Tick Safety Guide: Tick Checks, Removal, and Symptoms to Know

When the weather warms up, many New Englanders are ready to get outside. Whether it’s having a picnic in a grassy field or or exploring a woodsy backyard, you’ll want to look out for ticks. To keep yourself, your family, and your pets safe from tick bites and tick-borne illnesses, prevention is key.

What Are Ticks?

Ticks are small, blood sucking, spider-like insects that make their homes in wooded or grassy places where they can attach themselves to passing animals - including humans!

They can carry diseases such as babesiosis, anaplasmosis, Powassan disease, and Lyme disease—the most common tick-borne infection. The latter is spread by blacklegged ticks when they bite mice or deer that are infected with the bacteria called B. burgdorferi. The infected tick then passes the disease onto humans with their bite.

Dr. Esteban DelPilar-Morales of Baystate Infectious Disease says, "Not all ticks carry infection, and even the deer tick or dog tick, which can certainly can carry infections, do not always have them. If you look specifically at the deer tick, about 4 in 10 of them carry agents that may cause infection here in Massachusetts."

How to Prevent Ticks from Attaching and Biting

If you, your family, or your pets are going to be out hiking in the woods or playing in bushy or grassy areas - including your own backyard - make sure you’re prepared.

• Wear long sleeves and long pants if you will be outdoors in or near a grassy or wooded area, or gardening in the vicinity of a bird feeder (that can attract mice which can carry Lyme disease bacterium).
• Tuck your pant legs into your socks to keep ticks from crawling up along exposed skin.
• Wear a hat.
• Light colored clothing will show the dark colored, tiny ticks more clearly if they are on your clothing.
• Apply repellents that contain 20% or more DEET (N, N-diethyl-m-toluamide) on the exposed skin. This spray can offer protection that lasts up to several hours.
• Spray your clothes with permethrin, an insecticide that kills ticks instead of just repelling them. Properly treating your clothes with a spray that has a 0.5% concentration of permethrin can give you protection anywhere from weeks to even year.
• Don’t apply your protection out of order. The CDC recommends that sunscreen go on first, followed by insect repellent.
• Don’t apply on cuts, wounds, or irritated or sunburned skin.
• Don’t spray in enclosed areas. Spray outdoors.
• Always follow product instructions on repellents, avoiding hands, eyes, and mouths.

There is no data that "natural repellents" such as citronella have any effect on ticks.

Follow guidelines to prevent ticks on pets, including checking pets daily and using a veterinarian-approved tick preventive.

How to Check for Ticks

When returning indoors after being out in wooded and grassy areas, hiking, camping, playing, and gardening, you need to check thoroughly for ticks. Dr. DelPilar-Morales says, "Ensuring that you check yourself after coming in from from doing any activities outside, even in your own yard, is important."

Ticks can be very difficult to spot, ranging in size from a small poppy seed to an apple seed. They are easier to identify, however, after becoming very swollen while feeding on the blood of their host. Many tick identification charts exist –a good resource is the Massachusetts Department of Public Health. Be sure to check everything thoroughly - preventing a tick bite is easier than treating a tick bite.

Dr. DelPilar-Morales has a good trick: "I always tell my patients not to look for ticks, since you are likely to miss them. Instead, look for 'new freckles,' since some of them can be quite small and easily missed."

Check Gear, Accessories, & Pets

Look at everyone and everything that may have come along for your outdoor adventure. Ticks can ride into the home on backpacks, picnic blankets, and pets, then attach to a person later.

Check Clothing

Check clothing for any visible signs of ticks, then as an additional precaution you can tumble clothes in the dryer set to high heat for at least 10 minutes before throwing them in the wash.

Take a Shower

Showering in warm water can also be a good way to gently wash off unattached ticks that have made it from clothing to you or your child’s skin. Be careful not to vigorously scrub the skin and risk breaking in half a tick that might have become embedded in the skin.

Check Tick “Hot Spots”

Check your children and yourself for commonly missed places that ticks can hide.

Common tick hot spots are:

• under the arms
• inside the belly button
• behind the knees
• in and around the ears, including the folds of the ear
• waist and back
• groin, pelvic area, and in-between the legs
• scalp and hairline
• the back and buttocks

Pets have tick hot spots, too! Be sure to check between the toes, inside the ears, and in other places where ticks can commonly hide.

