LYME DISEASE AND TICKS
A Complete Guide to Lyme Disease and Ticks in Children
- QUICK ANSWER
What is Lyme disease in children?
Lyme disease is an infection children get from the bite of an infected blacklegged tick, also called a deer tick. It is caused by a bacterium, Borrelia burgdorferi. Most children get a rash first, though the rash is often not a bullseye. Ticks can also carry other germs, including Bartonella, Babesia, ehrlichiosis and tularemia, so the tick that bit your child matters as much as the diagnosis you're chasing.
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WHAT IT IS
What is Lyme disease?
What are the co-infections?
Lyme disease is what happens when a blacklegged tick carrying Borrelia burgdorferi stays attached long enough to pass the bacteria into your child's body. In the United States it is the most commonly reported illness spread by ticks.
Co-infections are the other germs the same tick, or a different tick, can carry at the same time. The ones parents hear about most are Babesia, a parasite that infects red blood cells, and Bartonella, a bacterium best known for cat scratch disease. They are not the same illness, and they don't respond to the same treatment. That's the part that matters.
A child can also pick up ehrlichiosis, Rocky Mountain spotted fever, tularemia, or alpha-gal syndrome from a tick. In Nebraska those are actually more likely than Lyme.
What's actually happening in the body?
When a tick bites, it doesn't just take blood. It puts saliva back in, and anything living in that tick goes in with it. For Lyme, the bacteria spread out from the bite site through the skin, which is what makes the rash grow outward over days rather than appearing all at once.
Your child's immune system takes time to notice. That gap is why a blood test drawn in the first week or two is so often negative. The test isn't looking for the bacteria. It's looking for your child's antibody response, and the response hasn't been built yet. ³
RECOGNITION
What does the Lyme rash look like on a child?
Most parents are watching for a bullseye. Most rashes aren't one.
The Lyme rash is called erythema migrans. It shows up in about 89% of children with Lyme disease, which makes it the single most useful sign you have.⁴ But a systematic review of 53 studies and 8,493 patients found that central clearing, the ring-within-a-ring look, appeared in only about 19% of US cases.⁵ Most are a solid, even patch of pink or red.
It also grows. A tick bite reaction is itchy, small, and fades in a day or two. The Lyme rash gets bigger over days and usually doesn't itch or hurt much at all.
Where it hides on a child
In one pediatric study, the most common place was the head and neck, and those children were younger, median 6 years old.⁶ Check the scalp, hairline, behind the ears, armpits, groin and diaper area, waistband line, and behind the knees.
On darker skin
The rash is harder to see and more often missed. Black patients waited a median of 35 days for the right antibiotic versus 7 days for white patients, and had nearly 5 times the odds of presenting with disease that had already spread.⁷
If your child has this rash, don't wait for a test
In a study of 201 children, blood tests were positive in only 37% of those with a single rash.⁴ A negative test at that stage does not mean your child doesn't have Lyme. This is one of the few points where every side of the Lyme debate agrees: the rash is treated on sight. Call your child's pediatrician the same day.
And here's the fact that changes how you should think about all of this. About 3 in 4 US patients with the Lyme rash never recall the tick bite that caused it.⁸ Nymph ticks are the size of a poppy seed. Your child was never going to feel it.
RIGHT NOW
How do I get a tick off my child?
Use clean, fine-tipped tweezers. Grasp the tick as close to the skin as you can. Pull straight up with steady, even pressure. Don't twist, don't jerk, and don't squeeze the tick's body. Then wash the bite and your hands.⁹
Get your child still first. A steady pull is what keeps the mouthparts intact, and a wriggling child is how tweezers slip. Sit down. Take a breath. Tell them what you're doing.
Grasp close to the skin's surface. Right at the head, not on the body. Squeezing the body is what you're trying to avoid.
Pull upward, steady and even. No twisting. No jerking. If the mouthparts break off, take them out with the tweezers. If they won't come out easily, leave them and let the skin heal.
