Pediatric Lyme Disease Treatment Under 8

How Is Lyme Arthritis Treated

Most children with Lyme arthritis recover after 28 days of antibiotic treatment. The most common antibiotics prescribed for Lyme disease are:

• Doxycycline for children eight years of age or older
• Amoxicillin for children under eight years of age

If the symptoms persist after a course of antibiotics, a second course of antibiotics may be prescribed.

In persistent cases of Lyme arthritis, your rheumatologist may prescribe non-steroidal anti-inflammatory drugs , disease-modifying antirheumatic drugs , or intra-articular corticosteroids.

Awareness Of Lyme Disease

1.1.1 Be aware that:

• the bacteria that cause Lyme disease are transmitted by the bite of an infected tick

• ticks are mainly found in grassy and wooded areas, including urban gardens and parks

• tick bites may not always be noticed

• infected ticks are found throughout the UK and Ireland, and although some areas appear to have a higher prevalence of infected ticks, prevalence data are incomplete

• particularly high-risk areas are the South of England and Scottish Highlands but infection can occur in many areas

• Lyme disease may be more prevalent in parts of central, eastern and northern Europe and parts of Asia, the US and Canada.

1.1.2 Be aware that most tick bites do not transmit Lyme disease and that prompt, correct removal of the tick reduces the risk of transmission.

1.1.3 Give people advice about:

• where ticks are commonly found

• the importance of prompt, correct tick removal and how to do this

• covering exposed skin and using insect repellents that protect against ticks

• how to check themselves and their children for ticks on the skin

• sources of information on Lyme disease, such as Public Health England’s resources and guidance on Lyme disease and organisations providing information and support, such as patient charities.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on awareness of Lyme disease.

What Are The Symptoms Of Lyme Disease In A Child

Symptoms can occur a bit differently in each child. They usually appear within 3 to 30 days after a tick bite. Lyme disease has early and late-stage symptoms. Early stage Lyme disease is more easily cured with antibiotics than late-stage disease. Most cases of late-stage disease occur when early stage disease is not treated.

One of the most common symptoms is a ring-shaped rash that looks like a bull’s-eye. It may be pink in the center and have a darker red ring around it. The rash does not occur in every case of Lyme. If it does occur, the rash may:

• Appear several days after infection
• Last up to several weeks
• Be very small or very large, up to 12 inches across
• Look like other skin problems such as hives, eczema, sunburn, poison ivy, or flea bites
• Itch or feel hot, or not be felt at all
• Go away and come back several weeks later

Several days or weeks after a bite from an infected tick, your child may have multiple ring-shaped rashes on the body and flu-like symptoms such as:

• Headache

Months to a few years after a bite, these symptoms may occur:

• Inflammation of the joints
• Nervous system symptoms such as numbness in the arms and legs, tingling and pain, and trouble with speech, memory, and concentration

The symptoms of Lyme disease can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

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Treatment For Other Forms Of Lyme Disease

People with other forms of disseminated Lyme disease may require longer courses of antibiotics or intravenous treatment with antibiotics such as ceftriaxone. For more information about treating other forms of Lyme disease, see:

The National Institutes of Health has funded several studies on the treatment of Lyme disease that show most people recover within a few weeks of completing a course of oral antibiotics when treated soon after symptom onset. In a small percentage of cases, symptoms such as fatigue and myalgia can last for more than 6 months. This condition is known as post-treatment Lyme disease syndrome , although it is also sometimes called chronic Lyme disease. For details on research into chronic Lyme disease and long-term treatment trials sponsored by NIH, visit the visit the National Institutes of Health Lyme Disease web siteexternal icon.

Is It Lyme Disease Or Is It The Flu

While there are some similarities between early Lyme disease symptoms and the flu, theyre very different illnesses. Flu symptoms in babies and toddlers include fever, cough, sore throat, runny nose, muscle aches, fatigue, nausea, vomiting and diarrhea.

Lyme disease symptoms include joint pain, swollen lymph nodes and headache in addition to fever, chills and nausea. Lyme is also most common during the spring and summer months, when the flu is usually uncommon. Additionally, many people who get Lyme disease also have a noticeable bulls eye rash.

