Emily Oster

7 min Read Emily Oster

Emily Oster

Ticks, Lyme Disease in Kids, and a Possible Vaccine

An ounce of prevention...

Emily Oster

7 min Read

It’s spring, which means we are coming up on tick season in the Northeast. We live in Rhode Island, which means we do have ticks, especially out in the woods where we force our children to hike most weekends. Within the past few years, we’ve had a number of tick bites, including several on my son and one that I found on my stomach in the shower (gag).

Ticks are one of my husband’s primary nemeses. In the spring, he treats our clothes and boots with an anti-tick spray and then walks around the woods loudly announcing that he hopes ticks land on his boots so they will shrivel and die (I don’t know if this is actually how the spray works). Anytime we are outside, even in the middle of the winter, he insists on a nightly tick check.

What I am saying here is that ticks occupy significant brain space in our house. And while I definitely roll my eyes, he is not completely wrong. Where we live, ticks carry Lyme disease, which can be debilitating if not caught early. And Lyme is not uncommon — the CDC estimates almost 500,000 cases a year.

Today’s post is, therefore, three things.

First: If you’re interested in ticks in general (who isn’t!) and how to think about length of exposure, removal, and how worried you should be, there is this post from the archive. It’s everything you wish you didn’t need to know about ticks. There is also a great graphic on how to respond if you find a tick on your child (or you).

Second: a discussion of Lyme disease in kids — what to look for, when it might be a diagnosis, a bit on treatment.

Third: some exciting notes about a possible Lyme disease vaccine, currently in trials, which will make my household very happy.

Lyme disease in kids

Lyme disease is a tick-borne bacterial illness, caused by a family of spirochete bacteria. Other bacteria in this family cause syphilis and a number of other febrile illnesses. The big-picture overview on Lyme is that it is very treatable if caught early but can be more resistant to treatment if caught only later.

If you find a tick on your child, even if it has been there for several days, you are in a relatively good position, Lyme-wise. As I talk more about in the tick post linked above, depending on the length of time the tick has been there, it may or may not make sense to treat the child with antibiotics prophylactically (i.e. before you see any symptoms). But even if you do not, you can watch carefully, and if a rash develops, you can treat quickly.

Things can become more complicated when the tick exposure is unknown. For example, a tick can bite, stay for several days, and fall off without your knowing (in some cases, they are extremely small — it’s easy to miss, even if you’re with your child a lot).

In about 89% of cases in kids, Lyme disease will manifest as a rash. The rash is often a distinctive bullseye shape but may simply be a red circle. If your child (or you, but I’m focusing today on kids) has this rash and no other symptoms, the disease is considered “early localized.”

A close-up of a classic Lyme disease bullseye rash on an arm.
“Classic” Lyme rash via the CDC.

Treatment for Lyme at this point is typically done with doxycycline, an antibiotic, for 10 days. Younger children may sometimes be treated with amoxicillin for a slightly longer time frame. Full recovery is about 95% after this treatment, and generally within a few weeks or sooner.

If Lyme progresses without treatment, it moves from localized to “early disseminated.” This may happen within weeks or months of not being treated, often if the early rash was not present or was missed. Disseminated disease is categorized by a rash plus other symptoms. For children, the primary other symptoms are multiple rashes, facial nerve palsy, meningitis, and carditis. It is common for children to have fever, fatigue, and headache and generally feel crummy.

Facial nerve palsy — which is second to multiple rashes as the common presentation in kids — is a condition characterized by partial paralysis of a part of the facial muscles. Kids may have trouble closing an eye, resulting in irritation.

If a child presents to a doctor with some combination of these symptoms, they will typically be tested for Lyme — in some cases, a persistently unwell child even without a specific symptom will warrant a test. There are some complications about the value of this testing, since Lyme does not always show up quickly in the bloodstream.

At this stage, the treatment for Lyme also starts with doxycycline. Depending on the severity, it may also be necessary to treat with other IV antibiotics, although a long course of oral antibiotics is generally preferred (14 to 21 days).

