Where should you go if a child is bitten by a tick?

Immediate Actions After a Tick Bite

Safe Tick Removal Techniques

Tools for Tick Removal

If a child presents with a tick attached, the first destination should be a pediatrician’s office, urgent‑care clinic, or emergency department, depending on symptom severity and time since attachment. Prompt professional evaluation reduces the risk of tick‑borne illness.

Effective removal requires proper instruments to avoid leaving mouthparts in the skin. Recommended items include:

Fine‑point tweezers (e.g., straight‑point or angled medical tweezers) with a smooth grip.
A tick removal device such as a plastic “tick key” or a specialized hook‑type tool.
Disposable gloves to prevent direct contact with the tick’s saliva.
Antiseptic wipes or solution for cleaning the bite site before and after extraction.
A sealable container (e.g., a zip‑lock bag) for preserving the tick in case laboratory testing is needed.

The procedure: don gloves, grasp the tick as close to the skin as possible with tweezers, pull upward with steady, even pressure, and avoid twisting. After removal, disinfect the area, place the tick in the container, and retain it for at least 24 hours if a healthcare provider requests identification.

Step-by-Step Guide

If a child is bitten by a tick, follow these actions in order.

Remove the tick promptly with fine‑pointed tweezers, grasping close to the skin and pulling straight upward. Clean the bite site with alcohol or soap and water.
Record the date of the bite, the tick’s appearance, and the location where the bite occurred. This information assists health professionals in assessing disease risk.
Call the child’s primary care physician or pediatrician within 24 hours. Provide the recorded details and ask whether a follow‑up appointment is needed.
If the child develops fever, rash, severe headache, joint pain, or any unusual symptoms, proceed to an urgent‑care clinic or emergency department without delay.
Contact the local health department for guidance on regional tick‑borne illnesses and recommended testing protocols. Many jurisdictions operate dedicated tick‑bite hotlines.
When advised by a medical professional, arrange for laboratory testing for Lyme disease, anaplasmosis, or other relevant infections. Follow the prescribed treatment plan precisely.

These steps ensure prompt medical evaluation, appropriate testing, and timely treatment, reducing the risk of complications from tick‑borne diseases.

First Aid After Removal

Cleaning the Bite Area

When a tick has attached to a child, the first action is to cleanse the site before any further evaluation. Prompt cleaning reduces the risk of secondary infection and helps identify the tick’s attachment point.

Wash hands thoroughly with soap and water.
Apply mild antiseptic soap to the bite area; avoid harsh chemicals that could irritate delicate skin.
Rinse with clean, lukewarm water, ensuring all soap residue is removed.
Pat the skin dry with a disposable paper towel or clean cloth; do not rub.
Inspect the area for the tick’s mouthparts; if any remain, remove them with fine‑tipped tweezers, grasping as close to the skin as possible and pulling straight upward.

After the bite zone is disinfected, seek professional assessment. The appropriate destinations include a pediatric clinic, an urgent‑care center, or an emergency department if the child shows signs of severe reaction (fever, rash, difficulty breathing). Contact the primary care provider for guidance on whether a follow‑up appointment is needed, especially if the tick was attached for more than 24 hours or if the region is known for tick‑borne diseases. Prompt medical evaluation ensures proper monitoring, possible prophylactic treatment, and documentation of the incident.

Applying Antiseptics

Apply a suitable antiseptic to the bite site as soon as the tick is removed. Use a 70 % isopropyl alcohol solution, povidone‑iodine, or chlorhexidine gluconate; avoid hydrogen peroxide because it can delay healing. Clean the skin with a sterile gauze pad, press gently to spread the antiseptic, and allow it to dry before covering the area with a clean bandage.

After disinfecting, obtain professional medical assessment. Take the child to a pediatric primary‑care office, an urgent‑care centre, or an emergency department if any of the following occur: fever, rash, headache, joint pain, or the bite area enlarges or becomes painful. Prompt evaluation ensures appropriate testing for tick‑borne infections and necessary antibiotic therapy.

Antiseptic application checklist

Choose alcohol, povidone‑iodine, or chlorhexidine.
Apply with a sterile gauze pad.
Cover with a clean bandage.
Record the time of removal and any symptoms.

Immediate care locations

Pediatric clinic – routine assessment.
Urgent‑care centre – rapid evaluation for early symptoms.
Emergency department – severe or systemic reactions.

