How to prevent tick bites—and, if necessary, treat them

Summer is upon us, and with the change of season comes fun in the sun, long lazy days, and unfortunately, tick bites. If you have noticed an increase in tick sightings in your area, you aren’t alone—the tick population, and the diseases they transmit, are on the rise. 

This information is probably enough to make you want to wrap your children in bubble wrap and stay indoors until winter. But take heart: Effective tick prevention is possible, and should an infection occur, treatment is available. “The general prognosis, when treated early, is good,” says Sylvia Owusu-Ansah, MD, MPH, FAAP, a pediatric emergency medicine physician in Pennsylvania, a region with endemic Lyme disease in the United States. “Tick-borne illnesses can progress to illnesses that affect the heart and nervous system, which can lead to poor prognosis and possible death, but [that] does not happen too often.” 

The keys to combating tick-borne illnesses, such as Lyme disease, Rocky Mountain spotted fever, anaplasmosis, babesiosis, and other infections are tick prevention, early diagnosis, and prompt treatment. 

Before the bite: How to avoid ticks

The best way to stay healthy is not to get bitten at all. “Blacklegged ticks (one of the biggest offenders for disease transmission) like wooded/brushy areas and will sit on vegetation, waiting for a person or animal to come into contact with them,” says Curtis Russell, Ph.D., senior program specialist at Public Health Ontario, a leading organization working in the area of vector-borne diseases. 

But you shouldn’t just worry about hiking. These areas can include urban gardens and parks, according to Aileen M. Marty, MD, FACP, a professor of infectious diseases at Florida International University. Ticks are prevalent even in yards and other commonly visited areas.

“Most people get infected in the summer months as that’s when the black-legged ticks in the immature or nymph stage are most abundant,” Russell says. “These ticks are extremely small, about the size of a poppy seed, and are really hard to notice.” 

For non-chemical protection, Russell recommends wearing light-colored, long-sleeved shirts and pants tucked into socks so that ticks are more noticeable and have to crawl farther before getting to your skin. He also suggests bathing as soon as you are back home and washing your clothes. 

“If a tick is attached, it takes at least 24 hours for a black-legged tick (if it is infected with the Lyme disease-causing bacteria) to transmit the bacteria to you,” he says. “Taking a shower once you come in from outdoors increases the likelihood of washing off a tick before it has a chance to attach to you and possibly transmit the bacteria. Running your clothes through the dryer for 60 minutes will also help to kill any ticks on your clothing.”

While widely circulated “home remedy” bug repellants on the internet may seem like a valid alternative, they are usually less effective against ticks. Dr. Owusu-Ansah recommends using an EPA-approved insect repellent that contains 20% or more DEET, picaridin/icaridin, or IR3535 on exposed skin. She also suggests treating clothing and equipment such as boots, pants, socks, and tents with permethrin (0.5%).

Dr. Marty stresses the importance of protecting pets from ticks, both for their own health and to keep them from bringing ticks into contact with their humans. Your veterinarian can provide you with the steps to take.

Even with showering, daily visual tick-checks are also important, alone or preferably with help, “especially under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and on the hairline and scalp,” says Dr. Owusu-Ansah.

After the bite: How to remove a tick

If you or your child happens to get a tick attached, prompt tick removal is key. To safely remove an embedded tick, Dr. Owusu-Ansah and the Centers for Disease Control recommend the following:

1. Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible. (There are specialized tick-removing tools as well.) 

Don’t use nail polish, petroleum jelly, or heat to detach the tick from the skin.

2. Pull upward with steady, even pressure. 

Don’t twist or jerk the tick; this can cause the mouth parts to break off and remain embedded in the skin. If this happens, remove the mouth parts with clean tweezers. If you can’t move the mouth parts easily, leave it alone and let the skin heal.

3. Thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water after removing the tick.

If possible, save the tick for identification or testing should symptoms arise.

If infection sets in

Not all tick bites require medical attention or result in illness, but there are symptoms to look out for after a tick bite occurs.

“Common symptoms for most tick-borne illnesses are flu-like symptoms,” says Dr. Owusu-Ansah. These can include fever, headache, chills, muscle aches, and fatigue. 

With some infections, such as Lyme or Rocky Mountain spotted fever (RMSF), a rash may or may not appear. For Lyme and Southern Tick-Associated Rash Illness (STARI), this rash takes on a bull’s-eye appearance and can be one of the first symptoms to show up (three to 30 days after infection with Lyme). 

The rash that comes with RMSF can vary. According to the Centers for Disease Control and Prevention (CDC), a rash often begins two to five days after the onset of fever. Only 35%-60% of patients see the red to purple rash associated with RMSF by the sixth day or later. 

The usual course of treatment for tick-borne infection is antibiotics. Which antibiotic and how much depends on the patient, the infection, the severity, and the symptoms. “For the skin rash, we typically start patients 12 years of age [and older] on doxycycline but will use amoxicillin as an alternative, and azithromycin as a third option,” Dr. Marty says. “For children, we start with amoxicillin.” 

If you have flu-like symptoms and think your tick bite caused an infection, see your healthcare provider for a treatment plan.