If Lyme is not recognized or not effectively treated, it is possible for it to manifest months later with different symptoms. The most common of these is arthritis, especially in the knee. Lyme arthritis would be suspected if a child had a swollen and tender knee joint, with the ability to walk but with some difficulty.

The treatment here is also doxycycline, typically for a longer period (28 days). In these cases, there is a need for more follow-up to ensure that symptoms are resolving.

In all three cases, the basic idea is the same: This is a bacterial infection, with a bacteria that is especially responsive to doxycycline (and other antibiotics). The more established the infection is, the more treatment you need. A quick note: In about 15% of cases, people with Lyme get worse (fever, fatigue) in the first day of therapy (this is called a Jarisch-Herxheimer reaction). It is not a signal to stop treatment but a signal that it’s working.

Final point: There is discussion and debate about chronic Lyme disease, which is a poorly understood condition. Limited evidence in children does not suggest that long-term non-specific consequences are common. If this is in your set of concerns, it’s worth diving in much more deeply with a trusted doctor. 

A Lyme disease vaccine!  

It would be great to have a Lyme disease vaccine. Even though the disease is largely treatable, if you miss the tick and the rash, the symptoms can be scary and take a while to resolve. Treatment with antibiotics for a month is a recipe for feeling terrible stomach-wise. At the moment, however, the only available vaccine is for dogs.

There used to be a human Lyme vaccine! It was called LYMErix, and it worked. Unfortunately, after some (probably unfounded) concerns about adverse reactions, demand went down, and 20 years ago it was pulled off the market.

Now Pfizer is in the game with a new possible vaccine, which targets a protein on the outer surface of the Lyme bacteria. The vaccine is currently in Phase 3 trials, meaning it’s out in the world, being tested for efficacy in people in areas where Lyme disease is common. It’s already been through trials for safety and for an immune response, so this is the last in-the-field test that the FDA requires. If the trial is successful, the company will submit for FDA approval. This is likely to be a few years. The Phase 3 trial began in August 2022, and these things take time to enroll, to generate follow-up data, and to submit.

Until then…

Until then, what are the lessons here?

First: re-read that tick piece! The best way to avoid Lyme, plus all the other tick-borne diseases, is to check yourselves for ticks. Please also enjoy this wonderful song about the romance of doing so.

Second, if your child does show up with a characteristic rash, see a doctor even if you didn’t see a tick there. Treating early is better.

Third, depending on where you live, Lyme is worth keeping in mind as a possible diagnosis if your child has facial palsy, unusual rashes, or arthritis in the knee. Your doctor is likely to suspect it, but it’s always good to be your own informed advocate.

A decision tree for what to do if you notice a tick on your child.
Community Guidelines
0 Comments
Inline Feedbacks
View all comments
A green mosquito coil on a yellow background.

Jun 03 2022

2 min read

What Should I Do to Prevent Lyme Disease?

Ask ParentData

Emily Oster
Close up of a tick on a plant

Apr 19 2021

9 min read

A Decision Tree for Ticks and Lyme Disease

That's it, this is just a post about ticks.

Emily Oster
A medical registrar talking to some students during a seminar at the hospital.

Apr 22 2021

2 min read

Reader Tips on Ticks

Wow, you guys had a LOT of great stuff to say about ticks. I cannot do it justice, but here Read more

Emily Oster
A toddler has fun playing outside with a parent.

Sep 27 2023

2 min read

Should I Worry About EEE from Mosquitos?

I just saw that mosquitoes are now testing positive for EEE in Massachusetts. We live about 50 miles away from Read more

Emily Oster

Instagram

left right
Do men really get worse colds? Not really, but they definitely think so! 

#mancold #perceptionvsreality #sickday #staystrong #emilyoster

Do men really get worse colds? Not really, but they definitely think so!

#mancold #perceptionvsreality #sickday #staystrong #emilyoster
...

💧 Is your kid drinking bathwater? Here’s the 411: It’s gross but not dangerous! Comment “Link” for my full guide to bathtime.