When to Seek Medical Attention

Warning Signs and Symptoms

Localized Reactions

A tick bite on a child often produces a localized reaction at the attachment site. Typical findings include redness, swelling, tenderness, and a small papule or bump. In some cases, an expanding erythema migrans rash appears, forming a target‑shaped lesion that may reach several centimeters in diameter.

If the reaction is limited to mild redness and a small bump without systemic symptoms, a routine medical evaluation is appropriate. When the area enlarges rapidly, becomes intensely painful, or is accompanied by fever, headache, or joint pain, immediate assessment is required.

For evaluation of localized tick‑bite reactions, the child should be taken to one of the following facilities:

The family pediatrician’s office for a scheduled visit.
An urgent‑care clinic for same‑day assessment when the pediatrician is unavailable.
A hospital emergency department if the reaction is severe, rapidly progressing, or if the child exhibits systemic signs.

Prompt examination ensures proper identification of potential infection and timely initiation of treatment.

Systemic Symptoms

A tick bite can trigger systemic reactions that require prompt medical evaluation. Recognizable signs include fever, severe headache, neck stiffness, muscle aches, joint pain, rash that expands beyond the bite site or appears in a “bull’s‑eye” pattern, nausea, vomiting, and unexplained fatigue. Neurological changes such as confusion, seizures, or difficulty walking also signal a serious response.

When any of these symptoms develop, the child should be taken to a facility capable of rapid diagnosis and treatment. The appropriate options are:

Emergency department for high‑fever, neurologic impairment, or rapidly spreading rash.
Urgent‑care clinic if symptoms are moderate, such as persistent fever or localized joint pain, and immediate laboratory testing is needed.
Pediatrician’s office for early, mild systemic signs, provided the practitioner can arrange prompt laboratory work and prescribe antibiotics if indicated.

Delaying assessment increases the risk of complications from tick‑borne illnesses such as Lyme disease, Rocky Mountain spotted fever, or anaplasmosis. Immediate evaluation enables laboratory confirmation, initiation of appropriate antimicrobial therapy, and monitoring for disease progression.

Types of Medical Professionals to Consult

General Practitioner/Pediatrician

When a child is found with an attached tick, the initial medical contact should be the child’s primary care physician—either a family doctor or a pediatrician. These clinicians are equipped to:

Examine the bite site and confirm proper tick removal.
Assess the risk of tick‑borne infections based on species, attachment duration, and local disease prevalence.
Order appropriate laboratory tests if early signs of infection appear.
Provide guidance on symptom monitoring and preventive measures.
Refer to an infectious‑disease specialist or urgent care facility if severe symptoms develop, such as fever, rash, or joint pain.

The appointment should be scheduled promptly, ideally within 24 hours of discovery. Bring the tick, if possible, in a sealed container for identification. The physician will document the encounter, record the removal method, and advise on follow‑up visits to ensure timely detection of any emerging illness.

Emergency Room Visits

When a child is bitten by a tick, immediate medical evaluation often requires a visit to the emergency department. The ER provides rapid access to clinicians trained to assess tick attachment, remove the parasite safely, and initiate treatment for potential infections such as Lyme disease or Rocky Mountain spotted fever.

Reasons to choose the emergency room include:

Signs of severe allergic reaction (hives, swelling, difficulty breathing)
Fever, severe headache, or stiff neck developing within 24 hours
Rapidly expanding rash or bullseye lesion around the bite site
Neurological symptoms such as confusion, weakness, or loss of coordination
Uncertainty about the tick’s species, duration of attachment, or removal technique

In the ER, physicians will:

Examine the bite area and surrounding skin for erythema or necrosis.
Perform a thorough physical assessment to detect systemic involvement.
Order laboratory tests (e.g., complete blood count, serology) if infection is suspected.
Administer appropriate antibiotics, antihistamines, or corticosteroids based on clinical findings.
Provide instructions for follow‑up care and prevention of future bites.

If none of the listed emergency criteria are present, a primary‑care pediatrician or urgent‑care clinic may manage the case. However, any rapid change in the child’s condition warrants immediate transport to the nearest emergency facility.