From the What to Expect editorial team and Heidi Murkoff, author of What to Expect When You’re Expecting. What to Expect follows strict reporting guidelines and uses only credible sources, such as peer-reviewed studies, academic research institutions and highly respected health organizations. Learn how we keep our content accurate and up-to-date by reading our medical review and editorial policy.

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What Are The Symptoms Of Lyme Arthritis

Lyme arthritis usually occurs during a later stage of Lyme disease that has not been treated. For many children, arthritis is the first symptom of Lyme disease they experience, and most do not remember being bitten by a tick.

Symptoms of Lyme arthritis include:

• Joint pain, usually in the knees
• Joint swelling, usually in the knees
• Limping or inability to put weight on a limb

Early symptoms of Lyme disease may include:

• Enlarging, warm rash at the site of the bite that can last days to weeks, often with a partial central clearing so that it looks like a bulls eye
• Fever

If left untreated, later stage symptoms of Lyme disease can include:

• Rash on other parts of the body
• Bells palsy
• Severe headache and neck stiffness
• Pain and swelling in the large joints
• Heart palpitations

How Can I Prevent Lyme Disease

The best way to prevent Lyme disease is to prevent tick bites. This means wearing light-colored clothing, long sleeves and tucking pant legs into socks or boots. Remove any ticks you see on clothing, skin or hair right away. It is also helpful to treat clothes with permethrin or use insect repellant with DEET.

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Treatments For Lyme Disease In Kids

Your childs doctor can check for Lyme disease with lab tests. If the tests come back positive, the pediatrician will start an antibiotic treatment.

The treatment for Lyme disease is the same for babies, toddlers and children of all ages. It’s safe, and children usually respond really well to it.

Infections with less severe symptoms are usually treated for two weeks with amoxicillin. When Lyme disease causes truly swollen joints, not just pain, it can take four weeks to treat, often using doxycycline.

Management Of Pediatric Lyme Disease: Updates From 2020 Lyme Guidelines

CONFLICT OF INTEREST DISCLOSURES: Dr Meissner serves as a Food and Drug Administration advisor on the Vaccines and Related Biological Products Advisory Committee and as a Centers for Disease Control and Prevention work group consultant for the Advisory Committee on Immunization Practices. Dr Steere has served as a consultant for Roche, Zeus, and Viramed, all makers of diagnostic tests for Lyme disease.

Pediatrics

H. Cody Meissner, Allen C. Steere Management of Pediatric Lyme Disease: Updates From 2020 Lyme Guidelines. Pediatrics March 2022 149 : e2021054980. 10.1542/peds.2021-054980

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What Causes Lyme Disease In A Child

Lyme disease is caused by bacteria that are spread to people by tick bites. The ticks that carry the bacteria are:

• Black-legged deer tick. These are found in the Northeastern, Mid-Atlantic, and North-Central U.S.
• Western black-legged tick. These are found on the West Coast of the U.S.

Not all ticks carry the Lyme disease bacteria. Depending on the location, less than 1 in 100 to more than half of ticks in that area may be infected with Lyme.

Patient Sample And Follow

The patient sample contained information about age, gender, symptoms, duration of neurological symptoms, diagnosis , antibiotic treatment , pleocytosis in CSF, intrathecally produced specific anti-Borrelia antibodies, and clinical outcome at 2-month follow-up . A total of 321 children between 1 and 19years of age were included in the study. Patients were classified as definite LNB or possible LNB . The diagnosis of definite LNB was defined according to the European case definition, by clinical symptoms attributable to LNB without other obvious reasons, mononuclear pleocytosis in CSF and intrathecally produced specific anti-Borrelia antibodies . The diagnosis of possible LNB was defined by clinical symptoms attributable to LNB without other obvious reasons, mononuclear pleocytosis in CSF, absence of intrathecally produced specific anti-Borrelia antibodies, response to antibiotic treatment and no signs or laboratory findings of other disease. All definite LNB and possible LNB patients received and were clinically improved on antibiotic treatment and are considered as LNB patients.

