You may not have appreciated the harsh winter, but there’s one species that did: ticks. According to scientists, the snow that covered much of the country acted like a cozy blanket for the critters, allowing them to survive and propagate in unusually high numbers. And they’re not just hanging out in the deep woods. “We’re finding plenty of infected ticks in built environments, places like city parks, playgrounds, work campuses, college campuses,” a Binghamton University researcher told CBS Boston last month.

What’s especially worrisome is that ticks’ favorite meal appears to be kids. Children between ages 5 to 14 are the most common carriers of Lyme disease, which can cause a wide range of serious medical problems, from joint pain and fatigue (in the early stages) as well as neurological, behavioral, and emotional disturbances (in more advanced cases). An early CDC study of 64 New Jersey grade schoolers with Lyme found that median duration of their illness was 363 days, and the mean number of school days missed because the child was too ill to attend was 103 days. 78% of the parents stated that their children experienced a fall in grade point average during the time of illness.

According to experts, it’s time that parents start thinking of tick prevention the way we do sun protection or hand washing. For those of us who grew up thinking that the little bugs were nothing more than an icky nuisance, taking daily measures against ticks is a hard new habit to start. But Nevena Zubcevik, D.O., an attending physician at Harvard Medical School and the Co-Director of The Dean Center for Tick Borne Illness at the Spaulding Rehabilitation Hospital, has generously shared these easy-to-follow guidelines for keeping kids safe from ticks this summer and beyond.

STARTING IN THE SPRING…make your home and yard an unhappy place for ticks.
Pruning excess bushes and making sure you keep the grass short in your yard is a good practice. So is spraying the yard for ticks—there are lawn-care companies who offer organic options to insecticides. If you have a dog, consider applying anti-tick medication monthly, even in winter months. Dogs and other pets frequently bring ticks into the house.

EVERY MORNING…Spray your kids with a research-proven tick repellent.
“Tick prevention, given the wide area of presence, should be a daily practice,” says Dr. Zubcevik. You don’t have to venture out to the woods to get a tick bite. Recent studies show that urban parks, yards and play areas have ticks that carry these diseases. The reason for the widespread presence of ticks is that they live on small rodents like mice, squirrels and rabbits. They are also found on migratory birds, so ticks carrying illnesses generally found in other parts of the country can now be detected most anywhere.
Long pants and socks are especially helpful for defending kids against ticks, which tend to attach to their hosts’ ankles and legs first. But it can be unreasonable to ask kids to wear long clothes on a hot summer’s day. A recent Consumer Report showed that sprays such as Repel with lemon eucalyptus or Sawyer with 20% picaridin have the capability of keeping mosquitoes and ticks away for up to 8 hours – and outperformed compounds with DEET in their testing. “Those compounds are also safer than DEET for repetitive use in children,” says Dr. Zubcevik.

IN THE EVENING…Check your kids’ bodies for ticks, and wash bodies and clothes.
Ticks mostly live on wood or bushes and tall grass. They’ll attach to your leg and can crawl up and enter the waist or hairline area. Since kids are short, they also often brush by a bush and end up with a tick in or around their earlobe, hair or armpit. A prompt shower with a full body tick check after being outdoors on daily basis can help find ticks that just attached and catch them before they have transmitted disease.  Making sure you check between toes, in belly button and earlobes as well as the buttocks, groin and hair is key. Hair-drying in the summer can help kill small ticks that would otherwise be missed with a tick check – though time consuming, such practice can help long term prevention.

IF YOU FIND A TICK…Remove it, freeze it, and talk to a doctor.
If you find a tick you can use thin tweezers to catch the tick at the insert site, closest to the skin and gently jiggle the tick until it detaches. If the tick is embedded deep, then a visit to the doctor would be warranted, says Dr. Zubcevik. (Never burn or squeeze a tick. The tick carries most of the bacteria in the stomach and by squeezing it you run a risk of injecting the contents into the person. You should then keep the tick, and freeze it in a ziplock bag and then send it for testing.) The testing is done at UMass, and in five business days they will let you know whether the tick has any serious illnesses.
If the result is positive for a tick-borne illness, talk to your child’s pediatrician about options. There are some opposing views about prophylactic treatment. Some physicians say that because the diseases the ticks carry can be debilitating and in some cases life-threatening, it’s important to treat if there was evidence of a bite; while others disagree and prefer to wait for symptoms of illness. “The problem is that the longer you wait, the higher the chances the bacteria has had time to spread throughout the body, in which case it might be more difficult to treat,” Dr. Zubcevik says. Current studies at John’s Hopkins University show that up to 35% of people develop chronic symptoms despite treatment for Lyme. “We do not know what the exact reasons of these chronic symptoms are,” notes Dr. Zubcevik. “Scientists have postulated that it could be an autoimmune reaction that is triggered by the infection, chronic inflammation, or continued infection by the bacteria.”

ALWAYS BE ON THE LOOKOUT…for signs and symptoms of Lyme.
Red flags are flu like symptoms, joint pains or swollen joints, sudden change in behavior, sudden development of repetitive movements, lethargy, fatigue, and headaches. A classic “bulls-eye” shaped rash around the bite site may be present, but not always, and therefore should not be required for diagnosis of this illness.
One big reason kids are at high risk is that they generally do not communicate symptoms very well. Parents should know that in case their kids develop any symptoms that are new and concerning, they should be vigilant to find out whether or not their child needs treatment. “Currently we have very poor testing for Lyme disease,” says Dr. Zubcevik. “The current test misses 89% of Lyme disease cases in the first 8 weeks of infection.”
Since testing is so inadequate, Dr. Zubcevik warns, results should not be depended on exclusively for diagnosis. Symptoms and risk factors should also be strongly considered. “The treatment is actually quite benign,” she says. “We use antibiotics such as amoxicillin for children under the age of 8 and doxycycline for older kids. Both of these antibiotics have good safety records and are generally well tolerated. With these facts in mind, both parents and physicians should feel comfortable starting a patient on antibiotics if they clinically present as Lyme.”

Bottom line…As long as Lyme remains so tricky to diagnose and treat, taking precautions is key. “Parents should be vigilant with prevention,” says Dr. Zubcevik. “It’s what we have most control over.”

The Tick Toolkit
	Repel with lemon eucalyptus or Sawyer with 20% picaridin have been tested to keep mosquitoes and ticks at bay for up to 8 hours.
	Fine tip tweezers like these by TAMSCO will allow you to remove ticks more easily.
	When sprayed on a child's socks or clothes before heading out in grassy, wooded or overgrown areas, Permethrin helps repel ticks.
	Get kids jazzed for a nightly bath or shower with a fun soap, like Method's Mickey Mouse lemonade body and hair wash.