Remove the tick as soon as you see it, with tweezers or a tick remover close to the skin, straight out. Wash with soap and water and note the date. Then watch the spot for up to a month: a round or ring-shaped redness that grows to more than five centimetres may be Lyme disease (borrelia) and should be assessed by a doctor. It is treated with antibiotics. Fever and headache one to four weeks after the bite may be TBE (tick-borne encephalitis), and there is a vaccine against it that Region Stockholm recommends from the age of one.
Sunday evening in June, shower after a day at Hellasgården, and on the back of the two-year-old's neck sits a small black dot that will not come off with the flannel. Ticks are part of Stockholm from early spring to late autumn, and the archipelago and the area around Lake Mälaren are among the densest in the country. Most bites come to nothing at all. Here is how to remove the tick properly, what to look for over the coming weeks and how to tell the harmless from what needs assessing.
Removing the tick, step by step
- Get out tweezers or a tick remover. The pharmacy sells removers shaped like a small card or a hook, and they are the easiest on children. Fine-tipped tweezers work just as well.
- Grip close to the skin, around the tick's head, not the body. If you squeeze the body, its contents are pushed into the wound.
- Pull straight out, calmly and firmly. A little twisting makes no difference either way. If the head stays in: leave it, it works its way out on its own.
- Wash with soap and water, or disinfectant.
- Note the date and the place on the body, in your phone. That is the information the doctor will want if a redness appears in three weeks.
- No oil, no butter, no grease, no match. Old advice that makes the tick vomit into the bite.
How long the tick has been attached matters for Lyme disease: the sooner it is off, the lower the risk. That is why the evening check after a day outdoors matters more than which tweezers you use.
What to watch for, and for how long
| Ordinary bite reaction | Lyme disease | TBE | |
|---|---|---|---|
| When | Straight away, the first day | A few days to a month after the bite | One to four weeks after the bite |
| What it looks like | A small red dot or bump, up to a couple of centimetres, itchy | A round or ring-shaped redness that grows, usually over five centimetres, rarely itchy | No change to the skin. Fever, headache, tiredness, sometimes in two rounds |
| Other signs | None | Sometimes tiredness, fever, a swollen joint, facial droop in children | High fever, severe headache, stiff neck, sensitivity to light, vomiting |
| What you do | Nothing, it passes in a few days | Call 1177 (the national healthcare helpline), assessed at the vårdcentral (local health centre), antibiotics | Call 1177, with a stiff neck and severe headache 112 |
| Protection | Evening checks and clothing | Quick removal. There is no vaccine | Vaccine, recommended in Stockholm from age one |
Lyme disease in children
Lyme disease is caused by a bacterium passed on from the tick after it has been attached for a while. The most common sign is the ring-shaped redness, erythema migrans, which grows slowly from the bite site and can reach more than ten centimetres. In children, Lyme disease can also cause a facial droop, a swollen joint, usually the knee, or just tiredness and fever without any redness. All of this is treated with antibiotics and clears up. No blood tests are needed for the redness. The doctor looks and treats. Do not wait for it to disappear, because it will eventually even without treatment, but the bacterium remains.
TBE and the vaccine
TBE is a virus that causes inflammation of the brain, is passed on directly at the bite and cannot be treated. Most people who are infected get a cold-like fever after one to two weeks and recover, but some get a second phase with high fever, severe headache, stiff neck and sensitivity to light that requires hospital care. Small children often get a milder illness than adults, but not always. Region Stockholm recommends the vaccine for everyone from age one who lives in or spends time in the county. The primary course is several doses in the first year and then boosters. Ask BVC (the child health clinic every family is enrolled in) or 1177 about the schedule and what currently applies to the cost.
Call 1177 if
- A redness at the bite grows and becomes larger than five centimetres, or is ring-shaped
- Your child gets a fever, headache or is unusually tired within a month of a bite
- Your child gets a swollen joint, usually a knee, without having hurt it
- One side of the face droops or your child cannot close one eye
- The tick is on the eyelid or in a place you cannot reach
- Your child has got many ticks at the same time
Call 112 if
- Your child has a high fever with severe headache and a stiff neck, and cannot bend the head towards the chest
- Your child is very drowsy, hard to wake or confused
- Your child has a seizure
- Your child has difficulty breathing or swelling of the face and throat after a bite, which is very rare but does happen
How to reduce the number of bites
- An evening check every day after forest, meadow, long grass or garden: the hairline, behind the ears, the neck, the armpits, the groin, the backs of the knees, the navel. Make it part of the evening routine from May to September.
- Clothing: long trousers tucked into socks and long sleeves in the forest. Light-coloured clothes so the ticks show up.
- The route: paths rather than long grass and bushes, and a blanket when you sit down.
- Insect repellent that is approved against ticks and for your child's age, according to the pharmacy.
- Pets: the dog and the cat carry ticks indoors. Check them too.
- The vaccine against TBE, from age one in Stockholm.
Ticks are no reason to keep children indoors. Our outing guides, for example Nature reserves in Stockholm with kids and The Stockholm archipelago with children, all go through tick country. The evening check is the price.
How we do it with our families
Our nannies who are out with children in forests and parks in summer do the evening check before the parents get home, if the session runs past shower time, and they carry a tick remover in their bag. If they find a tick they remove it, wash, and write on the note where it was and the date, so the parents know what to watch for and from when. In August Esther found a tick behind the ear of a three-year-old in Täby after a day at the lake. The note that evening had a little cross on a drawn figure, behind the left ear, and the date. Three weeks later the mum had something to compare with when she wondered about a redness, which turned out to be a mosquito bite.
This text is general information and does not replace advice from BVC, your vårdcentral or 1177. If you are worried about your child, call 1177. In an emergency, call 112.
Would you like a nanny who knows your child, knows what is normal for them and notices when something is different? Book a free first meeting with the nanny in your home.
Read more: Wasp and bee stings in children · Sun protection for children · Nature reserves in Stockholm with kids · The Stockholm archipelago with children
Frequently asked questions
How do we remove a tick from a child?
With a tick remover or fine-tipped tweezers as close to the skin as possible. Pull straight out, calmly and firmly, without squeezing the body. If a piece of the mouthparts stays in, it is harmless and works its way out like a splinter. Wash with soap and water. No oil, no butter, no grease.
What does Lyme disease look like?
Usually a round or ring-shaped redness that grows from the bite site, typically larger than five centimetres, from a few days up to a month after the bite. It rarely itches and does not hurt. A redness that appears straight away and is smaller than a couple of centimetres is an ordinary reaction to the bite and not Lyme disease.
Do we have to call a doctor after every tick bite?
No. A tick bite with no symptoms needs no care and no tests. Watch the spot for up to a month. Call 1177 if a growing redness, fever, headache, tiredness or a swollen joint appears, or if your child develops a facial droop. Lyme disease in children is treated with antibiotics and clears up.
Should my child be vaccinated against TBE?
Region Stockholm recommends the TBE vaccine for children from age one who live in or spend time in the county, and the Stockholm archipelago and the Mälaren area are among the places where infection is most common. The vaccine protects against TBE but not against Lyme disease. Ask BVC or 1177 about the schedule and the current cost.
Where do ticks attach on children?
Usually high up: at the hairline, behind the ears, on the neck and in the armpits, but also in the groin, the backs of the knees and the navel. Children are short and walk close to the grass, so they get more ticks on the head than adults do. Check once every evening after a day in the forest or long grass.