Information to Provide to the Doctor

Tick Characteristics

Ticks are arachnids measuring 2–5 mm when unfed, expanding to 10 mm or more after a blood meal. Their bodies consist of a capitulum for attachment, a scutum covering the dorsal surface, and legs equipped with sensory organs that locate hosts.

The life cycle includes egg, larva, nymph, and adult stages. Each active stage requires a blood meal from mammals, birds, or reptiles. Larvae and nymphs often feed on small mammals such as rodents, while adults preferentially attach to larger hosts, including humans and dogs.

Ticks can transmit bacteria, viruses, and protozoa. Notable pathogens include Borrelia burgdorferi (Lyme disease), Anaplasma phagocytophilum (anaplasmosis), and Rickettsia spp. Transmission typically occurs after the tick has been attached for 24–48 hours, though some agents may be transferred more rapidly.

Key characteristics relevant to medical response:

Flattened, oval shape that becomes engorged after feeding.
Dark brown or reddish coloration, sometimes with a pale scutum.
Presence of a cement-like secretion that secures the mouthparts to the skin.
Ability to remain attached for several days, increasing infection risk.

Accurate identification of the tick species and the duration of attachment guides treatment decisions. Prompt removal with fine‑tipped tweezers, followed by a clinical evaluation, ensures appropriate diagnostic testing and, if necessary, prophylactic antibiotics. Health‑care facilities equipped for vector‑borne disease assessment—such as pediatric urgent care centers, family medicine clinics, or emergency departments—are the appropriate destinations for a child who has been bitten.

Time of Bite and Removal

When a child is found with a tick, the clock starts ticking for both removal and medical evaluation. Immediate removal reduces the chance of pathogen transmission; delayed removal increases risk. The following timeline guides the response:

Within the first hour – Use fine‑tipped tweezers to grasp the tick as close to the skin as possible and pull steadily upward. Clean the bite site with antiseptic. No medical visit is required unless the child shows signs of an allergic reaction.
Within 24 hours – Observe the bite for rash, fever, headache, or joint pain. If any symptoms appear, seek pediatric care promptly. Early consultation allows for possible prophylactic antibiotics for diseases such as Lyme disease.
After 48 hours – If the tick remains attached, repeat removal with the same technique and disinfect the area. Persistent attachment beyond two days markedly raises infection probability; urgent evaluation by a healthcare professional is advisable.
Beyond 72 hours – Regardless of symptoms, arrange an appointment with a pediatrician or urgent‑care clinic. Laboratory testing for tick‑borne illnesses may be indicated, and treatment decisions will depend on exposure duration and clinical presentation.

In all cases, documenting the date and estimated time of attachment assists clinicians in risk assessment and management.

Potential Health Risks

Common Tick-Borne Diseases

Lyme Disease

A tick bite on a child can transmit Borrelia burgdorferi, the bacterium that causes Lyme disease. Prompt medical evaluation reduces the risk of systemic infection and long‑term complications.

The appropriate venues for assessment are:

The child’s regular pediatrician or family physician, who can perform a physical examination, order serologic testing, and prescribe prophylactic doxycycline when indicated.
An urgent‑care clinic, if the pediatric office is unavailable within a few hours and the bite occurred within the past 72 hours.
A hospital emergency department, when the child exhibits fever, severe headache, facial palsy, joint swelling, or a rapidly expanding rash, suggesting early disseminated disease.

During the visit, clinicians will:

Verify proper tick removal and document the attachment duration.
Inspect for erythema migrans or other skin manifestations.
Conduct laboratory testing (ELISA followed by Western blot) if symptoms exceed 30 days or if the rash is atypical.
Initiate a single dose of doxycycline (or amoxicillin for children under eight) as prophylaxis when the tick was attached for ≥ 36 hours in an endemic area.

If the child lives in a region with known Lyme disease prevalence, contacting the local health department can provide guidance on testing sites and preventive education. Immediate consultation with a qualified medical professional is the safest course of action.

Tick-Borne Encephalitis

If a child is bitten by a tick in an area where tick‑borne encephalitis (TBE) occurs, immediate medical assessment is essential. The first destination should be a pediatric emergency department or an urgent‑care clinic that can initiate evaluation for viral encephalitis. Facilities must have access to laboratory testing for TBE virus (PCR, IgM/IgG serology) and the ability to start antiviral or supportive therapy if indicated.

