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(UPDATED May 1, 2023)<\/p>\n
As the weather warms up and summer approaches, many of us are getting excited for weekend family hikes, outdoor BBQs and camping trips. I know I am!<\/p>\n
But unfortunately, with the great outdoors, comes the not-so-glamorous reality that there are lots of creepy crawlies out there that can transmit some pretty nasty infections. Yes \u2013 I\u2019m talking about TICKS! EEUUWWWW!!!<\/em><\/strong> There\u2019s nothing quite as prehistoric-looking and spine-tingling as a tick (except for maybe a cockroach). And the knowledge that the blacklegged deer tick (Ixodes scapularis<\/em>) \u2013 tiny creatures as small as a poppy seed or a sesame seed \u2013 can transmit infections such as Lyme disease (Borrelia), Bartonella, Babesia, Erhlichia, Anaplasma, Tularemia, Rocky Mountain spotted fever, relapsing fever, Colorado tick fever, Powassan virus, just to name a few, make them seem somehow even more like something out of a sci-fi horror movie.<\/p>\n The blacklegged deer tick<\/p><\/div>\n And if you think that Lyme disease from blacklegged deer ticks is just a concern on the East Coast – think again. A Stanford study in 2014<\/a> found that nearly every park in the San Mateo, Santa Clara, Santa Cruz and Mendocino counties that was sampled (these are the parks that I hike with my children!) had ticks that were infected with Borrelia<\/em> spirochetes (the organism responsible for Lyme disease). Another Stanford study in 2015<\/a> sampled additional parks from Sonoma County to Santa Cruz County and confirmed that virtually all of the parks contained ticks that were infected with Borrelia <\/em>spirochetes, including a newly identified species called Borrelia miyamotoi<\/em>.<\/p>\n And shockingly, a report<\/a> in 2019 by the CDC shows that tickborne and mosquito-borne infections have TRIPLED over the last 13 years. (1) This includes Lyme disease, which accounts for 82% of all tick-borne diseases. And the authors note that “underreporting might have substantially limited the number of cases analyzed. As noted, the number of Lyme disease cases reported to NNDSS is estimated to represent a fraction of incident cases.” So the number is likely actually MUCH HIGHER!<\/span><\/p>\n (If you want to cut to the chase and know what to do if your child gets bitten by a tick, DOWNLOAD my FREE GUIDE HERE<\/a>!)<\/b><\/span><\/p>\n The biggest concern with getting a tick bite is the risk of transmission of a tickborne illness. Lyme disease takes the spotlight, with horror stories abounding on the internet, but Babesia and Bartonella can be just as devastating. In children, these infections can become an autoimmune encephalitis called PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome), of which PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) is a subset. Children with PANS\/PANDAS develop a sudden-onset of fears, anxiety, OCD behaviors, rages, tics, bedwetting, handwriting regression and brain fog after exposure to certain infections or toxins. An infection like Lyme or strep can trigger an autoimmune, inflammatory reaction in the brain that results in neuropsychiatric symptoms – their brains are literally on fire. PANS\/PANDAS and chronic pediatric Lyme disease have become a very large part of my holistic pediatric practice, and while I have been able to thankfully help many of these children recover from this devastating illness using a holistic integrative approach, my preference would be that kids never got it in the first place! And one of the first steps is making sure that we as parents know exactly what to do when our children get bitten by a tick.<\/p>\n (Side note: PANS\/PANDAS is such an important issue that I have been interviewed about it to educate other functional medicine practitioners. You can listen to my 2-part interview on Fx Medicine Australia HERE: PANDAS Part 1<\/a> and PANDAS Part 2<\/a>\u00a0 and my interview with Dr. Kara Fitzgerald on New Frontiers in Functional Medicine HERE: Functional Medicine Pediatrician Dr. Song on PANS\/PANDAS Dx and Treatment<\/a><\/em><\/span><\/strong>)<\/em><\/span><\/strong><\/p>\n The first and most important step is to try to PREVENT<\/strong> a tick bite in the first place. Prevention includes the following key steps:<\/p>\n If you\u2019re a DIY kinda person, you can certainly make your own essential oil-based sprays, lotions or wipes. Or, if you\u2019re like me and prefer something ready-made, you can try one of the following:<\/p>\n Regardless of which essential oil product you choose to use, the key is to apply frequently, every 2-3 hours or more frequently after sweating or swimming. Remember \u2013 essential oils are effective because of their scent. If you can\u2019t smell it, chances are a tick can\u2019t smell it either and won\u2019t be repelled appropriately.