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.
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 Lehman’s experience and compassion are evident on every page of this
book, and they help guide the reader—child, 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