Tick one more worry of our list
August 5, 2015 5:39 AM   Subscribe

My wife is going to a rural area in Poland with our 5 year old daughter for a week to visit family. This location is known to host a lot of ticks during the Summer, of which a significant portion has borrelia. We are worried that our daughter might get Lyme's disease. What to do? More details after the fold.

We have seen friends suffering from Lyme's disease, so we know that the risk is real. But this is even worse in infants where Lyme's disease can damage parts of the nervous system. What does the hive mind suggest to minimise the risk, apart from not going? My wife already has white trousers for our daughter that close at the socks. We know deet can be used for tick prevention. But what are the real risks of using date on the skin of a 5 year old? And are there any alternatives we could try? Thanks for any insights!
posted by hz37 to Health & Fitness (14 answers total) 9 users marked this as a favorite
Make her wear a hat if she is going in the woods, so a tick can't fall off a tree and onto her head as easily. Do a daily tick check.

According to the FDA, insect repellant containing deet is unsafe for children under two months of age; five years is well over that and should be fine. She's only going to be using it for a week, and you're worried about Lyme disease, so I would use it.

Here is a handy guide from the CDC on tick prevention. They recommend using products that contain permethrin on shoes/clothing, since it can kill ticks and will remain protective through several washings. They also recommend showering after going inside.
posted by J. Wilson at 5:56 AM on August 5, 2015 [4 favorites]

One thing to bear in mind is that ticks generally have to be attached to the body for 24 hours to transmit Lyme disease. (In this way it is different from mosquito-borne illnesses, which obviously don't require a lengthy bite to be transmitted.) To be conservative, I would check for ticks morning and night, and otherwise not worry too much. If you do find a tick, remove it properly.
posted by sudo intellectual at 5:58 AM on August 5, 2015 [7 favorites]

* Use DEET.
* Do a thorough tick-check every night. The dangerous ones are tiny.
* If you find a tick, be sure not to squeeze/crush it when you remove it. And don't use a match or vaseline to try to make it back out; this can make the tick expel its stomach contents and infect you, even if it hasn't been attached for 24 hours.

We live in an area with lots of Lyme-carrying ticks. The squished-tick scenario is how my then-5-year-old got infected. Fortunately, 2 weeks of antibiotics seemed to take care of things.
posted by belladonna at 6:08 AM on August 5, 2015 [3 favorites]

If you or your child does get a tick bite, prompt treatment with antibiotics is very effective. Just don't wait a week.
posted by alms at 6:21 AM on August 5, 2015 [2 favorites]

When I have had Lyme, it's because I have missed ticks in a tick check. I wouldn't have gotten Lyme if I'd had a parent or two to search for me.
posted by RJ Reynolds at 6:33 AM on August 5, 2015 [2 favorites]

Hi, I right now I am working a summer job for the Washington State Department of Agriculture placing biological pest traps on apple, crabapple and hawthorn trees. Some of my areas are very heavy with ticks, and I have become an unfortunate expert, since they get on me every day-- I mostly remove them from inside my clothes, but two or three times a week my wife also has to remove ticks that have attached to my flesh. Here are the lessons I have learned, in order of importance:
1. DEET doesn't really work. It might have some small deterrent, but I still get 3-5 ticks in my clothes when I am in one of my high-density areas. What does work is a chemical called PERMETHRIN. It is generally held to be safe for mammals-- in my opinion it is safer than DEET, which does scary things to your DNA. The best way to apply it is in a spray form to your clothes. Here is one formulation, there are many more. Spray your clothes, and they will kill any ticks that get on them. The sprays stay effective for six or more trips through the wash, then needs to be reapplied. This is still an insecticide, even though it is a safe one, so you need to do your own research and be comfortable with it. But for me, I regard it as absolutely essential and safer than DEET. Adding in the travel complication with clearing customs, I would probably just treat your clothes with the spray in your home country so that you don't have to do any extra explaining to Polish officials why you brough a bottle of chemicals into their country.
2. Despite popular myth, ticks don't have heads. The technical term is "mouthparts", and that is what is is-- a mouth at the top of their bodies. As others have mentioned, current CDC recommended removal technique is to lift smoothly and strongly in a steady upward motion with tweezers. Take a good pair of chisel-point, flat-tip tweezers with you. Take two just in case.
3. As others have said-- the most important thing is to have ANOTHER PERSON check you for ticks. You need a second set of eyes for all the places on your body you can't see. This includes "flaps" like armpits, belly (if one exisits) and butt, where ticks love to hide. Get a good flashlight to help. This one is super bright, and small, and cheap. In my experience, ticks can take a long time to find a spot and latch on (no head, remember? They can't be too smart). I find the majority of my ticks crawling around inside my t-shirt and underwear briefs, not attached to my body.
4. Which reminds me-- have a disposal method. Many ticks have flat, surprisingly strong bodies, and resist being crushed by fingers. It's like they have cockroach armor or something. Also, I don't like to touch them with my fingers (they are ticks, after all). I have encased them in kleenex and crushed them, then flushed them down the toilet in the past. Currently I put them in a vial of alcohol and turn them to my boss for analysis, though.
5. Finally, even though this is a super gross topic, as other posters have mentioned, if you remove the ticks before 24-48 hours, chances of Lyme disease transmission drop to almost zero. The most important thing to do is check yourself and your clothing every day, and you will be just fine.
6. Entry points. Think about where ticks might get in. Unfortunately I have a lot of data points on this one. I blocked entry through my pants by going back to blousing my boots like I used to do in the military. This works! The second most popular entry point for me is at my waist, since my shirt often comes untucked during the exertion of work in rough terrain. I haven't solved this one yet, although sometimes I consider making myself a long fabric "tick cummerbund" to wrap around my waist. I haven't done it yet because of the heat. The third entry point is through my shirt's neck/collar area. It helps a little to button up my shirt as high as I can stand in the heat. Long sleeves also help a lot if you can tolerate them (I can't.) All things to think about.

