Katie MacDonald, MSN, CPNP is a pediatric nurse practitioner for Inova Urgent Care and the Children’s Emergency Room at Inova Loudoun Hospital – Loudoun County’s only emergency facility solely dedicated to caring for children and adolescents. It is also the first and only sensory-friendly ER in Loudoun County.

Inova Urgent Care offers specialized pediatric urgent care services at the Dulles South, Reston, Tyson’s Corner, and West Springfield urgent care locations.

While tick exposure can occur year-round, ticks are most active during warmer months. Inova Urgent Care shares helpful tips to help protect and prepare your family for tick season.

Tips for preventing tick bites:

  • When outdoors where ticks are prevalent (grassy, brushy or wooded areas), wear long clothing and tuck pants into socks.
  • Take a shower after being outside to help remove unattached ticks.
  • Always do a thorough tick check after being outdoors. Check armpits, backs of knees, the groin, scalp, hair lines and belly buttons. Ticks can be tiny (as small as 1 millimeter in diameter). They are less likely to transmit disease or infection when found early.
  • Tumble dry clothing in a hot dryer for 10 minutes to kill any ticks on the clothes.

Tips for applying tick repellent:

  • Apply to clothing and exposed skin outdoors in the open air. Avoid the face and open wounds.
  • To minimize possible overuse or ingestion, do not allow children under 10 years of age to apply tick repellent themselves.
  • Do not use combination sunscreen and insect repellent products. Sunscreen requires much more frequent application than insect repellent. 
  • Permethrin is tick repellent for use on external clothing. It will last through multiple wash cycles and is great for shoes, socks and outdoor items. Sweat changes the effectiveness of permethrin and therefore should not be applied to skin.
  • DEET is an effective tick repellent for skin and clothing. Products containing 20 to 30% DEET is recommended for children and teens.
  • Products containing DEET and Picaridin are safe and effective for use in children as young as 2 months of age. These ingredients have been proven to be the most effective, especially when compared to natural repellents. 
  • For a natural repellent, the CDC lists garlic oil and mixed oils that contain rosemary, lemongrass, peppermint, thyme, cedar and geraniol as acting tick repellents. However, studies have shown that these oils are not as effective as products containing DEET or Picaridin. It is important to note that there have been reports of babies – especially less than 6 months of age – who have exhibited skin sensitivity to oils. It may be best to avoid oils in young children and in those with sensitive skin.

Tips for tick removal:

It is safe to attempt tick removal at home. If you cannot remove it successfully or are concerned about the removal, please seek help from a professional. 

  • Use tweezers with a fine-tip or point.
  • Grasp the tick as close to the skin as possible. With firm, steady and constant pressure, pull until the entire tick comes out. Avoid twisting or squeezing the tick too tightly.  If the entire tick does not come out, try to also remove the parts that were left in the skin.
  • Do not use petroleum jelly or ointment to smother the tick – it does not work.
  • Never try to “burn out” a tick. It is very dangerous and ineffective. You will end up with a burn and still need to have the tick removed from the skin.
  • Once the tick is removed, clean the skin well with soap and water or alcohol.  
  • Save the tick in a plastic bag or container if you plan to take it to your doctor.
  • Closely monitor the site of the tick for 30 days. You may notice some local irritation, inflammation and redness a few days after removal. This does not indicate Lyme disease. If a rash or other concerning change develops, please have the area evaluated as soon as possible.

Are antibiotics required after a tick bite?

There is no exact answer to this question as every situation is unique. Some circumstances will require antibiotic treatment after a tick bite, and some will not. The best advice is to have the case evaluated by a clinician who is familiar with the most current evidence based research and protocols.

Antibiotics are only recommended for the prevention of potential Lyme disease, a bacterial infection spread by black-legged ticks. They are not recommended for the prevention of other tick borne illnesses such as anaplasmosis, babeosis, erlichiosis, Rocky Mountain spotted fever or other rickettsial diseases. If a person contracts Lyme disease, antibiotics are required for a longer course of time.

What are the guidelines for tick bite prophylaxis antibiotic use?

  • The tick can be identified as a black-legged tick (deer tick) and was attached in an area that is endemic for Lyme disease. 
  • The estimated time of attachment is 36 hours. This is determined based on the degree of tick engorgement with blood or the likely time exposure to the tick.
  • One single dose of doxycycline is the preferred antibiotic of choice to prevent Lyme disease. It should be started within 72 hours of tick removal. Benefits of giving the antibiotic outweigh the risks. 

Is doxycycline safe for children?

The quick answer is yes. There is sufficient evidence that shows a short course of doxycycline can be administered to young children safely. It is reasonable to give children a dose of doxycycline antibiotic for prophylactic treatment of Lyme disease even if they are younger than 8 years old. Recent data from three studies showed 0 out of 127 children developed teeth staining when treated with doxycycline.

If you have questions regarding Lyme disease, are sick or have developed a rash following a tick or insect bite, please seek medical care from your primary care provider or an urgent care center.