<\/p>\n While you\u2019re out on the trails, take time to periodically scan their body for ticks. Carefully check behind and in your child\u2019s ears, back of the neck, hairline and run your fingers through your child\u2019s scalp. Look under the collar of their shirt and in\u00a0 their armpits.\u00a0 Check their waistline under their pants and any other possible points of entry. You are literally going to be looking for something that looks like a speck of dirt or a new freckle that you hadn\u2019t noticed before. The nymph, the smallest form of the deer tick that is most prevalent in spring\/summer, is literally the size of a poppy seed. Until you actually find one embedded, it can be difficult to appreciate just how tiny and difficult to spot they are!<\/p>\n Once you\u2019re back home, take your child\u2019s clothes off and wash in hot water or put in the dryer on high for 30-60 minutes. Take a warm shower IMMEDIATELY to wash away ticks that haven\u2019t fully attached yet, and do another thorough tick check after the bath. Be as thorough as possible because most people with Lyme disease never notice the tick that gave it to them. Ticks love warm, moist, dark areas of the body so check hidden areas especially in or around the ear, hairline and scalp, bellybutton, armpits, groin\/genitalia, or areas where clothing was pressed against the skin (waistline, underwear line, neckline).<\/p>\n The first thing to do when you find a tick on your child:<\/p>\n STAY CALM and DON\u2019T PANIC!<\/span><\/strong><\/p>\n The first time I found a tick on my son after we had been swimming in a river in Mendocino County, I thought there was a speck of dirt on his chest. But when I tried to flick it off and it didn\u2019t budge, my heart sank and my stomach churned because I knew exactly what it was. It took everything in me to not freak out and show the panic in my eyes as I was gently pulling it out, all the while holding my breath. The next time I found a sesame seed-size tick was in my daughter\u2019s ear while I was giving her a bath after she had been playing in our front yard. (We live in a suburban town in the Bay Area, but we do have deer that sometimes wander through our yard from the hills, so I\u2019m sure some deer ticks were deposited on our grass as they were passing by \u2013 yikes!). Even this second time around, I thought it was a speck of dirt and tried to pick it off with my finger nail. I didn\u2019t feel any less like freaking out, but somehow I managed to keep it together!<\/p>\n The second thing is to REMOVE THE TICK.<\/span><\/strong><\/p>\n There are several things you should NOT do when your child has a tick bite, besides not panic.<\/p>\n DO NOT<\/span> use Vaseline, gasoline, fingernail polish, rubbing alcohol, or any other caustic substance on the tick.<\/p>\n DO NOT<\/span> put a lit match next to the tick or squeeze or crush it.<\/p>\n Doing any of these can inadvertently cause the tick to regurgitate more of its saliva that carries Borrelia<\/em> and other infections into your body.<\/p>\n What you SHOULD do:<\/strong><\/span><\/p>\n (There are various tick-removing devices available. I\u2019ve tried a few but I honestly haven\u2019t found any as effective as a pair of good \u2018ol-fashioned tweezers)<\/p>\n Now that the tick is successfully removed, what next? What do you do with that little baggie holding that fear-inducing poppy-sized vermin? Do you give you child antibiotics? Do you just wait and see if your child develops symptoms of Lyme disease?<\/p>\n Remember:<\/span> The goal is to PREVENT LYME DISEASE. Lyme disease, if caught early and treated appropriately<\/em> does NOT have to go on to be a devastating chronic illness.