Rocky Mountain Spotted Fever (RMSF) in Children

What is Rocky Mountain spotted fever in children?

Rocky Mountain spotted fever (RMSF) is a bacterial infection. It’s spread by the bite of an infected tick. It most often occurs from April until September. In warm areas, it can occur any time of year. It’s most common in mid-Atlantic and southeastern states. RMSF can be a serious illness and can lead to death if not treated.

What causes RMSF in a child?

The disease is spread to people through a bite from an infected tick. It’s not spread from one person to another. In the U.S., the bacteria are spread by these types of ticks:

• American dog ticks

• Rocky Mountain wood ticks

• Brown dog ticks

Which children are at risk for RMSF?

Children are more at risk for RMSF if they live in an area where ticks are active.

What are the symptoms of RMSF in a child?

Symptoms can be a bit different for each child. Common symptoms include:

• Fever

• Headache

• Decreased appetite

• Chills

• Sore throat

• Stomach pain

• Nausea and vomiting

• Diarrhea

• Body aches

• Sensitivity to light

• Bleeding

Around day 3 of the illness, a non-itchy rash may appear on the wrists and ankles. It may then spread to the legs and torso. It may also spread to the palms of the hands and soles of the feet.

Many of these symptoms may be caused by other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is RMSF diagnosed in a child?

The healthcare provider will ask about your child’s symptoms, health history, and any recent risk of a tick bite. Your child will also need a physical exam. The exam will include checking the rash. Your child may also have tests, such as skin biopsy samples and blood tests. These are done to confirm the diagnosis.

How is RMSF treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment may include antibiotic medicine. Doxycycline is the antibiotic used most often. Your child will need to take the medicine even after the fever goes away. Doxycycline is a medicine that can stain a child’s adult (permanent) teeth. But if RMSF is suspected, it's more important to treat the illness. Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all medicines.

Other treatments may include:

• Making sure your child gets lots of rest

• Giving your child plenty of fluids to stay hydrated

• Giving over-the-counter medicine for fever and discomfort

Don't give ibuprofen to a child younger than 6 months old, unless your child's healthcare provider tells you to. Don’t give aspirin (or medicine that contains aspirin) to a child or teen. It could cause a rare but serious condition called Reye syndrome.

What are possible complications of RMSF in a child?

RMSF is a serious illness that should be treated as soon as possible. Death may occur in untreated cases of RMSF.

How can I help prevent RMSF in my child?

Once a child has had RMSF, they can’t be infected again.

You can help prevent RMSF by protecting your child from tick bites.

Ticks can’t bite through clothing, so dress your child and family in:

• Long-sleeved shirts tucked into pants

• Socks and closed-toe shoes

• Long pants with legs tucked into socks

Choose light-colored clothing so that ticks can be easily seen. Check your child often for ticks, including:

• Behind the knees, between fingers and toes, in underarms, and the groin

• In the belly button

• In and behind the ears, neck, hairline, and top of the head

• Where underwear elastic touches the skin

• Where bands from pants or skirts touch the skin

• Anywhere else clothing presses on the skin

• All other areas of the body and hair

Run fingers gently over the skin. Run a fine-toothed comb through your child's hair to check for ticks.

Other helpful tips include:

• When possible, use cleared or paved paths when walking through wooded areas and fields.

• Shower after outdoor activities are over for the day. It may take up to 4 to 6 hours for ticks to attach firmly to skin. Showering may help remove any loose ticks.

Use repellents safely. Do not let children handle repellants. Follow all instructions on the product you use. Only use EPA registered products for children. Ask your child's healthcare provider if you have any questions. Common repellants used against ticks are:

• DEET. This is for skin. It may also be used on clothing. Products that contain DEET repel ticks. But they may not kill the tick and are not 100% effective. Use a children's repellent with the lowest amount of DEET and no more than 30% DEET. Products that contain DEET should not be used on babies less than 2 months old. Don't put repellent near your child's mouth, nose, or eyes. Don't put it on open cuts or sores. 

• Permethrin. This chemical is for clothing, tents, and other fabric. It is known to kill ticks on contact. Treat fabric with small amounts of a product that contains permethrin. Don't use permethrin on the skin.

Check your pets for ticks. Talk with your pet’s veterinarian about tick prevention medicine.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

• Symptoms that don’t get better, or get worse

• New symptoms

Key points about RMSF in children

• Rocky Mountain spotted fever (RMSF) is a bacterial infection. It’s spread by the bite of an infected tick. It’s not spread from one person to another.

• Common symptoms include fever, headache, sore throat, and stomach pain. Around day 3 of the illness, a non-itchy rash may appear on the wrists and ankles. It may then spread to the legs and torso. It may also spread to the palms of the hands and soles of the feet.

• Treatment may include antibiotic medicine. Doxycycline is the antibiotic used most often.

• RMSF is a serious illness that should be treated as soon as possible. Death may occur in untreated cases of RMSF.

• Once a child has had RMSF, they can’t be infected again.

• You can help prevent RMSF by protecting your child from tick bites.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.