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What Are Possible Complications Of Lyme Disease In A Child

Some children may develop post-Lyme disease syndrome . This means that some symptoms last longer than 6 months. Symptoms can include:

• Ongoing muscle and nerve pain
• Tiredness
• Problems with memory

PLDS does not respond to antibiotics. That’s because there isn’t an active infection anymore. Treatment is aimed at helping to control the symptoms.

How Do I Remove A Tick From My Child

If you find a tick attached to your child, remove it as soon as possible. Ticks can stay attached and feed for five or more days. Removing a tick within 24 to 36 hours of it starting to feed is likely to prevent Lyme disease.

• Use fine-tipped tweezers to grasp the ticks mouth-part area close to the skin surface .
• Pull upward with steady, even pressure .
• Dont twist or jerk the tick this can cause the mouth-parts to break off and stay in the skin. If this happens, remove the mouth-parts with tweezers. If you cant, leave it alone and let the skin heal.
• When possible, disinfect the bite area after removal .

Figure A and B – Reproduced with permission from the United States Centers for Disease Control and Prevention .

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History And Physical Examination

The clinical diagnosis of Lyme disease can be straightforward in patients with a history of tick exposure and the characteristic finding of an erythema migrans rash.12 The CDC has defined erythema migrans rash as an expanding red macule or papule that must reach at least 5 cm in size .11 According to the Infectious Diseases Society of America guidelines, erythema migrans rash is the only clinical manifestation sufficient to make the diagnosis of Lyme disease in the absence of laboratory confirmation.20 Although one study concluded that primary care physicians in a Lyme diseaseendemic area of France correctly identified erythema migrans in 72 percent of patients,22 the study was limited by lack of complete clinical information for the participants.

A number of conditions resemble erythema migrans however, the rapid and prolonged expansion of an erythematous lesion is unique to erythema migrans.11 Lesions most often occur at anatomic sites that are unusual for cellulitis and other conditions that mimic erythema migrans therefore, a complete skin examination should be performed before excluding erythema migrans.20

Developing New Guidelines On Lyme Disease

Public comments are still being accepted, but antibiotic treatment options for children are likely to be expanded to include the use of doxycycline.

By Perri Klass, M.D.

For all of you with strong opinions and relevant experiences regarding Lyme disease, the has been extended until Sept. 9.

The guidelines are not final yet thats the whole point of a public comment period but they represent consideration, consensus and compromise by a wide variety of specialists looking at data on an infection which everyone understands is often frustrating for patients and for doctors as well, and which continues to be a source of public anxiety.

The guidelines were developed after a great deal of discussion and literature review by experts from the Infectious Diseases Society of America, the American Academy of Neurology and the American College of Rheumatology, as well as people from other specialties, notably cardiology and pediatrics.

I asked Dr. H. Cody Meissner, who is professor of pediatrics and director of pediatric infectious disease at Tufts, to talk about some of the issues that are particularly relevant to children with Lyme, and about the process of working on the guidelines, for which he represented the American Academy of Pediatrics. Bearing in mind, always, that the guidelines as they stand are not finalized, he pointed particularly to a change in the antibiotics recommendations for children.

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How Can I Protect My Child From Deer Ticks

Ticks cannot jump or fly. They climb tall grasses or shrubs and wait for potential hosts to brush against them.

If you live, hike or camp in rural or wooded areas where you may be exposed to ticks, especially from late spring to early fall, you should take precautions. Here is what you can do to help prevent contact with infected ticks:

• In wooded areas and parks, stay on paths to avoid areas where ticks are most common.
• Ensure you and your children are dressed in long, loose-fitting clothes that cover the arms and legs, a hat and closed shoes . Tucking shirts into pants and pants into socks are extra precautions.
• Use insect repellents containing DEET or icaridin as directed on the label. Reapply as suggested.
• Practice daily full body checks for ticks, and remove any attached ticks.
• Shower or bathe within a few hours of being outdoors.
• Keep gardens tidy and landscaped if you live near a wooded area.

Currently, there is no vaccine to prevent Lyme disease in humans.