Clean the bite and your hands with rubbing alcohol or soap and water. Never crush a tick with your fingers.
Save the tick in a sealed bag. Write the date and where your child was. That information is useful even when a lab result wouldn't be.
Never use petroleum jelly, nail polish, alcohol, or a hot match
How long does a tick have to be attached?
The CDC now says more than 24 hours for Lyme, not the older 36 to 48 hours you'll still find online.¹¹ In lab studies a single infected nymph didn't transmit Lyme within the first 24 hours, but several feeding at once occasionally did.¹²
Here's the part almost nobody tells parents: not every tick-borne germ waits. Powassan virus has been transmitted after as little as 15 minutes, and the researchers wrote plainly that no grace period exists.¹³ So don't use the clock to decide whether to care. Use it to decide how fast to move.
Read the full guide: what to do after a tick bite, including whether to test the tick, the 72-hour antibiotic window, and why doxycycline is now considered safe for young children.
TESTING
Why did my child's Lyme test come back negative?
Because the standard Lyme test measures antibodies, not bacteria. Early on, your child hasn't made enough antibodies to detect. A meta-analysis found two-tier testing was only about 46% sensitive in early Lyme disease, rising to 99% in late disease.³
Sensitivity of standard two-tier Lyme testing by stage (Waddell et al., 2016)³
Stage of Illness | How Often the Test Finds It | What That Means for You |
|---|---|---|
Late, with arthritis | 46.3% | A negative test rules nothing out. Treat the rash. |
Spread to nerves or heart | 89.7% | The test is now reliable. |
Early, with the rash | 99.4% | A negative test here is meaningful. |
Antibodies also stick around. A positive test months later can't tell you whether the infection is still there, and the CDC says so directly.¹⁴ That cuts both ways, and parents deserve to know it cuts both ways.
Read the full guide to Lyme testing in children. It covers how two-tier testing works, what specialty labs like IGeneX do and don't claim, what the mainstream criticism actually says, and the two Borrelia species the standard test can miss.
CO-INFECTIONS
What are Bartonella and Babesia?
Two names parents hear constantly. They are not two kinds of Lyme.
Babesia
Babesia is a parasite that infects red blood cells. It is not a bacterium, which is why the antibiotics used for Lyme do nothing to it. Treatment is a different, short course of medication.
It causes fever, fatigue, chills and sweats rather than a distinctive rash. It's uncommon in children: in five years of CDC data, children under 10 were 1.2% of US cases.¹⁵
Bartonella
Bartonella is a bacterium, best known as the cause of cat scratch disease. Its established vector is the cat flea. The CDC states there is no evidence it spreads to people through tick bites.¹⁶
You'll read online that it causes stretch-mark rashes and sudden psychiatric change in children. The published evidence for that is thin, and I explain exactly how thin.
THE QUESTION I GET ASKED MOST
Can Lyme disease cause PANS or PANDAS?
There is no established link, and I'd rather tell you that than sell you a story. The PANS Research Consortium wrote in its own 2017 guidance that it was unaware of an unequivocal case of PANS associated with Lyme disease.¹⁷
The largest study ever done on this looked at 1,132 children with lab-confirmed Lyme infection of the nervous system, compared against 11,320 matched children. It found no increase in psychiatric or developmental diagnoses.¹⁸ Other work using a broader definition of Lyme did find higher rates of mood disorders in adults, and the disagreement between those studies comes down almost entirely to how they defined a case.
So why do I still ask about ticks? Because a previously well child who changes overnight has a reason, and my job is to find it. What moves me is the story, not a marker: a camp in the woods the summer before everything changed, a trip to Minnesota, a rash nobody photographed. Without that story, a Lyme test on a Nebraska child is far more likely to mislead you than help you, and a false positive costs a family months.
