How is subcutaneous tick treated in a child? - briefly
The tick must be removed with sterile forceps, taking care to extract the entire mouthpart and then cleanse the wound with an antiseptic. If the attachment lasted more than 24 hours or signs of tick‑borne disease develop, a short course of appropriate pediatric antibiotics (e.g., doxycycline) is indicated.
How is subcutaneous tick treated in a child? - in detail
Management of a subcutaneous tick infestation in a pediatric patient requires prompt identification, safe removal, and appropriate follow‑up care. Immediate steps focus on confirming the presence of the arthropod beneath the skin, assessing the depth of embedment, and evaluating for signs of infection or systemic involvement.
The removal procedure should be performed under aseptic conditions. Recommended technique:
- Clean the surrounding area with an antiseptic solution such as chlorhexidine or povidone‑iodine.
- Apply a local anesthetic (e.g., lidocaine 1 % without epinephrine) to minimize discomfort.
- Use a fine‑point sterile forceps or a specially designed tick‑removal tool to grasp the tick as close to the skin surface as possible.
- Apply steady, gentle traction to extract the entire organism without crushing the body.
- If the mouthparts remain embedded, consider a small incision with a sterile scalpel blade to free the remnants, followed by thorough irrigation.
Post‑removal care includes:
- Irrigating the wound with sterile saline.
- Applying a topical antibiotic ointment (e.g., bacitracin or mupirocin) and covering with a sterile dressing.
- Monitoring for local erythema, swelling, or discharge over the next 48–72 hours.
Systemic prophylaxis may be indicated based on epidemiological risk factors and symptomatology. Considerations:
- Initiate a short course of doxycycline (4 mg/kg/day divided twice daily) for 5–7 days if the tick species is known to transmit Borrelia burgdorferi or Rickettsia spp., and the child is older than 8 years.
- For children younger than 8 years, use azithromycin (10 mg/kg once daily) as an alternative.
- Document the date of removal and, if possible, retain the tick for species identification.
Follow‑up evaluation should assess:
- Resolution of the local wound.
- Absence of fever, rash, or neurologic signs suggestive of Lyme disease, Rocky Mountain spotted fever, or other tick‑borne illnesses.
- Serologic testing when clinical suspicion persists, especially if the tick was attached for more than 24 hours.
Education of caregivers emphasizes: