April 16, 2013

Ask: How do I remove a tick?

Duke pediatrician Brian Eichner tells us how to remove ticks you find dug into your child's skin -- and, better yet, how to avoid them in the first place.

Q. I've been reading about the dangers of ticks in our area. If I find a tick on my child's skin, what should I do?

A: First, I’m glad that the weather is finally nice enough to spend a lot of time outside! As you know, it is difficult to spend an extended amount of time outside in this area without a tick ending up on you or your loved ones. The easiest way to deal with ticks is to prevent them from attaching and biting in the first place.

To prevent tick bites, wearing long-sleeved shirts and long-legged pants is a good idea. This minimizes their access to skin. It may seem counter-intuitive to do this in summer, but it is worthwhile if you are spending time where there are likely to be a lot of ticks. (As a side note, years ago, when helping my wife with her graduate school project on a summer day in the woods of Wisconsin, I was stubborn and did not heed her advice to cover up. That afternoon, I pulled more than 20 ticks off of myself).

Additionally, tick repellant such as DEET (also a mosquito repellant) can be effectively applied to exposed skin. DEET is safe to use for infants as young as 2 months old. Unlike sunblock, tick repellant does not need to be re-applied every hour or two to be effective over the course of a day. It is also possible to treat “outdoorsy” clothing with a tick repellant chemical known as permethrin.

After spending time outside, check your family members for ticks on their bodies. It is important to check the clothing as well as the entire skin surface (please do not confuse the goal here with the Brad Paisley song about checking his lover for ticks…). This way, if a tick is on the body, it likely hasn't been there for long, which minimizes the risk of disease spread, if the tick is indeed carrying an illness. Ticks transmit illness into human blood when they utilize the blood for a meal; humans are exposed to infection when the tick regurgitates the meal (not visible). This requires a VERY long period of time (up to 48 hours), so there is a generous window of time in which to intervene! It is also a good idea to bathe after the tick check; this will not remove any attached ticks, but it may help remove ticks that have not yet started their meal.

Now, to answer your question about tick removal, there are several things to keep in mind. The first is to avoid interventions that are likely to leave the mouth part behind or to cause the tick to vomit (which, as discussed above, is what causes transmission of disease). Thus, squeezing, crushing or puncturing the tick during removal is not recommended. Only tweezers or protected fingers should be used for this. Do NOT apply petroleum jelly, a lit match, fingernail polish, or rubbing alcohol; all of these practices (advocated for many generations) can worsen the situation.

When actually removing the tick, grab the tick as close to the skin surface as possible with the tweezers. Then, apply gentle but firm, steady pressure without jerking or twisting the tick. After the tick is removed, disinfect the area of skin where the tick was located.

While there are multiple diseases that are tick-borne, the great majority of tick exposures do not result in human disease. Therefore, there is no reason to take a preventative antibiotic after being exposed to ticks unless strict criteria are met. One of these criteria is a Lyme disease rate of greater than 20 percent in the local tick population, which means there is never a reason to need preventative (meaning you have not had symptoms) antibiotics for a tick bite in North Carolina!




Brian Eichner is a general pediatrician and assistant professor of Pediatrics at Duke Children's Primary Care-Roxboro Street in Durham. He enjoys providing care for children who are healthy as well as those with complex medical conditions. Dr. Eichner also serves as the medical director of the Duke Pediatric Diagnostic Clinic. He and his wife have lived in the Triangle since 2006.

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