Key criteria for selecting the appropriate center:

Pediatric emergency or urgent‑care unit with 24‑hour staffing.
On‑site or rapid‑access laboratory capable of TBE diagnostics.
Availability of infectious‑disease or neurology consultation.
Established protocol for tick‑bite management and post‑exposure vaccination if indicated.

If the nearest emergency department lacks TBE testing, the child should be transferred to a regional hospital equipped with a virology laboratory. Contact the local public‑health authority for guidance on regional referral pathways and vaccination recommendations for close contacts. Prompt evaluation reduces the risk of severe neurological complications associated with TBE.

Anaplasmosis

When a child sustains a tick bite, prompt medical evaluation is essential because the bite can transmit Anaplasma phagocytophilum, the bacterium that causes anaplasmosis. Early detection reduces the risk of complications such as high fever, severe headache, or respiratory distress.

The appropriate point of care depends on symptom severity:

Mild or no symptoms: schedule an appointment with the child’s regular pediatrician or a local urgent‑care clinic. The clinician can remove the tick, assess the bite site, and order a complete blood count and PCR test for Anaplasma if indicated.
Fever, severe headache, muscle aches, or respiratory difficulty: proceed directly to an emergency department. Hospital staff will perform rapid laboratory screening, initiate intravenous doxycycline if warranted, and monitor for organ involvement.
Uncertainty about available services: contact the regional health department for guidance on nearest facilities equipped to handle tick‑borne illnesses.

Typical diagnostic steps include a peripheral blood smear, serology, or molecular testing for Anaplasma DNA. Treatment of confirmed cases relies on doxycycline, administered for 10–14 days; dosing guidelines differ for children under eight, requiring pediatric‑specific instructions.

After treatment begins, follow‑up visits ensure symptom resolution and verify that laboratory markers return to normal. Parents should retain the removed tick for identification and report the encounter to their healthcare provider, as this information aids accurate diagnosis.

Diagnostic Procedures

Blood Tests

If a child is found with a tick attachment, the first step is to obtain professional medical evaluation. Primary options include a pediatrician’s office, an urgent‑care clinic, or an emergency department if systemic symptoms are present. These facilities can order the necessary laboratory examinations.

Blood testing serves two purposes: confirming infection and guiding treatment. The most common investigations are:

Complete blood count (CBC) with differential – detects anemia, leukocytosis, or thrombocytopenia that may accompany infection.
Serologic assay for Borrelia burgdorferi (IgM and IgG) – identifies antibodies to the Lyme disease pathogen; repeat testing after two weeks improves sensitivity.
Polymerase chain reaction (PCR) for Borrelia DNA – useful when early disease is suspected and serology may be negative.
Liver function panel – assesses hepatic involvement, which can occur in later stages of tick‑borne illnesses.
Renal function tests – monitor kidney status if systemic infection is suspected.

Timing influences interpretation. Initial serology performed within the first week of exposure often yields false‑negative results; a convalescent sample collected 2–4 weeks later confirms seroconversion. PCR can detect pathogen DNA earlier but may not be available in all laboratories.

Specimen collection should be performed by trained staff. Most pediatric practices have on‑site phlebotomy services; urgent‑care centers usually coordinate with external laboratories; hospitals provide comprehensive testing in their clinical labs. Results are typically returned within 24–48 hours for CBC and chemistry panels, while serology and PCR may require 3–5 days.

In summary, immediate evaluation at a child‑focused medical setting enables prompt ordering of CBC, Lyme serology, PCR, and organ‑function panels. Early detection through these blood tests informs timely antibiotic therapy and reduces the risk of complications.

Physical Examination

When a child presents after a tick attachment, the first point of care should be a primary‑care clinic, urgent‑care center, or emergency department, depending on symptom severity and access. Prompt evaluation limits the risk of tick‑borne disease progression.

The clinician’s examination focuses on the bite site and systemic signs. Essential components include:

Visual inspection of the attachment area for engorgement, erythema, or ulceration.
Full‑body skin survey to identify additional ticks or rash, especially erythema migrans.
Palpation of regional lymph nodes for enlargement.
Measurement of temperature, heart rate, blood pressure, and respiratory rate.
Neurological assessment for headache, facial palsy, or altered mental status.
Joint examination for swelling or tenderness.

