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The One Thing Not to Do this Tick Season

It’s that lush, beautiful time in New England when everyone wants to spend time outside in the sunshine… but if one thing is keeping them in, it’s ticks. Concerns peak from May through July, when people get more tick bites and tick-borne illnesses than any other time of year. It’s a common discussion topic and concern among parents. There’s also a lot of misinformation out there.

I’ve found that part of mommying is worrying—a large part. We worry about every thing our child does, doesn’t do, might do, or might not do. When you spend a lot of time outdoors, much of your worrying might be about ticks. Everyone knows someone who has had a tick on them already this year. Everyone has a friend or friend-of-a-friend who has suffered with Lyme disease. To imagine our little ones dealing with it… well, our worrying mother minds go into overdrive. To get to the bottom of it all and to ease my mind as well as yours, I did some heavy reading on the topic. I also interviewed outdoor enthusiast, best friend for life, and Family Physician and division Chief of Primary Care at UPMC- Susquehanna in Williamsport, PA, Matthew Meeker, DO.

Photo Credit: Matthew Meeker

Dr. Meeker loves the great outdoors. He enjoys biking, kayaking, photography, and hiking. He’s

been to 25 national parks and is looking forward to his 26th this summer: Mt. Rainier National Park in Washington. Both his first date and his proposal with his fiancé occurred on hikes. His all-time favorite hike was at the Haystacks in Worlds End State Park in Pennsylvania. Who knew PA also had a park named World’s End? He says, “Nothing beats a strenuous hike for some good views.” I asked him a million questions about ticks and the pathogens they carry, and he patiently answered each one.

Number one concern: there was talk about “tick apocalypse” with one ecologist from New York theorizing that this year’s tick problems would be worse than usual. This was a HUGE topic among moms in March. There are theories about the number of ticks fluctuating due to the white-footed mice population, drought, and winter temperatures. In actuality, it’s difficult to predict how bad of a year it will be, and it can vary widely even from one neighbor’s backyard to another’s. The state’s public health department reports that, while Lyme disease reports have generally increased since 1990, in each of the past three years, the number of confirmed and probable cases in Massachusetts has actually dropped. Dr. Meeker says, “Every year I hear people say, ‘The ticks are really bad this year,’ but in my own practice [in Williamsport, Pennsylvania], I haven’t been seeing any more than previous years.” This being said, it is a concern. 95% of Lyme disease cases reported are from 14 states according to the Center for Disease Control (CDC), and these are states concentrated in the northeast and midwest. Interestingly, the highest proportion of reported cases come from Martha’s Vineyard and Nantucket.

CDC Reported Cases of Lyme, 2015

Lyme disease remains the biggest concern regarding ticks. Other concerns are Rocky Mountain Spotted Fever, anaplasmosis, babesiosis, and Powassan. Having read some alarming reports about Powassan, I asked Dr. Meeker how concerned I should be. He said, “I’ve never seen it, which according to the CDC makes sense because in the last 10 years, there have only been 75 reported cases nationwide. The symptoms are pretty severe, so it’d be unlikely you would not receive appropriate medical attention if you developed it.” Phew. So that’s one thing not to spend time worrying about.

Let’s get to the main concerns, then. Here’s more from my interview with Dr. Meeker.

Wike Baby: What are the risks associated with tick bites, and what are the signs and symptoms?

Dr. Meeker: First, most tick bites are harmless, though compared to other insect bites they are more likely to carry diseases. The vast majority of tick bites will result in a local allergic reaction usually in the form of a hive, painful or itching swelling, and sometimes just a local skin infection. These usually develop within the first two days of a bite. However, some can transmit Lyme disease, Rocky Mountain Spotted Fever, and anaplasmosis. These are usually experienced a few days to a few weeks after a bite. Symptoms generally include fever, headaches, muscle/joint pain, swollen joints, rashes either local or full body, sometimes bells palsy (one-sided facial droop), swollen lymph nodes, neck stiffness. Less commonly, people can have involvement of the heart and have symptoms of shortness of breath, chest pain, heart rhythm abnormalities and/or involvement of the neurologic system such as confusion, nerve pain.

WB: Are there any different or additional risks for children or infants?

DM: The risks are not much different for children and infants; however, their symptoms can sometimes be more subtle. Because they are not always the best at explaining the symptoms, they may be more likely to have a delay in diagnosis.

WB: Some parents know to monitor the site of a tick bite for the bulls-eye shaped rash. Can we clear this up: does Lyme always present a bulls-eye?

