Lyme Disease Symptoms in Children

Deer tick on finger
Lyme Disease. Lauree Feldman / Getty Images

Lyme disease is sometimes misdiagnosed, usually because people misidentify Lyme disease symptoms and because it can sometimes be difficult to confirm that a child has Lyme disease.

Children can get Lyme disease after they get bitten by a tick, usually a deer tick, that is infected with the Borrelia burgdorferi bacteria, especially if the tick isn't removed before 48 to 72 hours.

This makes it important to do daily tick checks if your child has been in an area where he might be bitten by a tick, such as while camping.

Lyme Disease Symptoms

The first symptom of Lyme disease is the classic rash that most people are familiar with—erythema migrans. This circular rash occurs at the site of the tick bite, about seven to 14 days after the tick bite, although it may begin as early as three days or as late as 32 days after the tick bite.

This erythema migrans rash is usually described as:

  • Looking like a target or bull's eye, with a central red spot, an area of clear skin, and a red border
  • Being itchy, warm, and sometimes painful
  • Gradually expanding to a size of 7 to 14 inches
  • Lingering for about two weeks

In addition to the rash, other Lyme disease symptoms that some children have to resemble flu-like symptoms and can include fever, myalgia (muscle aches), chills, headache, fatigue, and joint pain (arthralgia).

More serious symptoms can occur in those children who aren't treated and develop early-disseminated Lyme disease.

These symptoms can include having multiple erythemas migrans lesions, fever, myalgia (muscle aches), headaches, fatigue, pink eye (conjunctivitis), swollen lymph glands (lymphadenopathy), aseptic meningitis, facial nerve palsy (Bell's palsy), and more rarely, carditis (inflammation of the heart) with heart block.

Symptoms of late Lyme disease, which may begin several months after the initial tick bite, include arthritis that most often affects large joints, like a child's knees. These joints may stay swollen and tender for one to two weeks at a time. Some children rarely develop chronic neurological symptoms, including numbness and tingling in their hands and feet, shooting pains (radiculoneuritis), and concentration problems.

Fortunately, the late symptoms of Lyme disease can usually be prevented with early treatment with antibiotics.

Keep in mind that not all children have all of the classic Lyme disease symptoms, which makes it important to see your pediatrician if your child develops a rash or fever following a tick bite, especially if you live in an area where there are a lot of Lyme disease cases.

What You Need To Know

  • Even in hyperendemic areas (places where there are a lot of Lyme disease cases), the risk of developing Lyme disease is usually estimated to only be about 1 to 3 percent. It is so low because not all deer ticks are even infected with the bacteria that causes Lyme disease and most people remove ticks before they have been attached for a 48- to 72-hour period, which doesn't give the bacteria time to infect them.
  • In the United States, most cases of Lyme disease (hyperendemic areas) occur in southern New England, New York, New Jersey, Pennsylvania, Minnesota, Wisconsin, and the northern Pacific coast.
  • Lyme disease is usually diagnosed based on the history of a tick bite and finding signs and symptoms that suggest that the child has Lyme disease. Laboratory testing is available but is not always necessary. Testing ticks for the Lyme disease bacteria is not usually recommended.
  • Most cases of Lyme disease occur during the summer.


Gershon: Krugman's Infectious Diseases of Children, 11th ed.

Long: Principles and Practice of Pediatric Infectious Diseases, 3rd ed.