Let me know here or in memail if you have other questions. My biology buds at WSDA say that they do have Lyme disease in Poland and the rest of Europe, so your concern is real, but don't let it spoil your trip. Have fun out there!
posted by seasparrow at 6:59 AM on August 5, 2015 [24 favorites]

Take a good pair of chisel-point, flat-tip tweezers with you. Take two just in case.

You really want to grab the tick as close to the skin as possible, without squeezing the abdomen. The current CDC guidelines recommend fine-tip tweezers. Curved ones are probably a good idea- something like this or this. Personally, I use a gadget called a Tick Twister. A recent BMJ clinical review:
Ticks should be removed using fine forceps by steadily pulling the tick upwards (fig 3). PHE, the NHS, and studies that have examined different methods of tick removal all recommend that fine tipped forceps should be used to grasp the tick as close to the skin as possible and then to pull steadily upwards with an even pressure. They do not recommend twisting or jerking the tick because this may break the mouthparts.

Although forceps are considered the best removal method, some specially designed tick removal tools are also available. However, these tools have been studied only in animals and not yet in humans. One study recruited pet owners through veterinarians and asked them to remove ticks from their pets using four different tick removal tools that were randomly assigned using an intervention grid. A total of 236 ticks were removed by both pet owners and veterinarians. The study concluded that people removing the ticks preferred the tick remover tool (O’Tom Tick Twister) over fine tipped forceps because the ticks were easier to grab and quicker to remove. The tool also used less force for extraction and caused less damage to the ticks mouthparts. Another animal study compared three commercially available tick removal tools (Ticked Off, Pro-Tick Remedy, and Tick Plier) against medium tipped forceps. They concluded that the commercially available tools removed nymphs better than forceps because they removed more cement and caused less damage to tick mouthparts. However, nymphs were still more difficult to remove than adults. The authors of this study recommended commercially available tools over medium tipped forceps because they removed nymphs better. More studies assessing the use of these tools in humans are needed before commercial tick removal tools can be recommended in humans. If a person is inexperienced in removing ticks, tools such as these may be an option for ease of use, but we recommend the use of fine tipped tweezers for tick removal until more evidence is available.
posted by zamboni at 8:00 AM on August 5, 2015 [2 favorites]

Along the lines of the Tick Twister linked above, I've had great luck with this Tick Key - it's easy to use, very effective, and doesn't seem to come with much risk of upsetting the tick in a way that might get anyone infected.
posted by dialetheia at 9:16 AM on August 5, 2015 [1 favorite]

In Europe, you can get a vaccine for tick-born encephalitis, also---it's recommended for me for travel to Slovenia; I don't know if it's recommended for travel to Poland. But it's not available in the States.

The doctor who did the travel consult for my kids also recommended permethrin spray on clothing for insect repellent purposes; apparently it's quite safe (they use it on scalps at a higher concentration to treat lice and scabies), but the carrier that it's in is kind of nasty, so you do want to spray it on clothes when they're not being worn.
posted by leahwrenn at 10:44 AM on August 5, 2015 [2 favorites]

In central Europe i would think the greater worry is actually TBE (Tick Borne Encephalitis), in many European countries the vaccinaitons are available, however, the injections are on a spaced apart schedule. I dont know this website but it was the only English language source I could find quickly and the schedule looks right/resembles the schedule used in Austria.
I don't think you would be able to get this for your daughter during the week in Poland.
As others have said, your wife should search your daughter's body and remove them as required. And actually it is less likely that the tick drops onto your head, than that the tick sits on grass and attaches itself onto you as you brush through the tall grass. This is how I got them onto myself - walking through tall grass withbare legs.
If your wife speaks Polish, the best will be if she goes to a pharmacy once they are there and inquiries about local repellents and recommendaitons on what to do about TBE if one of them indeed has a tick.
posted by 15L06 at 11:30 AM on August 5, 2015 [1 favorite]

Just chiming in to emphasize looking in nooks and crannies when doing tick checks. Like, in the butt crack, between the toes, behind the scrotum for boys... I found ticks in two out of those three places recently for my son. (Not saying which two to preserve just a -bit- of privacy for him...)
posted by wyzewoman at 12:04 PM on August 5, 2015 [1 favorite]

Seconding the advice about twice-daily checks. I've had Lymes more than once, but my children never have. I've checked my daughters religiously, and also found ticks on several occasions, but if they are removed within a day, there is no problem. Everyone else I know has the same experience. A small child can get them everywhere on the body - one of my daughters had one between her eye-lashes! But they seem to be easier to remove from children, and it has never been a problem.
The reason I have gotten Lymes more than once has been that I have been busy and unfocused while removing a tick, so the mouth-parts were not properly removed. Busy and not focused on themselves is what mothers of small children often are, so probably your wife should think about her own safety.
Other people I know who have had tick-borne illnesses have typically been elderly - and for some reason unable to reach the place where the tick is and asking for help too late.
posted by mumimor at 1:51 PM on August 5, 2015 [2 favorites]

CoolTools have reviewed a bunch of tick related stuff over the years: hth, good luck on your trip.
posted by aeighty at 8:30 AM on August 6, 2015

Tights are even better than trousers. No gaps below the waist.
Even thin pantyhose material is enough to provide a barrier, it is a common recommendation for hunters, but that would be under another layer because they rip easily.
posted by Elysum at 7:10 AM on August 7, 2015

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