, having the tick examined by a healthcare provider to confirm the species can be helpful in making treatment decisions.
When to Call Your Pediatrician
Contact your child's healthcare provider if:
You're unable to remove the tick completely
You're unsure about the tick species and want it examined
Your child develops fever, rash, or other symptoms within 30 days of the bite
You're concerned about the bite site or have questions about prophylaxis
And Remember…
Remember, the vast majority of tick bites do not result in illness. The key is prompt, proper removal and vigilant monitoring. Don't let fear of ticks keep your family from enjoying outdoor activities—just be prepared and know what to do.
You're doing so great. Just take it one step at a time.
Sending you a big hug,
Anjuli
Disclaimer: This blog post is for informational purposes only and should not replace the specific instructions provided by your child's surgeon or healthcare provider. Always follow the post-operative care instructions given by your medical team.
References:
American Academy of Pediatrics. Red Book: 2021 Report of the Committee on Infectious Diseases. Lyme Disease.
Wormser GP, et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2020.
Centers for Disease Control and Prevention. Lyme Disease. Available at: https://www.cdc.gov/lyme/causes/index.html
Centers for Disease Control and Prevention. Blacklegged Tick Surveillance. Available at: https://www.cdc.gov/ticks/data-research/facts-stats/blacklegged-tick-surveillance.html