How to Remove a Tick

If you do find a tick on the skin, only use the safe removal methods recommended by experts. Do not use common suggestions like petroleum jelly or hot matches, which are not effective and can cause injury. These methods may make matters worse by triggering the tick to release more of its bodily fluids, and that could cause further infection.

The CDC offers the following tips on how to remove a tick:

• Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible.
• Pull upward with steady, even pressure. Don’t twist or jerk the tick, which can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal. These will not cause harm and cannot transmit disease. Your body will expel these parts in a few days.
• After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol or soap and water.
• Dispose of a live tick by submersing it in alcohol, placing it in a sealed bag or container, wrapping it tightly in tape, or flushing it down the toilet. Never crush a tick with your fingers.

Testing ticks for infection after finding and removing them is not typically done. It may help, however, to have a picture of the tick. "Knowing what kind of tick bit the patient can be very helpful determining what kind of organisms the patient might have been exposed to," says Dr. DelPilar-Morales.

Should I Go to the ER with a Tick Bite?

Typically, no, a tick bite doesn't need to be seen by an emergency physician, says Dr. Seth Gemme, Chair of Emergency Medicine for Baystate Health.

If you recognize or think you or your child have been bitten by a tick, call your primary care physician or your child's pediatrician. Go to Convenient Care if you find the bite on a weekend or holiday.

"In this area of the country, we will typically provide preventive antibiotic treatment for tick bites if it's within 72 hours of the bite," says Dr. Gemme.

Dr. DelPilar-Morales explains further that patients need to meet certain criteria for preventive antibiotic treatment for a tick bite, including:

• The attached tick can be reliably identified as an adult or nymphal I. scapularis 
• The tick has been attached for 36 hours on the basis of the degree of engorgement of the tick with blood or of certainty about the time of exposure to the tick.
• Antibiotic can be started within 72 hours of the time that the tick was removed.
• Doxycycline (an antibiotic) treatment is not contraindicated (such as from an allergy). 
• Ecologic information indicates that the local rate of infection of these ticks with B. burgdorferi is 20%. (This is true for all of Massachusetts. If your tick exposure happens elsewhere, consult local resources.) 

How Long Does a Tick Need to Be Attached to Cause Illness?

"For Lyme disease specifically, ticks needs to be attached for 24 to 36 hours to be able to transmit infection. However, for other infections, sometimes a few seconds of attachment can be more than sufficient," says Dr. DelPilar-Morales.

A report called Vital Signs, published by the CDC, notes illnesses transmitted by blood-feeding ticks and insects capable of transmitting pathogens – bacteria, viruses, or parasites – from one host to another, have more than tripled nationwide.

Always check for ticks after spending time outdoors - the sooner you can remove it, the better.

When To Call the Doctor

If illness develops within a few weeks of a tick bite, seeing a doctor is recommended immediately. 

Symptoms of Lyme Disease

You can identify and treat Lyme disease early by looking out for early symptoms. Within the first two weeks of being bitten by a deer tick, you may see:

• One or more rashes which may or may not resemble a classic bulls-eye (may appear within 3-30 days, typically before the onset of fever)
• Chills
• Fever
• Headache
• Fatigue
• Achiness

If left untreated, Lyme disease, in its later stages, can:

• Affect the heart
• Spread to the nervous system, resulting in facial paralysis (a loss of muscle tone or “drooping” of one or both sides of the face)
• Cause meningitis

Dr. DelPilar-Morales warns, "The classical bull's-eye usually presents about a week or so after a tick bite but will then disappear a week thereafter. Most patients may be fully asymptomatic during this time and the rash can be easily missed, although some may have nonspecific symptoms that may include fevers. If left untreated, it can cause Lyme carditis, Bell's palsy, meningitis, and arthritis in adults and children."

These other presentations can be weeks, months, and at times, even years after original infection if not treated. It is important to know that fever, general malaise, and tiredness can be symptoms of other tickborne infections, not just Lyme, so a visit with your provider is important to ensure appropriate is testing done.

Lyme disease in its early phases is easily treated and completely cured by a two week oral antibiotic treatment. The best protection against Lyme disease is prevention through careful preparation and thorough post-activity tick checks.