The Kids

Be Very Afraid of Ticks

The threat of tick-borne diseases is serious and growing. And you’re probably not doing enough to protect your family.

Bad things come in small packages.

Photo by ErikKarits/iStock

All parents have at least one issue that keeps them up at night worrying over their kids. For some, it’s gun violence. Others, cyberbullying. For me—especially in the spring and summer—it’s ticks.

Ticks aren’t just gross (though gross they sure are). They’re dangerous. Every year we see more ticks spreading more nasty diseases, many of which are difficult to diagnose and treat. This is my plea: Take ticks seriously and consider doing more to keep you and your kids safe from them, because what you’ve been doing may not be enough.

Let’s start with some facts. Ticks in the U.S. can spread more than 14 diseases. They are “the most significant vectors of infectious diseases in the United States,” according to a write-up from a recent scientific conference. Research suggests that where I live, in the lower Hudson Valley in New York, more than half of adult-stage blacklegged ticks harbor the bacterium that causes Lyme disease. (It’s also carried by one-fifth of nymphal-stage blacklegged ticks—the tiny ones that are hard to see and therefore often go unnoticed for days.) Another 1 in 5 adult blacklegged ticks in the region is infected with the bacterium that causes anaplasmosis; 1 in 30 harbors the potentially deadly deer tick virus; and another 1 in 30 can pass along the parasite that causes babesiosis. And yes: Ticks can and do often harbor multiple pathogens, so that’s fun too.

You’ve probably heard about Lyme disease, named after the town that had a cluster of outbreaks of the illness in Connecticut in 1975. It’s a treatable bacterial infection that is estimated to sicken about 300,000 Americans a year, but it can be difficult to diagnose, particularly in the one-quarter of people who don’t develop the characteristic bull’s-eye rash. When left untreated, Lyme can spread to the joints, heart, muscles, and brain. The U.S. Centers for Disease Control and Prevention notes that one out of every five to 10 Lyme sufferers continues to have symptoms such as memory problems, joint pain, and sleep problems even after they have been fully treated. As for the other infections I mentioned: Anaplasmosis, caused by a bacterium, and babesiosis, caused by a parasite, both invade red blood cells, and although they are treatable, they can also be very hard to diagnose because they incite only vague flu-like symptoms. Deer tick fever, also known as powassan virus—what Richard Ostfeld, a disease ecologist at New York’s Cary Institute of Ecosystem Studies, calls his “worst nightmare”—is an untreatable viral infection that, according to a recent study, has killed a whopping one-third of New Yorkers who have caught it since 2004.

But enough about the tick-borne diseases in my neck of the woods. Ticks make people sick everywhere in the U.S. People in the South and South Central states—especially North Carolina, Oklahoma, Arkansas, Tennessee, and Missouri—have to contend with Rocky Mountain spotted fever, a nasty bacterial infection spread by dog and wood ticks that can be fatal if antibiotic treatment isn’t started within several days of symptoms. They also have to watch out for ehrlichiosis, a bacterial infection spread by the Lone Star tick; tularemia, a bacterial infection that can be spread by several ticks; Southern tick-associated rash illness, an infection whose cause is unknown and is frequently confused with Lyme; and Heartland virus, which is so new that no one knows much about it yet. Midwesterners have Lyme disease, anaplasmosis, and powassan to deal with. And out West, tick-borne diseases are less common, but they run the gamut: People bitten by ticks can come down with Rocky Mountain spotted fever, anaplosmosis, Lyme, tularemia, and three other lovely ones: Colorado tick fever, tick-borne relapsing fever, and 364D rickettsiosis. Think you’re safe because you live in a big city? Nah. American dog ticks, which can transmit Rocky Mountain spotted fever, are crawling around many urban areas, and in recent years blacklegged ticks have been found in almost every borough of New York City. A whopping half of NYC blacklegged ticks harbor the bacterium that causes Lyme disease. Freaked out yet?

If you don’t remember being scared of tick-borne diseases when you were a kid, or even a decade ago, that’s because you weren’t. The reported prevalence of tick-borne diseases has basically doubled in the U.S. since 2003 and tripled since 1995. Some of this increase may be due to greater awareness and detection, but ticks are also spreading to new areas, “and in some places, the ticks have been getting more abundant and a higher percentage are infected,” Ostfeld explains. (Scientists don’t know exactly why this is happening—it could have something to do with how the U.S. landscape is changing, and climate change may also play a role.)

The obvious question is this: How do we protect our families from these disease-spreading parasitic creatures? You’ve probably heard the recommendations repeated ad nauseam: Use bug spray and tuck your pants into your socks when you go into the woods. That advice is all well and good, says Thomas Mather, director of the University of Rhode Island’s Center for Vector-Borne Disease and its TickEncounter Resource Center. “But no one does it,” he says. “And in the summer, who’s wearing long pants anyway?”

Consider some of the problems with bug spray. Sure, people might apply it before a long hike in the woods, but many encounters people have with ticks happen at unexpected times and in unexpected places, when no one is thinking about bug spray. I found a tick on my son’s ear last week, and I’m pretty sure he encountered it while playing outside for all of five minutes at a playdate. What parent sprays her kid before a playdate? (Also, I can only say I’m “pretty sure” he got it there because there’s really no way to tell when a tick encounter happens. Ticks can crawl around on the body for hours before they embed themselves. As Ostfeld explains to me, “We really don’t know where people are encountering the ticks that are making them sick,” and that’s a big problem.)

