By Holly Ahern

There have been many studies on the pediatric manifestations of Lyme disease done over the past several years. They all show a clinical picture that differs from adults, particularly when it comes to symptoms involving the nervous system.

Children often have more severe neurological symptoms that may show up as a change in school performance – declining academic performance, behavioral changes, and gaps in attendance. Teachers, a school nurse, or the school psychologist may the first to notice that something is wrong.

For schools, counties, and states, an additional consideration not factored into the societal cost equation is that students with Lyme disease may need federally mandated accommodations or supportive individual education programs to achieve their academic goals.

Children with Lyme disease can be profoundly ill, become wheelchair bound, or be unable to leave their beds. All of these things pose a challenge to everyone involved in the education and support of children with Lyme.

A list of physical symptoms associated with Lyme disease is provided below. It’s important to note that Lyme disease is a complex disease that does not always present in the same way.

Physical Symptoms Associated with Lyme Disease:

• Flu-like illness with fever and chills
• Gastrointestinal manifestations – chronic gastritis and/or colitis
• Cardiac complications – irregular heart rhythm (tachycardia or fibrillation), heart block
• Ocular defects – optic neuritis, neuropathy, conjunctivitis, uveitis, keratitis, ocular pain, decreased vision or loss of vision
• Rheumatologic symptoms – arthritis, myalgias, arthralgias, other musculoskeletal pain

Common Neurological and Cognitive Symptoms in Children with Undiagnosed Lyme Disease:

The following list of neurological and cognitive symptoms observed in children with Lyme disease was compiled from several published studies (Hamlen, R.A, and Kliman, D.S. Lyme disease: Etiology, Neuropsychological Sequelae, and Educational Impact. Pediatric School Psychology Communique, Newspaper of the National Association of School Psychologists. February 2007.)

• Headaches and neck stiffness
• Neuropathy (nerve pain) in back, legs or hands
• Paresthesia (tingling sensation, often in legs and hands), facial paralysis (Bell’s palsy), unusual sensitivity to light or sound.
• Deficits with memory – short term, sequential, spatial, and tracking; slowness of word and name retrieval.
• Decreased reading comprehension and handwriting skills
• Impaired speech fluency, stuttering and slurred speech
• Inability to accurately perform previously mastered mathematical calculations
• Vision problems — difficulty in the classroom in seeing and following visually presented material, frequent blinking or tics, inability to coordinate eye movements, targeting difficulties, and distorted visual images
• Musculoskeletal (movement) and coordination impairment, balance problems (clumsiness or vertigo)
• Executive function impairment — inability to activate or sustain effort and attention or manage frustration; confusion, sluggishness in expressing thoughts
• Frequent errors in speaking, writing, spelling, or dyslexic-like behaviors (in letter and number reversals)
• Severe and chronic fatigue unrelieved by rest — falling asleep in class, missing class due to tiredness
• Emotional and uncharacteristic behavioral presentation — withdrawal from peers or shift to a lower functioning group, depersonalization (loss of a sense of physical existence), cessation of involvement in sports or other extra-curricular activities, inattentiveness, attention deficit behavior, obsessive-compulsiveness, depression, anxiety, panic, aggression, defiance, explosive outbursts, mood swings, irritability, hyperactivity, nightmares and sudden suicidal thoughts
• Inability to perform at grade level — inconsistency or sloppy school work, late assignments, declining grades, being overwhelmed by schoolwork, missed school, school phobia.

While Lyme disease can manifest as an acute illness with a defined beginning and end, it can also be a chronic and debilitating condition for reasons not yet well understood.

In New York, the black-legged tick is thought to be the sole vector for Lyme disease. There are three life stages of this tick, all requiring a blood meal. In the spring and early summer, the form most commonly encountered is called the “nymph.” Nymphs are very tiny and hard to catch in the act of biting.

Adult-stage ticks are active whenever the air temperature is above freezing. People are exposed to adult ticks pretty much year round, with the only real exceptions being during the very cold winter months and the very hot summer months.

Activity can vary on a daily basis, so cold day followed by a warmer one can bring the ticks out to bite. When they’re looking for food, they tend to climb up on tall grass stalks and brush and grab hold to anything that walks by. Once aboard, ticks scurry to places where they are less likely to be noticed – back of the neck or scalp, groin, or behind ears for example.

Between blood meals, ticks are usually on the ground, under leaves or other ground protection to prevent them from drying out. Therefore even the simple act of raking leaves can result in exposure to ticks.

School districts should be aware that playgrounds and other outdoor school spaces can harbor ticks, and that each tick bite carries with it the risk of acquiring a life-altering tick-borne disease.

School districts could play an active role in protecting their students and their communities from tick-borne diseases by implementing active tick-reduction programs for their sports fields and playgrounds. Tick removal kits should become standard equipment, and staff should be trained in the proper way to remove imbedded (feeding) ticks from skin.

Educational programs for students and staff incorporating instruction on tick identification and how to avoid tick bites are available from Cornell Cooperative Extension offices and the New York State Department of Health.

Holly Ahern is an associate professor of microbiology at SUNY Adirondack in Queensbury, NY, and serves on the Advisory Committee for the New York State Senate Task Force on Lyme and Tick-borne Disease.