Both things are true at the same time. The change in your child is real. And Lyme is usually not the explanation. you can read what the evidence says about Lyme, PANS and PANDAS. or start with my complete guide to PANS and PANDAS in children.
WHERE WE LIVE
Do we have Lyme disease in Nebraska?
Yes, but rarely. Nebraska has reported 7.6 Lyme cases a year from 2019 to 2023, and Nebraska's health department has confirmed blacklegged ticks are now established in five counties: Douglas, Sarpy, Saunders, Thurston and Cuming.² In 2021, ticks collected in Thurston County tested positive for the Lyme bacterium, the first time that had been found in ticks collected in Nebraska. Tick-borne diseases can vary by location. Learn more about ticks in Nebraska and Iowa, county by county.
Nebraska DHHS puts it this way: this demonstrates that Lyme disease can be acquired in eastern Nebraska. However, Nebraska will likely remain a low prevalence state for Lyme disease.² Both halves of that sentence are true, and the old line that all Nebraska Lyme comes from travel is no longer accurate. If you’re in Nebraska or Iowa and want to know whether care is available in your area, see where I see families across Nebraska and Iowa.
Tularemia
Nebraska's rate is 8.5× the national rate, fifth highest. Incidence peaks in children ages 5–9.¹⁹
Ehrlichiosis
Up 166% in Nebraska over the prior five-year period. A rash shows up in up to 60% of children.²
Alpha-gal syndrome
A meat allergy from a lone star tick bite. Reactions come 2 to 6 hours after eating, which is why they're missed.²⁰
If your child suddenly refuses meat, or wakes up with hives and a stomachache a few hours after dinner, that's worth asking about. A CDC survey found 42% of primary care providers had never heard of alpha-gal syndrome.²¹
Read which ticks are actually in Nebraska and Iowa, what they carry, when they're worst, and how to check a child head to toe.
HOW I HELP
What I actually do for a family in this spot
Most families reach me somewhere in the middle. The tick is long gone. The pediatrician says everything looks fine. The internet says it's Lyme. And the child in front of you is not the child you had a year ago.
I start with the story, because the story is where the answer usually is. Where were you that summer. What changed first. What did the rash look like, if there was one, and does anyone have a photo. Then I look at the whole picture rather than one marker, and I say plainly what I think and why.
I will tell you when a test is worth running and when it isn't. I will not put a child on a long antibiotic course on the strength of a borderline band, and I'll give you my reasons rather than a vague no. When there's an objective finding, I get it in front of the right specialist rather than guessing on my own. And while the picture clarifies, I work on the things that are actually addressable now: bowels, sleep, food, and a nervous system that won't settle.
Rather than assuming what is causing your child’s symptoms, I use targeted testing to gather more information. Learn how the testing is chosen and read.
You've done everything right. You've shown up, pushed for answers, tried the strategies. And something is still being missed. That's what I'm here for.
- QUICK ANSWER
Book My Free 15-Minute Call
Bring me the summer, the story, and the questions nobody has answered. Fifteen minutes is enough for me to tell you whether this is worth chasing.
Free. No obligation. Not a sales call. Or call or text me directly at 402-988-1873 .
Go Deeper
You might also be wondering about
Who you'd actually be working with
Twenty-plus years of pediatric practice, and one method built around what everyone else missed.
When a child changes overnight
Rituals, rage, food refusal, a child who is suddenly not themselves. There is a name for that pattern.
What working together looks like
The free call, the deep-dive visit, testing chosen not defaulted, and the months that follow.
WHERE WE SERVE
In person in Omaha, and by telehealth in six states.
In Person
Omaha, Nebraska
Telehealth
Arizona, Colorado, Iowa, Nebraska, Tennessee, Virginia
Not on that list? Reach out anyway. I would rather tell you honestly what I can and can't do than leave you guessing, and if I can't see you I'll point you toward someone who can.