 A little soap or mold from toys isn’t harmful, and diluted pee is no big deal. Eating a lot of poop can make you sick, but in small amounts, it isn’t toxic.

Bottom line: Bathwater isn’t your kid’s best drink option, but don’t stress too much! Just keep an eye on them during bathtime for safety. 

#kidsbathtime #bathtoys #bathtimefuntime #emilyoster #parentdata

💧 Is your kid drinking bathwater? Here’s the 411: It’s gross but not dangerous! Comment “Link” for my full guide to bathtime.

A little soap or mold from toys isn’t harmful, and diluted pee is no big deal. Eating a lot of poop can make you sick, but in small amounts, it isn’t toxic.

Bottom line: Bathwater isn’t your kid’s best drink option, but don’t stress too much! Just keep an eye on them during bathtime for safety.

#kidsbathtime #bathtoys #bathtimefuntime #emilyoster #parentdata
...

Why is it that schools always call mom, even when dad’s the one with more availability? Comment “Link” to dive into the data on inequality in parental workloads.

A study shows just how deep the gender divide runs when it comes to household labor—even in something as simple as a phone call. Does this ring true for you? Share your experience in the comments 👇

#gendergap #momstruggles #parentsupport #emilyoster #parentdata

Why is it that schools always call mom, even when dad’s the one with more availability? Comment “Link” to dive into the data on inequality in parental workloads.

A study shows just how deep the gender divide runs when it comes to household labor—even in something as simple as a phone call. Does this ring true for you? Share your experience in the comments 👇

#gendergap #momstruggles #parentsupport #emilyoster #parentdata
...

Is your child getting enough sleep? 💤 Kids need 9-11 hours of rest for better focus, behavior, and health. Comment “Link” for an article on the importance of sleep and how to help your kids get more of it. It’s time to make sleep a priority!

#childsleep #childhooddevelopment #parentingtips #emilyoster #parentdata

Is your child getting enough sleep? 💤 Kids need 9-11 hours of rest for better focus, behavior, and health. Comment “Link” for an article on the importance of sleep and how to help your kids get more of it. It’s time to make sleep a priority!

#childsleep #childhooddevelopment #parentingtips #emilyoster #parentdata
...

Here’s my rant on motherhood inspired by the Barbie movie. Motherhood is hard enough without the unsolicited expectations we’re constantly assigned. As I always say, there is no secret option c. You’re doing great, and I hope you know that! 

Share this with a mom you think is doing great!

#parentdata #emilyoster #motherhood #barbiemovie

Here’s my rant on motherhood inspired by the Barbie movie. Motherhood is hard enough without the unsolicited expectations we’re constantly assigned. As I always say, there is no secret option c. You’re doing great, and I hope you know that!

Share this with a mom you think is doing great!

#parentdata #emilyoster #motherhood #barbiemovie
...

Ever seen a headline that makes your heart race, but when you dig deeper, the study behind it doesn’t hold up? That’s a panic headline! It’s designed to grab attention and spark fear, but the research it’s based on is often weak or irrelevant. Next time you see one, take a breath, look closer, and don’t let sensationalism get you stressed out.

What’s the most recent panic headline you’ve seen? Drop it in the comments and let’s break it down together! ⬇️

#parentdata #emilyoster #panicheadline #datadriven #riskmanagement #parentingstruggles

Ever seen a headline that makes your heart race, but when you dig deeper, the study behind it doesn’t hold up? That’s a panic headline! It’s designed to grab attention and spark fear, but the research it’s based on is often weak or irrelevant. Next time you see one, take a breath, look closer, and don’t let sensationalism get you stressed out.

What’s the most recent panic headline you’ve seen? Drop it in the comments and let’s break it down together! ⬇️

#parentdata #emilyoster #panicheadline #datadriven #riskmanagement #parentingstruggles
...

Is constant phone access impacting your child’s development? 📵 Today on the ParentData podcast, listen to @profemilyoster and @jonathanhaidt discuss the impact of phones and social media on learning and child mental health.

