Professional Documents
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The nurse should put up her Lyme radar when a child is a frequent
visitor to the office, has many and varied complaints, or has symptoms
that have eluded diagnosis by other health care providers.
The symptoms of Lyme disease in children are subtle and can be easily
missed or confused with other illnesses. These children often present
with a history of such diagnoses as juvenile rheumatoid arthritis (JRA),
hypercholesterolemia, migraines, Crohns disease, gastritis, maturation
delay, attention deficit/hyperactivity disorder (ADHD) and learning
disabilities. The nurse should always be suspect of a previous
diagnosis of JRA, especially if the child has also been diagnosed with
ADHD and/or migraines.
The parent may report that the child is moody and unpredictable and
that he has frequent headaches and stomach aches. He will often
report to the school nurse not feeling well, and will bring home notes
for poor behavior. The child with tick-borne disease usually has a high
number of school absences. If a child is sick frequently and the parent
reports he comes down with everything that goes around, immune
suppression due to chronic infection should always be suspect.
The parent may also report that the child has had a sudden change of
behavior. The quiet child has become loud and aggressive, the active
child has become passive, the happy child has become weepy and sad,
the calm child has started throwing fits and tantrums. The nurse
should always take note when there is a change in the childs usual
behavior.
The parent should be asked if the child has ever had a tick
attachment, even if the popular belief is that the area does not have
ticks that carry disease! Lyme and tick-borne co-infections are found in
every state. If the child has ever had rashes of any kind, the parent
should be asked to describe these in detail.
The nurse should be sure to ask about the childs environment, habits
and activities. Questions may include: are there wooded areas near
the home, are there deer around, does the child play out in the grass,
does the family go camping, do they have pets, are tick checks
routinely done, has the family traveled to highly tick-endemic areas?
Often parents wont recall a tick bite, but if there is exposure potential,
there may have been a bite that went unnoticed because it was in the
hair or another part of the body that was difficult to see.
If environmental factors dont sound suspect for tick exposure,
inquiries should be made regarding the mothers health status. If the
mother says that she has been diagnosed with fibromyalgia or chronic
fatigue syndrome, or that shes had vague complaints of joint pain and
fatigue since before the child was born, a congenital Lyme case may
be a possibility.
Nurses are the parents and childs first contact in the doctors office.
They can form a strong relationship with the parent and bond with the
child. They are the childs advocate. Since nurses have acute
observation skills, they would do well to become vigilant to the red
flags of Lyme disease. They can then encourage the physician to take
note of relevant history and symptoms and to pursue the possibility of
tick-borne disease.