<\/span><\/strong><\/p>\n The first thing I recommend doing immediately once you’re back home is to send the tick to a lab to determine whether or not it even carries Lyme or other tickborne infections. Some labs (including most public health labs) will only identify whether the tick is a blacklegged deer tick, and only if it is, will they test to see if it carries Borrelia burgdorferi. While knowing what kind of tick it is may be useful, it is more important to know whether the tick actually carries any infections. I do recommend checking for co-infections, and not just for Borrelia alone. Ticks can carry and transmit more than one infection, and knowing what symptoms to watch for can be very helpful in early diagnosis. One of my daughter’s ticks tested positive for Ehrlichia which she fortunately did not develop, and I was thankful to know to look for any subsequent symptoms of Ehrlichiosis rather than Lyme disease.<\/p>\n I recommend tick testing through a lab like TickReport<\/a>, TickCheck, <\/a>or Ticknology<\/a>. The turnaround time for these labs is 3-5 days from receipt of the tick.\u00a0But in the meantime, while you’re waiting for results, you\u2019re still stuck with the question of whether or not to take prophylactic antibiotics.<\/p>\n To take prophylactic antibiotics or not \u2013 that is the question.<\/strong><\/span> Prophylactic antibiotics may prevent the development of Lyme disease if given as soon after the tick bite as possible. One study showed that a single 200mg dose of doxycycline given within 72 hours of tick attachment may be effective in preventing the classic erythema migrans rash<\/a> within 4 weeks of a tick bite; however, the development of a rash is not necessarily a good endpoint as many people with Lyme disease never develop a rash, and this study had no long-term followup to determine if patients went on to develop symptoms of chronic Lyme disease. Most Lyme-literate practitioners do not believe that a single dose of antibiotics is adequate to prevent Lyme disease, and that at least a 3-week course of antibiotics is needed to ensure that you kill the Borrelia<\/em> in all of its life forms \u2013 the free-floating spirochete form, the evasive cell wall-deficient form, and the dormant cyst form. If you stop antibiotics too early, you may not kill the Borrelia<\/em> that is hiding out in its dormant cyst form and waiting for just the right moment to reactivate and convert to its free-floating spirochete form to cause trouble at a future date.<\/p>\n But antibiotics? Are they really necessary? And especially if your child already has gut issues, or you\u2019ve worked so hard to heal their gut? While a tick is unlikely to transmit Lyme and coinfections if it has been attached for less than 24 hours, there have been reports of transmission after just 16 hours. So, if you think that a tick has been attached for more than 16 hours, and especially if it looks engorged with blood, then in this case, I would strongly consider antimicrobial support. After caring for too many children and parents with chronic Lyme disease and other tickborne infections, I would rather mop up the after effects of gut dysbiosis and increased intestinal permeability (\u201cleaky gut\u201d) than mop up the after effects of chronic Lyme disease.<\/p>\n How long should you\/your child take antimicrobials?<\/strong><\/span> At least while you’re waiting for the tick test results to come back. If the results are negative for any tickborne infection, then you can stop the antimicrobial. If you did not send the tick to be tested, or the tick test comes back positive, the antimicrobial(s) chosen should be taken for a minimum of 3-4 weeks.<\/p>\n Which antimicrobial should you\/your child take?<\/strong><\/span> The antimicrobial chosen may be herbal or pharmaceutical, or a combination of both. For adults, a 3-week course of Doxycycline may be recommended. Theoretical concerns regarding teeth staining with Doxycycline\u00a0 in children under 8 years of age no longer seem to be warranted, and the CDC<\/a> now recommends “doxycycline as the treatment of choice for children all ages with suspected tickborne rickettsial disease… Previous concerns about tooth staining in children aged <8 years stem from older tetracycline-class drugs that bind more readily to calcium than newer members of the drug class, such as doxycycline.” In fact the 2018 AAP\u00a0Red Book <\/em>states that “doxycyclne can be used for short durations (i.e., 21 dys or less) without regard to patient age …”\u00a0Amoxicillin and Azithromycin are alternative antibiotic choices for children. Herbal antimicrobials targeted to Lyme and coinfections can also be used alone or in combination with pharmaceutical antibiotics. Just remember, though, that herbal antimicrobials can still disrupt the gut microbiome like antibiotic drugs, and the gut needs to supported just as fully as outlined below. The manufacturers that I recommend for herbal formulas for Lyme and coinfections include BioResource<\/a>, Researched Nutritionals<\/a> and Beyond Balance<\/a>.