Documentation records the tick’s location, size, and removal method. If the bite is recent, the provider may consider serologic testing or prophylactic antibiotics based on local disease prevalence and the child’s risk factors. Follow‑up appointments ensure early detection of evolving symptoms.

Treatment Options

Antibiotics

A child who has been bitten by a tick must be examined by a health‑care professional as soon as possible. Prompt assessment determines whether the bite requires antibiotic therapy, monitoring for early signs of infection, or simply observation.

Typical points of care include:

Pediatric primary‑care office
Urgent‑care clinic with pediatric capability
Hospital emergency department
Community health center with a clinician experienced in tick‑borne illnesses
Specialty infectious‑disease clinic (when referral is indicated)

If the clinician identifies a risk of Lyme disease or another bacterial infection, the standard prophylactic antibiotic is doxycycline, administered at a weight‑adjusted pediatric dose for a 10‑day course. The medication should be started within 72 hours of the bite and only after confirming that the tick was attached for at least 36 hours. Alternative regimens, such as amoxicillin, are used for children under eight years of age or when doxycycline is contraindicated.

Key points for antibiotic use:

Verify tick species and attachment duration.
Initiate treatment within the recommended time window.
Observe for rash, fever, joint pain, or neurologic symptoms during and after therapy.
Document dosage, duration, and any adverse reactions.

Seeking care at any of the listed facilities ensures that a qualified provider can evaluate the bite, decide on the necessity of antibiotics, and provide appropriate follow‑up.

Supportive Care

If a child has been bitten by a tick, immediate steps focus on wound care, symptom monitoring, and timely medical evaluation. Remove the tick with fine‑tipped tweezers, grasping as close to the skin as possible, and pull straight upward without twisting. Clean the bite area with soap and water or an antiseptic. Record the date of removal for future reference.

Observe the child for signs that may indicate infection or disease transmission, such as fever, rash, headache, joint pain, or fatigue. Document any emerging symptoms and the duration since the bite.

Seek professional assessment promptly. Appropriate venues include:

Pediatric primary‑care clinic or family physician’s office.
Urgent‑care center if symptoms develop rapidly or if the bite occurred in a region with known tick‑borne illnesses.
Emergency department for severe reactions, high fever, or neurological signs.

During the medical visit, convey the following information:

Exact location and date of the bite.
Description of the tick, if identifiable.
Any symptoms observed since the bite.
Recent travel history to areas with endemic tick‑borne diseases.

Supportive care may involve analgesics for pain, antipyretics for fever, and hydration. If a specific infection is diagnosed, clinicians will prescribe targeted antibiotics or other therapies. Until the appointment, keep the bite site covered with a clean dressing and avoid applying ointments that could mask symptoms.

Prevention and Follow-up

Preventing Future Tick Bites

Protective Clothing

Protective clothing reduces the risk of tick attachment when children play outdoors. Wearing long sleeves, long pants, and tightly fitted socks creates a barrier that prevents ticks from reaching the skin.

Recommended garments include:

Light‑weight, breathable fabrics treated with permethrin or similar repellents.
Pants with elastic cuffs or zippered ankles to seal the leg opening.
Closed‑toe shoes and gaiters that cover the lower leg and ankle.
Hats with brims that shade the neck and ears, reducing exposure in wooded areas.

If a child is found with a tick, immediate removal should be followed by a visit to a pediatric health professional—such as a family doctor, urgent‑care clinic, or emergency department—where the bite site can be examined, and appropriate prophylactic treatment can be administered. Before the appointment, inspect the child’s clothing for additional ticks and discard any contaminated items according to local health guidelines.

Tick Repellents

If a child is bitten by a tick, immediate evaluation by a pediatrician, urgent‑care clinic, or emergency department is required. Prompt assessment determines the need for antibiotic prophylaxis and monitors for early signs of Lyme disease or other tick‑borne infections.

Tick repellents reduce the likelihood of such encounters. Effective products contain:

DEET (20‑30 % concentration for children over 2 months) – provides up to 8 hours of protection.
Picaridin (10‑20 %) – comparable duration, less odor, safe for children.
IR3535 (10‑20 %) – suitable for ages 6 months and older, effective for moderate exposure.
Oil of lemon eucalyptus (30‑50 %) – not recommended for children under 3 years.

