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Rocky Mountain Spotted Fever (RMSF) in Children

What is Rocky Mountain spotted fever?

Rocky Mountain spotted fever (RMSF) is a bacterial infection spread by the bite of an infected tick. It usually occurs from April until September, but it can occur anytime during the year where weather is warm. The mid-Atlantic and southeastern states are most affected. The disease is spread to humans through a bite from an infected tick; it is not spread from one person to another.

In the U.S., the American dog tick, the Rocky Mountain wood tick, and the brown dog tick, have been identified as the ticks that transmit the RMSF bacteria.

What are the symptoms of Rocky Mountain spotted fever?

These are the most common symptoms of RMSF:

  • A nonitchy rash that usually starts around day 3 on the wrists and ankles, and spreading to the legs and trunk, then palms and soles

  • Fever

  • Headache

  • Decreased appetite

  • Chills

  • Sore throat

  • Stomachache

  • Nausea or vomiting

  • Diarrhea

  • Body aches

  • Sensitivity to light

  • Bleeding

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

The symptoms of RMSF may look like other conditions or medical problems. Always see your child's healthcare provider for a diagnosis.

How is RMSF diagnosed?

Your healthcare provider can diagnose Rocky Mountain spotted fever based on your symptoms and history of a tick bite. The appearance and characteristics of the rash are important, if your child gets one. Skin biopsy samples and lab tests are usually done to rule out other conditions and confirm the diagnosis.

What is the treatment for Rocky Mountain spotted fever?

Treatment may include antibiotics and treating the symptoms. Doxycycline is the antibiotic of choice, and it will be continued for several days after the fever goes away. Doxycycline is in the tetracycline drug family, and these drugs are usually not given to children under the age of 8 because of the risk of staining the permanent teeth. However, in the case of suspected RMSF, it is more important to treat the illness. 

How can Rocky Mountain spotted fever be prevented?

Once a child has RMSF, he or she cannot be reinfected. Some general guidelines for preventing RMSF include the following:

  • Since ticks cannot bite through clothing; dress your child and family in:

    • Light-colored clothing so that ticks can be easily seen 

    • Long-sleeved shirts tucked into pants

    • Socks and closed-toe shoes

    • Long pants with legs tucked into socks

  • Check your family often for ticks, including:

    • All parts of the body that bend: behind the knees, between fingers and toes, underarms, and groin

    • Other areas where ticks are commonly found: belly button, in and behind the ears, neck, hairline, and top of the head

    • Areas of pressure points, including:

      • Where underwear elastic touches the skin

      • Where bands from pants or skirts touch the skin

      • Anywhere else where clothing presses on the skin

  • All other areas of the body and hair, and run fingers gently over skin. Run a fine-toothed comb through your child's hair to check for ticks.

  • Other helpful measures include:

    • When possible, walk on cleared paths and pavement through wooded areas and fields.

    • Shower after all 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 insect repellents safely:

      • Products that contain DEET are tick repellents, but may not kill the tick and are not 100% effective. Use a children's insect repellent (20% to 30% DEET). The current recommendations from the American Academy of Pediatrics and the CDC for children older than 2 months of age are to use 10% to 30% DEET. Products that contain DEET should not be used on infants less than 2 months of age. Do not apply insect repellants around your child's mouth, nose, or eyes, or over cuts or open sores. 

      • Treat clothing with small amounts of a product that contains permethrin, which is known to kill ticks on contact. Do not use permethrin on the skin.

    • Check pets for ticks and treat as needed.

Medical Reviewers:

  • Freeborn, Donna, PhD, CNM, FNP
  • Lentnek, Arnold, MD