The other important thing to know about bug sprays is that many of them don’t work. Those “all-natural,” essential-oil-based sprays that so many parents love are basically worthless against ticks. DEET has been shown to repel ticks, but mainly at higher concentrations (upward of 20 percent). Some research also suggests that a newer repellant called picaridin works pretty well against ticks, but it can be hard to find. If you’re DEET-wary, by the way, note that the U.S. Environmental Protection Agency and the American Academy of Pediatrics both maintain that it’s perfectly safe to apply DEET to babies over 2 months of age and children; at any rate, a dose of DEET is undoubtedly safer than a tick bite. If you’re going to consider the risk of putting DEET on your kid, you have to also consider the risk of not putting DEET on your kid.

But since bug sprays work only when you remember to use them, Mather suggests that families living in tick-infested areas consider another tactic, too: Treating shoes and clothes with the synthetic pesticide permethrin, which, when commercially applied to clothes, can repel and kill ticks for up to 70 washes. Mather has research to back up this recommendation: In a 2011 study, he and his colleagues released 30 blacklegged tick nymphs on each of 15 volunteers who were wearing regular or permethrin-treated clothes. (Boy, am I glad I was not one of those volunteers.) Then they waited two hours to see what the ticks did. They found that the volunteers who were wearing permethrin-treated sneakers and socks were 74 times less likely to get tick bites—that’s a huge reduction in risk!—compared with those who wore untreated shoes and socks. Those who wore treated shorts were five times less likely to be bitten in surrounding areas. Even when ticks did bite people wearing the permethrin-treated clothes, four out of five of the biting ticks died within hours, making it unlikely that they could transmit disease. Based on these findings, Mather says, “permethrin in treated clothes is more effective than any other repellant.”

Shoes are the most important item to treat, because nymph ticks—the ones that cause the majority of tick-borne diseases, since they are hard to see and tend to go unnoticed—perch in spots close to the ground and often get to skin by crawling up shoes. To treat them, spray your family’s shoes with a permethrin product outside until they are soaked, and let them dry before you wear them. If you want permethrin-treated clothes—perhaps a good idea if you and your kids spend a lot of time outside in tick-infested areas, or if your kid is going to a woodsy camp—several companies, including L.L. Bean and Cabela’s, sell pretreated clothes and camping gear, and the Greensboro, North Carolina–based company Insect Shield will also treat your own clothes, making them tick-repellant for 70 washes. You can also treat clothes with permethrin yourself; doing so protects them for five or six washes.

I know what you’re thinking: Is it safe to let your kid wear clothes that have been treated with a synthetic pesticide? Again, if you live somewhere with a lot of ticks, you have to compare the risk from the pesticide with the risk from the ticks. The EPA says that permethrin-treated clothes are perfectly safe, even for young kids, because the amount of pesticide absorbed is very, very small. “We calculated, using the EPA’s figures, that a kid would have to wear 1,100 pairs of socks and shorts and T-shirts and hats—all at the same time—to get a dose of permethrin that would reach the EPA’s daily dermal no-observable effect level,” or the limit beyond which skin reactions to the pesticide can occur, Mather says.

There are other things you can do to keep your family safe, too. If you have a pet, make sure it is protected; Mather recommends long-lasting solutions such as Bayer’s Seresto flea and tick collar, which works for eight months. You can also discourage tick-carrying deer and mice from coming near your home. If you and your kids spend a lot of time in your yard, and you live in a tick-infested area, consider hiring a professional to treat your lawn or its perimeter with a pesticide in May or early June. (Mather says the synthetic options, such as bifenthrin, tend to work best.) The thing is, though, that preliminary findings suggest that even though synthetic lawn pesticides do kill ticks, they don’t necessarily reduce the incidence of tick-borne disease, a finding that supports the lack of understanding of where and when people actually encounter the ticks that make them sick. In other words, people who catch tick-borne diseases may not be getting them from ticks in their yards; nobody really knows.

This brings me to another point: Since you can’t guarantee that your tick prevention tactics will work all the time, you really need to do daily tick checks on yourself and your kids in the spring and summer. This doesn’t mean looking under your armpits and calling it a day. Nymph ticks, the ones that usually transmit disease, tend to embed themselves lower on the body in adults, so check behind your knees, in your belly button, and around your genitals, too—even in your butt crack. These ticks are about the size of a poppy seed, so get in there and look closely. For kids—especially those who like to roll around on the ground—you really need to check everywhere on their bodies, including around the hairline and ears.

The good news is that if you do a thorough tick check every day, you should be able to remove most embedded ticks before they can cause illness, because ticks usually don’t transmit pathogens for at least 12 hours; for Lyme, it generally takes 36 hours. (The one exception is powassan or deer tick virus—remember, the one that is Ostfeld’s worst nightmare—because research suggests ticks can transmit the virus within 15 minutes of attaching. But thankfully, this illness is still very rare; only 60 cases have been reported in the U.S. over the past 10 years.)

If you do find a tick, remove it as soon as you can by using tweezers to pull it upward with a steady, even pressure. (It’s generally a bad idea to touch ticks with your bare hands, as their saliva can seep out and potentially make you sick.) If the tick’s head or mouth parts remain embedded, don’t fret; they can’t transmit disease this way, and the body parts will eventually work themselves out. Mather suggests taping the removed tick to a postcard or putting it in a sealed plastic bag along with the date you removed it and then trying to identify the type of tick you found. (If you submit a picture of the tick to Mather’s team online, they’ll tell you what kind of tick it was and how long it had likely been embedded; they’ll even estimate the risk of becoming ill from it.) Then, reward your kid with some ice cream and yourself with an adult beverage, because you just won a battle against a very sneaky and dangerous opponent, small though it was.