Getting Children Through Tick Season Safely

Missouri is one of five states accounting for over 60% of the Rocky Mountain Spotted Fever, or RMSF, cases in the US.(1) It’s one of four states accounting for over 50% of ehrlichiosis cases.(2) Other tickborne diseases, such as Lyme disease, can affect children, but RMSF and ehrlichiosis are the only two that children are at risk of acquiring in Missouri.

Tickborne illnesses vary by location because of the geographic distribution of the species of ticks and other organisms that transmit disease, also known as vectors. RMSF and ehrlichiosis are caused by bacteria which are transmitted to humans through tick bites. In Missouri, the principle vector for RMSF is the American dog tick, and the lone star tick for ehrlichiosis.

The symptoms of these two tickborne infections are similar. Fever is always present in children. Other symptoms may vary but can include:

  • Body aches
  • Headache
  • Chills
  • Abdominal pain, nausea, vomiting, diarrhea
  • Decreased appetite
  • Non-itchy rash starting around the wrists and ankles several days after a fever starts — this may not develop in every case

As a parent, you can imagine that it would be difficult to distinguish an early tickborne infection with very common viral syndromes of childhood. Every spring at Tiger Pediatrics, we do a tickborne illness refresher with our nurses who triage phone calls because this distinction can be tricky, and the stakes are high. If RMSF or ehrlichiosis progresses without treatment, symptoms become more severe and can include neurological changes, damage to organs and critical illness.

If your child is having some of these symptoms during tick season, it’s not safe to assume they don’t have a tickborne illness because there’s no sign or known incident of a tick bite. The majority of people with confirmed cases of RMSF and ehrlichiosis have no known history of a bite. Ticks can attach, transmit infection, and detach without us knowing.

The time between a tick bite transmitting one of these infections to a child and the onset of symptoms ranges from 3 to 14 days. As a clinician, when I see a child in late spring or summer who has a persistent fever lasting several days without associated symptoms, like a prominent cough or runny nose that suggest a more common cause of fever, I’m interested in what exposures that child has had in the past 3 to 14 days. Risk factors for tick bites include spending time outdoors in wooded or grassy areas or near brush, or frequent contact with a dog or cat.

If your pediatrician suspects your child has a tickborne illness, it’s important to get blood tests to look for early clues and test for the organisms; however, lab results can be normal in the early stages. Because timely confirmation of disease with lab tests is rarely possible, if clinical suspicion is high, we often prescribe the antibiotic doxycycline rather than risk letting an infection progress to a critical state. The antibiotic should be continued for at least 3 days after the fever resolves, generally resulting in a 7- to 14-day course of doxycycline.

The best way to prevent tick bites is by using repellents. DEET products are safe for children as young as 2 months old. Checking for ticks after being outdoors also plays a significant role in preventing infection. It takes 4 to 6 hours of a tick being attached to the skin to transmit the bacteria that causes RMSF and about 24 hours to transmit ehrlichia.

The best way to remove a tick is to use tweezers with a grasp close to the skin. A common concern I hear from parents is when the tick’s head is left in the child’s skin after they remove the body. If this happens, wash the area with warm soapy water, but don’t fret if the head remains embedded. It will work its way out. The tick’s head is not what harbors infection; the body is.

Avoid trying to remove a tick using methods like applying nail polish or heat from a hair dryer. These methods actually increase the risk of transmission because they stimulate the tick to move its secretions, along with any bacteria the tick is harboring, into the bloodstream while it’s attached.

The CDC’s Tick Bite Bot is a helpful online tool for parents concerned about tick bites and symptoms of tickborne illness. This site also provides information for specific geographical areas where other tickborne diseases, like Lyme disease, are more common: ticks/modules/tickbite-bot-removal. html

By Janine Jacobs, MD

Dr. Janie Jacobs is a pediatrician at Tiger Pediatrics. She is accepting new patients at the Columbia – Keene Street location.

Sources: (1) CDC, Division of Vector-Borne Diseases ( | (2) CDC, Tickborne Diseases of the United States (