<\/p>\n Stephen Buhner, a highly regarded Lyme herbalist, recommends the herb Astragalus with adult dosage of 3000mg daily for 30 days after a new tick bite. For prevention, Buhner recommends that adults take Astragalus 1000mg daily during your time in a Lyme-endemic or tick-infested area may be helpful in boosting your immune system and preventing Lyme transmission. This may be a good option for you and your family if you live in a high-Lyme area and don’t want to potentially be on antibiotics for the entire season…\u00a0Immediately after a tick bite, Buhner has also found applying a topical paste made of andrographis tincture and green clay to be helpful in preventing infection.<\/p>\n If you or your child does get bitten by a tick, please discuss what antimicrobial regimen is best with your physician or a Lyme-literate practitioner.<\/p>\n Bottom line: <\/span>I would strongly consider giving your child an antimicrobial medication, pharmaceutical and\/or herbal, for at least 3-4 weeks after a tick bite, especially if you believe the tick was attached for more than 16 hours and looks engorged.<\/span><\/strong><\/p>\n Kimchi – Korean pickled cabbage<\/p><\/div>\n The gut can and should be fully supported while taking antimicrobials for Lyme prevention – whether they’re pharmaceutical or herbal. The goal is to minimize disruption to the gut microbiome and prevent gut dysbiosis and leaky gut (and yes, even herbal antimicrobials can cause gut dysbiosis). Be sure to give your child probiotics at least 1-2 hours after each antimicrobial dose, and continue for a month after the antimicrobial course is complete. To help you choose the best probiotic for your child, you can download my Guide to Choosing Your Child\u2019s Probiotic<\/a>. Load up on fiber-filled plant foods and awesome fermented foods like sauerkraut, beet kvass, \u201creal\u201d pickles like Bubbies, kimchi, miso soup, kombucha, coconut kefir and yogurt (if you tolerate dairy). Drink bone broth<\/a> for all that healing glutamine and gelatin to support the small intestinal lining and prevent leaky gut. And be sure to eat a whole foods diet full of variety and color to ensure that your child\u2019s gut gets all the phytonutrients it needs to stay healthy during this time.<\/p>\n Erythema migrans – the “classic” bullseye rash of Lyme disease<\/p><\/div>\n While the above precautions can be very effective in preventing Lyme disease, there may still be occasions where it\u2019s not enough. Watch the site of the tick bite for an expanding bullseye rash, and watch your child for symptoms of acute Lyme disease. Only about 50-60% of patients with Lyme disease ever develop the classic \u201cbullseye rash,\u201d or erythema migrans<\/a>, with a red ring that expands outward from the site of the bite. The vast majority of people with chronic Lyme disease never recall having a rash, so you want to watch for the other signs and symptoms of Lyme disease to know when to go see your doctor.<\/p>\n Acute Lyme disease can develop anywhere from 3 to 30 days after a tick bite so you\u2019ll want to be on guard for at least a month. Although again, if you\u2019ve taken the above precautions, the chance that your child will develop Lyme disease is significantly lowered and you can breathe a little easier!<\/p>\n Go immediately<\/strong> to your physician if you or your child develops any symptoms of early or late Lyme disease below. The following list can also be found in a convenient Lyme Symptoms Handout<\/a> from the Bay Area Lyme Foundation<\/a>. Remember, most people with Lyme disease don’t remember being bitten by a tick, so for some, late-stage Lyme symptoms will be their first sign of Lyme disease.