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  1. Rauer on July 2, 2019 at 3:33 pm


  2. ~ Jon R on July 2, 2019 at 4:46 pm

    As someone who has been affected by Lyme disease for over 11 years, I appreciate you giving tickbites the prevention and precautionary recognition they deserve. In my case, communication is key. In 2008, I was helping my Father do his annual landscaping routine in the South Run subdivision. Nothing out of the ordinary. Almost a year later I experienced an inexplicable swollen left knee (cantaloupe size). I assumed it to be related to an old sports injury. My doctor referred me to an orthopedist who I saw regularly for another 8 months. And Then My Right Knee Did The Exact Same Thing. I went back to my doctor and he was baffled. After an battery of tests and bloodwork, he determined Lyme. I had never heard of it. I never had the “classic” bullseye symptom. The irony is that my Father did get a “bullseye” a couple weeks after the landscaping; eighteen months prior. He went to the doctor and got treatment immediately; no big deal.

    The takeaways in my opinion:

    A) if you are bitten by a tick or show symptoms, have your doctor test you as early possible. While there is no “cure” for Lyme, early diagnosis can eradicate it in its tracks.
    B) The key indicator “bullseye rash” only occurs in about 70% of infections. It could be anywhere on your body. In my case, while I experienced flu-like symptoms, I never had the rash “heads up”.
    C) Spread the word. Awareness is key. Again in my case, both my Father and I got a bite. His was treated immediately. Mine took over 18 months to accurately diagnose. I might have had a different outcome with simple conversation.
    D) Do Not let this affect your summer activities. You have enough potential concerns. As an overactive youngster, when it was warm enough to go outside it was “Game On”. Along the way I have had a handful of tickbites. If I recall correctly, the remedy involved a freshly burnt match stick and tweezers. The thought of the possibility these little insects keeping me “sidelined” would have been unthinkable.

    It is amazing to me though that with the amount of “bumps and bruises” along the way, a little tick bite is what took me down. But not out. Just be aware of your surroundings, act accordingly, and please enjoy the splendor of the great outdoors and the celebration of the birth of our nation. 🙂

  3. R. Quinones on July 2, 2019 at 5:10 pm

    How/when should one get tested for Lyme disease?
    What are symptoms?
    What does bad rash look like?

    • Karen on July 3, 2019 at 11:03 pm

      You can get your tick tested By the Old Dominion University tick research team. They ask for a $50 donation to cover the expenses but there’s no charge if you just want to send it in for the study and don’t want the results.
      It is much easier to identify tick borne diseases in the tick itself versus teasing them out of the human immune system.
      Also see

  4. Diana on July 2, 2019 at 6:50 pm

    The guidelines for treatment are not correct. A single dose of doxycycline has been shown to be inadequate if Lyme disease has been transmitted. The blood tests for Lyme are not accurate in any situation, but are never accurate until the body’s immune system has been able to respond with the antibodies that the test is looking for. That is typically 3 weeks or more after the bite. By that time, the bacteria has been disseminated into connective tissue and other places in the body where antibiotic penetration is poor. By that time it becomes difficult to treat. A test is available from George Mason/Ceres NanoSciences to look for the antigen itself within urine. It is more accurate for early stage infections. It is in the final stages of FDA approval and is not yet covered by insurance. If I had a fresh bite, I would insist on that test and pay out of pocket. It is that important. Also you should save the tick in every case of a bite. Freeze it in a baggie. Find a lab which specializes in tick testing. Don’t surrender the tick to Labcorp or Quest. They threw out my 6 ticks without testing them. There are many types of ticks and many types of bacteria and viruses which can make us very sick. It’s much more than simply Lyme Borrelia burgdorferi. Have a full panel done on the tick by a qualified lab that specializes in tick testing. The info above about Ehrlichis is also inaccurate. Ehrlichia is trested with a course of doxycycline. It is a very common confection. Babes is is trested with a combination of two antibiotics. It is similar to malaria and is also a common coinfection. There are published case studies in peer-reviewed literature of Lyme transmission within the first 4 hours of a bite – so the information above is inaccurate in saying 36 hours. My Lyme and Babesia were transmitted within 12 hours. I have also had Ehrlichia transmitted within 6 hours. Based on the incorrect information in this article, I would not suggest going to an INOVA facility for treatment of tick-borne illnesses.

    • InovaNewsroom on July 26, 2019 at 1:50 pm

      Posted on behalf of Jill McCabe, Medical Director of Inova Loudoun Hospital Children’s Emergency Department: We follow the CDC and Red Book guidance on managing tick bites, diagnosing and treating Lyme. While we appreciate different opinions, and focus on the unique clinical scenario for each individual patient, we follow evidence-based practice.

  5. M. O’Neill on July 3, 2019 at 11:14 am

    My neighbor has had Lyme’s disease for several years. He suffers with flu-like symptoms continuously. He’s sure that his gardening hobby, together with a steady stream of deer passing through our yards led to the problem. I have used the Northern Virginia Whitetail Management Organization to try to control the deer population, but the results have been insignificant. The hunters harvested three deer last year, while they estimated that more than twenty successful hunts was the number which would be required to reduce the size of the herd.

  6. Angela on July 4, 2019 at 6:16 pm

    There are so many things wrong in this article, I can’t even type it all. I’ve had Lyme Disease for half my life. At the age of 51, I feel like I’m 80. Many doctors, including INOVA top rated doctors, have told me Chronic Lyme Disease is not in their “standard of care”.

    I’d like them to live just one day of my life.

    Real answers to this real disease can be found on LymeDisease.org.

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