Listen to this episode now and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #theanxiousgeneration #kidsmentalhealth #screentime #jonathanhaidt #emilyoster

Is constant phone access impacting your child’s development? 📵 Today on the ParentData podcast, listen to @profemilyoster and @jonathanhaidt discuss the impact of phones and social media on learning and child mental health.

Listen to this episode now and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #theanxiousgeneration #kidsmentalhealth #screentime #jonathanhaidt #emilyoster
...

Here’s your Monday reminder for the start of the school year: You’re doing a great job, rice bunnies or not!

This is a sneak peek from the Saturday newsletter on ParentData. Want more parenting tips and insights? Subscribe now at the link in bio.

#parentdata #emilyoster #parentingadvice #parentingtips #parentingquotes #parentingishard

Here’s your Monday reminder for the start of the school year: You’re doing a great job, rice bunnies or not!

This is a sneak peek from the Saturday newsletter on ParentData. Want more parenting tips and insights? Subscribe now at the link in bio.

#parentdata #emilyoster #parentingadvice #parentingtips #parentingquotes #parentingishard
...

Reflux: It’s more common than you think! Comment “Link” for an article by @thepediatricianmom breaking down the information we have about reflux — what it is, what you can do, and red flags to look out for.

This graph shows how reflux changes with age. Nearly half of all babies experience reflux by 3 months, often peaking around 4 months before improving by their first birthday. And remember, if you’re struggling, you’re not alone. The most effective treatment for infant reflux is time. It will get better!

#parentdata #refluxbaby #babyreflux #spitup #parentingadvice #emilyoster

Reflux: It’s more common than you think! Comment “Link” for an article by @thepediatricianmom breaking down the information we have about reflux — what it is, what you can do, and red flags to look out for.

This graph shows how reflux changes with age. Nearly half of all babies experience reflux by 3 months, often peaking around 4 months before improving by their first birthday. And remember, if you’re struggling, you’re not alone. The most effective treatment for infant reflux is time. It will get better!

#parentdata #refluxbaby #babyreflux #spitup #parentingadvice #emilyoster
...

We’re heading into a three-day weekend, which means a lot of you might take the opportunity to do some potty training. 

Here are some things to keep in mind:
🚽 It takes longer than three days (based on the data!)
🚽 Your child will have trouble staying dry at night.
🚽 Poop sometimes comes later than pee – this is common, you just have to work through it.

Comment “Link” for an article that breaks down potty training data from ParentData readers,  along with helpful tips and tricks.

#pottytraining #pottytrainingtips #pottytrainingproblems #parentdata #emilyoster

We’re heading into a three-day weekend, which means a lot of you might take the opportunity to do some potty training.

Here are some things to keep in mind:
🚽 It takes longer than three days (based on the data!)
🚽 Your child will have trouble staying dry at night.
🚽 Poop sometimes comes later than pee – this is common, you just have to work through it.

Comment “Link” for an article that breaks down potty training data from ParentData readers, along with helpful tips and tricks.

#pottytraining #pottytrainingtips #pottytrainingproblems #parentdata #emilyoster
...

Trampoline parks: great way to get the sillies out or injury haven? Or both? Comment “Link” for an article breaking down a 2023 study on injury trends in trampoline parks.

Here’s a visualisation based on the paper, showing the injury rate by area. Beware the foam pit and the high-performance areas! Slam-dunking, though, seems fine.

#parentdata #emilyoster #trampolinepark #childsafety #trampolinefun

Trampoline parks: great way to get the sillies out or injury haven? Or both? Comment “Link” for an article breaking down a 2023 study on injury trends in trampoline parks.

Here’s a visualisation based on the paper, showing the injury rate by area. Beware the foam pit and the high-performance areas! Slam-dunking, though, seems fine.

#parentdata #emilyoster #trampolinepark #childsafety #trampolinefun
...