<\/p>\n Early Localized Stage (days to weeks after tick bite)<\/strong> Early Disseminated Stage (weeks to months after tick bite) Late-Stage Lyme (months to years after tick bite) PLEASE NOTE that in children, symptoms of Lyme may also include behavioral changes (anxiety, depression, fears, OCD behaviors, tantrums\/rages), tics, developmental regressions (i.e., deterioration in handwriting), brain fog, slowed cognitive processing, and memory problems. <\/span><\/strong><\/p>\n If your child does develop signs of Lyme disease, please demand that your physician order more specialized Lyme testing through a lab like IGeneX<\/a> or at the very least order a complete Lyme IgG and IgM Western blot and not simply a Lyme antibody screen with a reflex to Western blot. Unfortunately, the diagnosis of Lyme is highly controversial, but you do NOT want to miss a diagnosis of Lyme disease. Due to the inaccuracy of current testing methods, even the CDC recommends basing the diagnosis of Lyme on clinical symptoms and not on laboratory findings. If your physician will not test appropriately or is not well-versed in Lyme disease, please find a Lyme-literate practitioner near you through ILADS<\/a> (International Lyme and Associated Diseases Society).<\/p>\n I often wonder why it is that some children go on to develop PANS or chronic Lyme disease from a tick bite, and other kids do not? Why do some adults go on to develop chronic Lyme disease with devastating neurologic symptoms, and others develop no symptoms at all?<\/p>\n I believe some of the answers lie in:<\/p>\n These are all the steps that you\u2019ve already taken above! 😊<\/p>\n Many of the kids that I see with chronic illness, including PANS\/PANDAS, have subtle red flags that they may have had underlying methylation and mitochondrial dysfunction that predisposed them to a greater risk for complications and long-term effects of certain chronic illnesses. These red flags include low energy, poor endurance, sensory issues, regressions after illness or prolonged recovery time compared with peers. They also include a family history of autoimmune illness, atopic disease (eczema, asthma, allergies), neurodegenerative disorders (autism, Alzheimer\u2019s, Parkinson’s, etc.), mental health disorders, infertility, blood clotting disorders, and early heart disease.<\/p>\n If your body is trying to fight off Borrelia<\/em> or other tickborne infections, its methylation and mitochondrial stress have increased. If your methylation and mitochondrial function is already impaired, then this added stress can tap out your reserves and be the proverbial \u201cstraw that broke the camel\u2019s back,\u201d so that what seems like a sudden development of neuropsychiatric symptoms is really the culmination of a long backstory of previous methylation, mitochondrial, immune, and detoxification stressors.<\/p>\n How do you support your child\u2019s methylation and mitochondrial function? After a tick bite, you can add supportive supplements like methyl-B12, l-methylfolate (or L-MTHF), coQ10, ribose, and L-carnitine.<\/p>\n But we\u2019re talking about true prevention. So even before that tick bite ever occurs, optimize your whole family\u2019s health with the steps below to bolster everyone\u2019s defenses.<\/p>\n Optimal health begins with the gut and ends with the heart. Optimal health means supporting body, mind, and spirit with the following steps:<\/p>\n![\"\"](\"https:\/\/healthykidshappykids.com\/wp-content\/uploads\/2017\/06\/Ticks-on-finger-300x224.jpg\")
Why Worry About a Tick Bite?<\/h2>\n
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<\/p>\nPrevention is Key<\/h2>\n
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What to do if your child gets a tick bite<\/h2>\n
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<\/p>\nHow to remove a tick<\/h2>\n
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What To Do After a Tick Bite<\/h2>\n
Get the Tick Tested<\/h2>\n
Should I Give My Child Antibiotics?<\/h2>\n
How do your support your child\u2019s gut with antibiotics?<\/h2>\n
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Watch for Signs of Lyme Disease<\/h2>\n
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What else can I do to prevent Lyme disease?<\/h2>\n
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