The Bottom Line
If you've read this far and you still don't know what to think, that's the right place to be. This is a subject where the loudest voices are the least careful ones, and you've been handed a lot of certainty by people who have never met your child. So let me be plain about where I land. Nebraska is a low-risk state and I am not going to make you afraid of your own backyard. Low risk is not no risk, the map here has changed in the last six years, and a child who changed suddenly deserves someone willing to take the whole story seriously before ruling anything in or out. You are not overreacting for asking. Bring me the summer, the questions, and the doubts. I'll tell you honestly what I think, and I'll tell you when the answer is somewhere other than here.
ABOUT THE AUTHOR
Amy Patton, DNP, APRN, CPNP-PC
Pediatric nurse practitioner and founder of Happy Kid Functional Medicine
This article was written by Dr. Amy Patton, DNP, APRN, CPNP-PC, FMACP, a board-certified pediatric nurse practitioner and functional medicine provider serving Omaha-area families through Happy Kid Functional Medicine . Dr. Patton specializes in root-cause pediatric care for children's gut health, sleep, behavior, nutrition, immune patterns, and whole-child wellness. She sees patients in person in Omaha and by telehealth across Arizona, Colorado, Iowa, Nebraska, Tennessee, and Virginia.
More about Amy Patton, DNP, APRN, CPNP-PC · Last updated: August 10, 2026
References - 23 sources · CDC, IDSA and peer-reviewed literature
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Nebraska DHHS. Reported Cases of Lyme Disease in Nebraska by Year, 2010–2023 (PDF).139 Nebraska cases across 2010–2023, averaging 7.6 a year over 2019–2023.
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Nebraska DHHS. HAN Update: Tickborne Diseases in Nebraska, May 13, 2026 (PDF).The five counties with established blacklegged ticks, the 2021 Thurston County pathogen detection, the state's low-prevalence position for Lyme disease, and the 166% rise in ehrlichiosis.
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Waddell LA, Greig J, Mascarenhas M, Harding S, Lindsay R, Ogden N. The Accuracy of Diagnostic Tests for Lyme Disease in Humans: A Systematic Review and Meta-Analysis. PLoS One 2016;11(12):e0168613.Two-tier testing sensitivity by stage: 46.3% early, 89.7% early disseminated, 99.4% late.
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Gerber MA, Shapiro ED, Burke GS, Parcells VJ, Bell GL. Lyme disease in children in southeastern Connecticut. N Engl J Med 1996;335(17):1270–1274.201 consecutive children, median age 7. Rash in about 89%; serology positive in only 37% of those with a single rash.
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Tibbles CD, Edlow JA. Does this patient have erythema migrans? JAMA 2007;297(23):2617–2627.Systematic review, 53 studies and 8,493 patients. Central clearing in 19% of endemic US cases.
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Occurrence of erythema migrans in children with Lyme neuroborreliosis and the association with clinical characteristics and outcome. BMC Pediatr 2018;18:189.Head and neck was the most common rash location; those children were younger and had more facial nerve palsy.
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Starke SJ, Rebman AW, Miller J, Yang T, Aucott JN. Time to Diagnosis and Treatment of Lyme Disease by Patient Race. JAMA Netw Open 2023;6(12):e2347184.n=1,395. Median 35 days to treatment for Black patients versus 7 days; 4.93 times the odds of disseminated disease.
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Marques A, Strle F, Wormser GP. Comparison of Lyme Disease in the United States and Europe. Emerg Infect Dis 2021;27(8):2017–2024.Only 25% of US patients with the rash recall a tick bite at the site, versus 60–64% in Europe.
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CDC. What to Do After a Tick Bite. NCEZID, reviewed Jun 11, 2024.The four-step removal method, the disposal guidance, and the folklore-methods warning.
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Needham GR. Evaluation of five popular methods for tick removal. Pediatrics 1985;75(6):997–1002.Petroleum jelly, nail polish, isopropyl alcohol and a hot match were tested. Zero ticks detached.