What Is Lyme Disease

Lyme disease is a multistage, multisystem bacterial infection caused by the Borrelia burgdorferi bacterium. It is transmitted by the bite of blacklegged tick .

Blacklegged ticks can be as small as a poppy seed, making it extremely difficult to spot them on the body. Blacklegged ticks are very common in certain areas in the United States including:

• The northeast
• The mid-Atlantic states
• The north central states of Wisconsin and Minnesota
• Northern California

Lyme disease was first reported in the U.S. in 1977, in Old Lyme, CT, giving the disease its name. Blacklegged ticks are most often found in wooded and grassy areas, but can be transported by animals to other areas.

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Treating Lyme Disease: When Do Symptoms Resolve In Children

Date:

Children’s National Health System

Summary:

Researchers in infectious disease examined how quickly Lyme disease symptoms typically resolve in children, a question that has received little prior study.

For many Americans, the warmer weather of summer means more time spent outside: More gardening and yard work, more hikes in the woods, more backyard barbecues. But for this year in particular, some experts predict warmer weather will lead to more ticks.

That potential boom in ticks could lead to another boom — in Lyme disease, a bacterial illness transmitted specifically by deer ticks. When ticks attach for at least 36 hours — what studies have shown is typically the lower bound needed to transmit Lyme-causing bacteria — many patients develop a bullseye-like rash at the site of the bite within seven to 10 days. If they’re not treated quickly, within weeks patients can develop symptoms such as headaches, heart arrhythmias, rashes and facial paralysis. Within months, Lyme can lead to arthritis, most commonly of the knee.

They found that after children with the early form of Lyme disease started treatment, their Lyme-associated headaches resolved rapidly — most within one to three days¬ — no matter how long headaches were present before they came to the hospital for treatment.

Children’s infectious disease experts routinely advise parents about how to protect their children from Lyme disease. Their tips:

Story Source:

Children With Lyme Disease

Children with Lyme disease have special issues. Since they cant always explain what feels wrong, they may just come across as cranky and irritable. They suffer when their bodies hurt, when their illness disrupts their sleep at night, when they struggle in school, when they dont even feel like playing. They may feel confused, lost and betrayed by parents and teachers who fail to recognize that they are sick and need help.

Mothers and fathers may not understand what the childs normal baseline is. Is this the terrible twos or the nine-year-old change or is something really wrong?

Because the symptoms of Lyme disease can be non-specific, vague and changeable, adults may not even realize these children are ill. They may suspect them of making things up to gain attention or to avoid school. Children with Lyme often have trouble in the classroom, because the disease can contribute to learning disabilities and behavioral problems.

Children are especially vulnerable to tick-borne diseases because they are physically low to the ground, where the ticks are. They play in leaves, roll on grass, cuddle with pets and otherwise increase their exposure to ticks.

LymeDisease.org is the publisher of The Lyme Times, a quarterly online magazine available to members. We have two issues that have a wealth of information about children and Lyme disease. Please click on the buttons below to view the Table of Contents of each issue.

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How Is Ld Treated

Treatment of LD should follow the clinical practice guidelines by the Infectious Diseases Society of America and the American Academy of Pediatrics .

There has been a shift to using shorter durations of antimicrobials and to more permissive use of oral drugs in select circumstances . Additionally, data on the safety of short courses of doxycycline for children < 8 years old, coupled with its proven efficacy for treating LD, including meningitis, has prompted more permissive use of this antimicrobial.

Arthritis frequency has decreased in the United States, probably because of improved recognition and earlier treatment of patients with early LD. Up to one-third of LD patients with arthritis experience residual synovitis and joint swelling, which almost always resolve without repeating the antibiotic course. For patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy, some experts recommend retreatment with another four-week course of oral antibiotics or with a course of parenteral ceftriaxone. For cases with ongoing arthritis, consultation with an expert is recommended. Consider hospitalization and constant monitoring for a child with heart block and syncope that may rapidly worsen enough to require a pacemaker.

The Jarisch-Herxheimer reaction can occur when therapy is initiated. Nonsteroidal anti-inflammatory agents should be started and the antimicrobial agent continued.