Lyme disease in childhood

    Many families and physicians are very concerned about the risks of Lyme disease in childhood.  Lyme disease can cause joint pains, joint swelling, nerve inflammation, heart inflammation, and many other problems.  Key to the care of children suspected of having Lyme disease is making sure that Lyme is properly considered as a possible diagnosis, but also that Lyme is not inappropriately diagnosed in a child with another condition.

    I have cared for many children who were not properly diagnosed with Lyme, but also many children who were incorrectly thought to have Lyme when they had another more serious condition which was allowed to get worse while they received multiple courses of antibiotics with brief, if any, improvement.  If you suspect your child has Lyme disease make sure they are carefully and fully evaluated and that all possible causes of their symptoms have been considered.  Children who are not better after their initial treatment for Lyme disease must be carefully and completely evaluated for other possible explanations of their illness.

 

A method to the madness!!

This page is provided by Thomas J. A. Lehman MD

Delivering the best care - with great care

 Dr. Lehman is the author of many textbook chapters and articles on the care of children and young adults with SLE.  He practices in New York City.  Click here for more information about Dr. Lehman or the Hospital for Special Surgery.

If you want a more detailed discussion of lyme disease in childhood click here for information regarding a book I have written.

Spring summer and fall all of us are besieged by parents who found ticks on or near their children. Does my child have Lyme disease? What if we don't catch it on time? Could he be permanently crippled? Will he get heart block, demented, paralyzed........?

Lyme is actually an easy disease to diagnose and treat if you remember a few key elements.

1) A positive test for Lyme disease is an immune reaction. It takes two to six weeks after the tick bite to develop. A positive test for Lyme in a child who was just bitten is not due to the tick that just bit him/her. It's an indication of previous exposure. It is not necessarily the explanation for the patient's complaints.

2) Symptoms of Lyme disease consist of the acute stage in which there is a 'flu-like' illness with fever and rash occurring about two weeks after the infection, and chronic manifestations including arthritis, heart block, Bell's palsy and other neurologic symptoms. The chronic manifestations usually do not appear until two to four months or more after infection. Chronic manifestations in the absence of a positive titer are extremely rare and should be assumed not to be due to Lyme disease.

3) Every child with unusual complaints should be investigated thoroughly whether or not he has a positive Lyme titer. In endemic areas such as ours as many as 10% of the asymptomatic individuals test positive for Lyme disease. That means 10% of the murder victims, 10% of the drunk drivers, 10% of the smokers with lung cancer. Do not assume a positive test means that is the explanation for the complaint. I have seen a child with a neuroblastoma treated for an extended period for Lyme disease 'that didn't get better'.

4) If a child has a positive test for Lyme disease and has not been previously treated he should be treated with 21 days of appropriate antibiotics even if he is asymptomatic. However, antibiotics will not cause the positive test to disappear. It may persist for years without indicating further infection. Treat it once then stop unless there are symptoms.

5) If a child has vague symptoms which might be Lyme disease, but the test is negative he should be evaluated thoroughly for other diagnoses. After a thorough evaluation a three-week trial of appropriate antibiotics may be warranted, but both extended antibiotic therapy or a trial of antibiotics without thorough evaluation are inappropriate. If a child with a negative test is not better after three weeks of antibiotics one must reconsider alternative diagnoses. Many families report, 'he's better when he's taking the antibiotics, but then immediately gets worse again.' There is no good evidence this is any more than 'placebo effect.'

6) There are many children with real Lyme disease who do well with antibiotics. There are a few in whom Lyme disease initiates a chronic arthritis. These children look genetically like the other children with chronic arthritis and Lyme may have only been the initiating event. Once they have been appropriately treated for Lyme, they must be appropriately treated for their arthritis. Continuing the antibiotics after 30 days of oral and 14 days of intravenous is more likely to cause harm than improve the arthritis.

It is impossible to put all of the information I think you should know on a web page.  I’ve spent the last year completing a book for the parents of children with muscle, bone, joint problems and rheumatic diseases.  Included are chapters on Lyme Disease, understanding the laboratory tests, and getting the best care for your child.  There are many chapters on different causes of fatigue, bone, joint and muscle pains in children.  If your child with Lyme disease is not getting better despite antibiotics, there’s a significant chance the diagnosis is wrong.  Have you considered the other possibilities?  This book will help you sort it out.

My book –click here to order at a discount from Amazon.com!!

 Yours today at Amazon.com for only $24.50

click here for more information about this book

Reviewers’ Comments

    Dr. Tom Lehmans experience and compassion are evident on every page of this book, and they help guide the readerchild, parent, and healthcare professional alike through the world of childhood arthritis.  This book is an absolute gem written with a single goal in mind:  improve the lives of kids with arthritis. -- Jack Klippel, M.D. President and CEO of the Arthritis Foundation

     Dr. Lehman has given parents and families of children with arthritis the first book that speaks to the parent and child as equals.  His book explains the illnesses, the medications, the lab tests, and the disease course in simple, understandable lay language and givens them valuable insight into how a pediatric rheumatologist thinks.  Bravo!-- Charles Spencer, M.D., Professor of Clinical Pediatrics, University of Chicago, La Rabida

 

It’s not just growing pains.
A guide to childhood muscle, bone, and joint pain,
rheumatic diseases and the latest treatments

 

Click here to see the table of contents

It has always been a frustration trying to answer the many questions I have received from people over the web.  I can’t take the time and give them the detail I would like to.  I have to take care of my patients.  This book is a distillation of my experience answering questions for parents and health professionals over 25 years of practice.  If you want to know about the diseases, the tests, the medications, or how to be sure you are getting the best care– If you are the family member of a child with joint pains, this book will give you the answers.  If you are a general physician, a pediatrician, or a nurse who cares for children with these diseases it will answer many of the questions families ask you, and you can recommend it to them.  It will also answer many of your questions about what shots to give, what precautions to take, and the other questions families, pediatricians, and other health care providers have asked me over the years.

Yours today at Amazon.com for only $24.50

 Dr. Lehman is the author of many textbook chapters and articles on the care of children and young adults with rheumatic diseases including SLE, JRA, dermatomyositis, scleroderma, Kawasaki disease and related conditions.  He practices in New York City.  Click here for more information about Dr. Lehman or the Hospital for Special Surgery.

The Arthritis Foundation also works with children with lyme disease.

Click for BOOKS dealing with arthritis in childhood

This site provided by Thomas J. A. Lehman MD
Chief, Division of Pediatric Rheumatology
The Hospital for Special Surgery
535 E 70 St,
New York, NY 10021
212-606-1151, fax 212-606-1938, e-mail goldscout@aol.com