I’m teaming up with @Wholefoods to remind you that even though school lunches can be tricky, they have everything you need, from conventional to organic, to give you peace of mind about the foods your kids eat. Through their rigorous Quality Standards, they ban 300+ ingredients from food. 

Does your kid have any special or weird lunch requests? Share in the comments! Tap the link in my bio for more tips and inspiration #WholeFoodsMarket

I’m teaming up with @Wholefoods to remind you that even though school lunches can be tricky, they have everything you need, from conventional to organic, to give you peace of mind about the foods your kids eat. Through their rigorous Quality Standards, they ban 300+ ingredients from food.

Does your kid have any special or weird lunch requests? Share in the comments! Tap the link in my bio for more tips and inspiration #WholeFoodsMarket
...

Travel is already stressful. Add kids to the equation, and it becomes even more complicated. Here are 3 tips and considerations for handling jet lag in kids.

#travelwithkids #jetlag #melatonin #parentingtips #parentdata #emilyoster

Travel is already stressful. Add kids to the equation, and it becomes even more complicated. Here are 3 tips and considerations for handling jet lag in kids.

#travelwithkids #jetlag #melatonin #parentingtips #parentdata #emilyoster
...

Happy 11th birthday to #ExpectingBetter 🎂🎉 Writing this book completely changed my life. I could never have imagined the opportunities and community it would lead me to. Grateful to all of you for reading and being here!

To celebrate, you can use the code “expectingbetter” for 15% off Web or Plus subscriptions on ParentData.org 💛

#bookbirthday #pregnancyadvice #parentdata #emilyoster

Happy 11th birthday to #ExpectingBetter 🎂🎉 Writing this book completely changed my life. I could never have imagined the opportunities and community it would lead me to. Grateful to all of you for reading and being here!

To celebrate, you can use the code “expectingbetter” for 15% off Web or Plus subscriptions on ParentData.org 💛

#bookbirthday #pregnancyadvice #parentdata #emilyoster
...

Screens have become a ubiquitous part of classroom life. Is this a good thing? Today on the ParentData podcast, I talk with @jessgrosewrites from the @nytimes. She recently ran a survey asking about kids’ screen usage after not being able to find studies and data on the subject.

“Nothing is all bad or all good. But I think overall, there just has been very little scrutiny into something that has been a massive shift in the way kids learn in the past, let’s say, two decades.”

Comment “Link” for a DM to listen to today’s podcast episode. 🎧

#screentime #technologyintheclassroom #parentdatapodcast #parentdata #emilyoster

Screens have become a ubiquitous part of classroom life. Is this a good thing? Today on the ParentData podcast, I talk with @jessgrosewrites from the @nytimes. She recently ran a survey asking about kids’ screen usage after not being able to find studies and data on the subject.

“Nothing is all bad or all good. But I think overall, there just has been very little scrutiny into something that has been a massive shift in the way kids learn in the past, let’s say, two decades.”

Comment “Link” for a DM to listen to today’s podcast episode. 🎧

#screentime #technologyintheclassroom #parentdatapodcast #parentdata #emilyoster
...

We surveyed the ParentData audience and here’s what you said about the worst baby products. Bottom of the list: unnecessary warmers. Don’t get your kid used to having warm diaper wipes! Nothing good can come of that.

Comment “Link” for the best baby items and other parenting wisdom from the ParentData community. Best general advice: get things used, and you do not need as much as you think. 

Add your advice below! What do you wish you’d known about in advance, and what was a waste? ⬇️

#parentdata #emilyoster #babyproducts #babyitems #newparents #firsttimeparents

We surveyed the ParentData audience and here’s what you said about the worst baby products. Bottom of the list: unnecessary warmers. Don’t get your kid used to having warm diaper wipes! Nothing good can come of that.

Comment “Link” for the best baby items and other parenting wisdom from the ParentData community. Best general advice: get things used, and you do not need as much as you think.

Add your advice below! What do you wish you’d known about in advance, and what was a waste? ⬇️

#parentdata #emilyoster #babyproducts #babyitems #newparents #firsttimeparents
...