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CDC. How Lyme Disease Spreads. Reviewed Sept 24, 2024.Current CDC wording is more than 24 hours of attachment, replacing the older 36–48 hour figure.
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Eisen L. Pathogen transmission in relation to duration of attachment by Ixodes scapularis ticks. Ticks Tick Borne Dis 2018;9(3):535–542.No transmission by a single infected nymph within 24 hours across 89 hosts; multiple nymphs occasionally transmitted by 24 hours.
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Ebel GD, Kramer LD. Duration of tick attachment required for transmission of Powassan virus by deer ticks. Am J Trop Med Hyg 2004;71(3):267–269.Transmission after as few as 15 minutes. The authors state that no grace period exists.
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CDC. Clinical Testing and Diagnosis for Lyme Disease, 2024.Antibody titers persist for months to years and cannot be used to judge whether infection has cleared.
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Gray EB, Herwaldt BL. Babesiosis Surveillance — United States, 2011–2015. MMWR Surveill Summ 2019;68(SS-6):1–11.Of 7,612 cases, ages 0–9 accounted for 90 (1.2%) and ages 10–19 for 137 (1.8%).
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CDC. About Bartonella Infection. Reviewed Mar 23, 2026.Verbatim: there is no evidence showing Bartonella are spread to people through tick bites.
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Cooperstock MS, Swedo SE, Pasternack MS, Murphy TK. Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part III, Treatment and Prevention of Infections. J Child Adolesc Psychopharmacol 2017;27(7):594–606.States that the Consortium is unaware of an unequivocal case of PANS associated with Lyme disease.
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Tetens MM, Graham EE, Andersen NS, et al. No associations between neuroborreliosis in children and psychiatric neurodevelopmental disorders: a nationwide, population-based, matched cohort study. J Child Psychol Psychiatry 2025;66(5):716–724.1,132 children with confirmed neuroborreliosis versus 11,320 matched comparators. No increased risk found.
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Rich SN, Hinckley AF, Earley A, Petersen JM, Mead PS, Kugeler KJ. Tularemia — United States, 2011–2022. MMWR 2025;73(51&52):1152–1156.Nebraska 0.547 per 100,000 versus 0.064 nationally, fifth highest state. Incidence highest in children aged 5–9.
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CDC. About Alpha-gal Syndrome.Symptoms usually appear 2–6 hours after eating meat or dairy; primarily associated with the lone star tick.
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Nebraska DHHS. HAN Advisory: Lyme Disease in Nebraska, April 28, 2022 (PDF).Of 9 Nebraska cases reported in 2021, five were acquired in highly endemic parts of the country and two were acquired in eastern Nebraska.
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CDC. Don't Wait: Remove Attached Ticks ASAP (fact sheet, 2025, PDF).Grasp the tick close to the skin to avoid squeezing its body, and do not wait to see a provider before removing it.
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Carpenter A, Drexler NA, McCormick DW, et al. Health Care Provider Knowledge Regarding Alpha-gal Syndrome — United States, 2022. MMWR 2023;72(30):809–814.Of 1,500 primary care providers surveyed, 42% had never heard of alpha-gal syndrome.
Questions about a plan, or something worsening on a plan we made together?
For a new or urgent symptom, call your child's pediatrician, urgent care, or 911.
With you in this, Amy
402-988-1873 · amy@happykidfm.com · 11320 Davenport Street, Omaha, NE 68154
Medical disclaimer: This page is educational and is not medical advice. It does not diagnose, treat, or replace individualized care from your child's pediatrician or licensed medical provider. Supplement types, doses, and combinations should be selected with a qualified clinician who knows your child's full history — never start a new supplement based on a web page alone. Always consult your pediatrician before making changes to your child's routine, and seek prompt medical care for a fever with an expanding rash, facial drooping, a severe headache with a stiff neck, trouble breathing, or any severe, sudden, or concerning symptom.