Application guidelines:

Apply to exposed skin and clothing, avoiding eyes and mouth.
Reapply after swimming, sweating, or at intervals specified on the label.
Use only the amount necessary; excess does not increase efficacy.
Store out of reach of children; keep containers sealed.

For children under 2 months, physical barriers (long sleeves, tick‑check clothing) are the only recommended protection. After any tick bite, remove the attached tick with fine‑tipped tweezers, grasp close to the skin, pull upward with steady pressure, and clean the area with alcohol. Document the bite location, time, and appearance of the tick for the healthcare provider.

In summary, proper use of DEET, picaridin, IR3535, or oil of lemon eucalyptus prevents bites, while immediate medical evaluation after a bite ensures appropriate treatment.

Checking for Ticks

When a child returns from outdoor activity, immediate visual inspection is the first line of defense against tick‑borne illness. Conduct a systematic skin survey, starting with the scalp, behind the ears, underarms, waistline, and between the legs. Use a fine‑toothed comb or a handheld mirror to improve visibility. If a tick is found, note its size, location, and attachment time before removal.

Removal should be performed with fine‑point tweezers, grasping the tick as close to the skin as possible. Pull upward with steady, even pressure; avoid twisting or crushing the body. After extraction, cleanse the bite site with antiseptic and wash hands thoroughly. Preserve the tick in a sealed container for identification if needed.

Following inspection and removal, the child should be taken to a qualified medical professional. Acceptable destinations include:

Pediatrician’s office for routine evaluation and guidance.
Urgent‑care clinic if the bite occurred within the past 24 hours or if the child shows early signs of illness.
Emergency department for severe reactions, extensive attachment, or systemic symptoms such as fever, rash, or joint pain.

Prompt medical assessment enables appropriate testing, prophylactic antibiotics, and documentation of the exposure, reducing the risk of complications.

Long-Term Monitoring

Observing for Delayed Symptoms

After a tick bite, immediate removal does not guarantee that disease will not develop. Continuous observation for delayed symptoms is a mandatory part of care.

Symptoms may appear days to weeks after exposure. The most common time frames are:

3–7 days: fever, headache, malaise.
5–10 days: expanding rash, often circular, sometimes called a “bull’s‑eye.”
1–2 weeks: joint or muscle aches, swelling of joints, especially knees.
2–4 weeks: fatigue, night sweats, nausea, abdominal pain.

Any of these signs, especially fever combined with a rash, require prompt evaluation. If a child develops a new rash, persistent fever above 38 °C, severe joint pain, or neurological signs such as confusion or facial weakness, immediate medical attention is essential.

Parents should schedule a follow‑up appointment with a pediatrician or visit an urgent‑care facility within 48 hours of the bite, even if the child feels well, to confirm that no early signs are present. The healthcare provider may order blood tests for Lyme disease, anaplasmosis, or other tick‑borne infections based on regional prevalence.

If the initial assessment is normal, continue daily checks for at least four weeks. Record temperature, rash appearance, and any changes in behavior or mobility. Contact a medical professional at the first indication of abnormal findings.

Observing diligently bridges the gap between tick removal and definitive diagnosis, ensuring that treatment can begin at the earliest possible stage.

When to Revisit the Doctor

After a tick bite, remove the parasite promptly, clean the area, and obtain an initial medical evaluation. The clinician will assess attachment time, species risk, and decide on immediate treatment.

Return to the doctor if any of the following occur:

Fever of 38 °C (100.4 °F) or higher, especially if it appears within 2–3 weeks of the bite.
Expanding redness or a circular rash (erythema migrans) at the bite site.
Headache, neck stiffness, or neurological signs such as facial weakness.
Joint swelling, severe muscle pain, or difficulty walking.
Persistent fatigue, nausea, or vomiting that does not resolve.
New or worsening symptoms after completing a course of prophylactic antibiotics.

Schedule a follow-up appointment:

Within 24–48 hours if the tick was attached for more than 24 hours and no prophylactic antibiotic was administered.
At 2 weeks post‑exposure if the initial assessment was inconclusive but risk factors were present.
At 4–6 weeks if laboratory testing for Lyme disease or other tick‑borne infections was performed and results are pending.

High‑risk children—those with compromised immune systems, a history of tick‑borne illness, or prolonged attachment—should be monitored more closely and may require earlier reassessment. Documentation of the bite, removal method, and any treatments given facilitates accurate follow‑up care.