DM: The majority of Lyme does show a bulls-eye rash (70-80%), however it is possible to not get the rash or to get some other form of rash. The rash, by the way, does not usually develop right away-- usually it’s a few days to weeks. It is not raised and typically does not hurt or itch, and it gradually expands in size. Oftentimes people mistake a location bite reaction to a bulls-eye, but this normally develops within minutes to hours. It also does not necessarily occur at the location of the bite.

WB: Another thing parents talk about is how long the infected tick must be attached or embedded to transmit a disease. Is it true that it needs to be attached for a period of time?

DM: In general it does take more than a bite and some sources suggest around 24 hours of attachment before Lyme can be transmitted. Per Infectious Disease Society of America guidelines, we do not start prophylactic antibiotics unless it’s been attached for greater than 36 hours and removed with 72 hours.

WB: What should I do if I have been bitten by a tick?

DM: If you have only been bitten and it is not latched on or embedded, you should just clean the area with antibacterial soap and water or rubbing alcohol. If is embedded, use a pair of fine tip tweezers, get it as close to the skin as possible and provide consistent upward pressure, avoid twisting as you can tear off the head. If the head does come off, you can try to remove the head with the tweezers, but if you cannot get it, just leave it alone, it’ll heal fine, just make sure to keep the area clean and watching for signs of skin infection.

WB: When should I call the doctor?

DM: Call doctor if a tick has been embedded for 36 hours or more, if you develop symptoms, or believe the area is infected.

WB: How do you recommend avoiding tick bites? What do you personally do to avoid tick bites when you are out on an adventure?

DM: Prior to going on a hike, you can apply an insect repellent containing DEET (10-30%), though not for children under 2 months. Wear long pants, closed shoes, and bandanas or hats. You can also buy gear that is pretreated with permethrin or get a permethrin spray for clothes and gear. During the hike, I really just recommend sticking to the center of trails and avoiding tall brush or grasses-- and just enjoy the hike. After your hike, try to take a shower after getting home, check yourself with a full body check, particularly behind the knees, armpits, between the legs, your head and hair and even your belly button. You also should check your dog (or cat if you have a hiking cat) and your boots, coats and backpacks. Personally, I’m really careful about walking in tall grasses especially with my dog Molly, and then I usually shower after a hike and check thoroughly for ticks. I also check Molly after all hikes.

WB: My daughter’s pediatrician recommends 10% DEET for my 5 month old. What percentage of DEET do you consider safe for babies and children?

DM: The percentage of DEET is related to how long it is effective, however there is a limit to this as well. After 30% you do not get much additional benefit. 10% DEET usually gets you about 2 hours of protection and 30% gets you about 5 hours. In general you should apply sunscreen prior to DEET. It is also safe to apply DEET when nursing or pregnant. You should avoid DEET in children under 2 months. Also, apply in open areas to avoid inhalation, and do not apply to open cuts or wounds.

WB: Do I have to bathe my child every day after applying insect repellant? Not to sound like a negligent parent, but who has time for a daily bath!?

DM: You do not have to go for the full bath. Washing exposed areas with water and soap is fine. However, a bath is a good way to do a full body check for ticks.

WB: I’m thinking of spraying my shoes and baby carrier with permethrin. If I use permethrin on my baby carrier, which touches my baby’s skin, is it harmful to my baby at all?

DM: It’s most likely safe, as only about 1% of the active ingredient is absorbed into the skin when applied directly to the skin. We use permethrin creams on children as young as 2 months for scabies. So when indirectly exposed through treated clothes and carriers, there is minimal absorption.

WB: I’ve heard of toddlers who have eaten some pretty outrageous things. My own baby is currently at the stage in which everything goes into her mouth. Out of curiosity, what would happen if your toddler ingested an infected tick…?

DM: Other than knowing you have a weird tick-eating baby, I’m pretty sure the stomach acids would kill it and the bacteria in the tick. Or they might get tick super powers, not sure what those would even be.

WB: Lots of people avoid the outdoors because of concerns around ticks. Do you recommend that people stay indoors because of the potential for tick bites outside?

DM: No way. As long as you practice good prevention and check at the end you’re good to go.

There you have it: the one thing not to do this tick season is to stay indoors because of your concerns! Let’s recap how to stay safe while enjoying the outdoors with your children:

  1. Use insect repellant with DEET, and apply it after you apply sunscreen.

  2. Wear tick-protective clothing, such as long sleeves, pants, and hats.

  3. Stick to paths and trails to avoid the brush where ticks live.

  4. Take a shower and wash your child’s exposed areas with soap and water after your wike.

  5. Do a full body tick check after being outdoors, particularly examining those warm and cozy, hard-to-see areas.

(Click photos for more information.)

Stay safe, and happy wiking!

I’d like to thank Dr. Meeker for his expertise, time… and friendship. Feel free to comment below with any thoughts, additional information, or concerns!

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