Q: What is the guidance regarding embedded tick removal for ECE providers?
A: It is recommended that removal of a tick from a child should be completed by the parent/guardian or medical professional as soon as possible. According to Dr. Brittany Massare, ECELS Advisor and Pediatrician, “The more time a tick is attached to a child increases the risk of Lyme disease transmission. In general, the CDC says it takes at least 36-48 hours of the tick being attached before Lyme is spread to the person. If a parent did a thorough tick check before bed the night before and did not see a tick, this is reassuring. But because attached ticks can be missed even with thorough checks and the CDC can’t say for sure there is no transmission of Lyme until at least 36 hours of attachment, prompt removal of any tick is recommended.”
OCDEL Certification recommends that if a childcare provider finds an embedded tick, they should immediately contact the child’s parent or guardian so that next steps can be determined quickly. This is consistent with regulation 132(a). While it is not recommended for a provider to remove an embedded tick, there is no regulation that states that they cannot do so. With that being said, it is advised that a provider not remove a tick unless there is written authorization by the parent and the provider has received the appropriate health and safety training to do so. Following proper technique for tick removal can be challenging; even with proper technique, heads can stay attached and need to be dug out, which can be difficult.
Tick Removal and Prevention:
- The Centers for Disease Control and Prevention (cdc.gov/ticks) provides information on prevention, removal and symptoms of tickborne diseases. Helpful resources include:
- Caring for our Children (CFOC) standard 188.8.131.52 https://nrckids.org/CFOC/Database/184.108.40.206 includes information on protection from ticks and how to remove a tick.
- Pediatric First Aid for Caregivers and Teachers (2nd ed.) First Aid Care for tick bites section states: “Don’t grab a tick by the rear of its body. The body might rupture. Then the infectious contents can enter the wound. If the ticks head breaks off in the skin, use tweezers as you would remove a splinter. Wash area with soap and rinse with Inform the parent or guardian that you have removed a tick from the child. Alert them to watch the bite area for appearance of a rash. If a rash appears, or the child becomes ill, the child needs medical care.”
- Managing Infectious Diseases in Child Care and Schools (5th ed.) includes a section on the roles of the teacher/caregiver and family, and states that a child does not need to be excluded from a group setting for a tick bite unless the child is ill with a tickborne illness and is unable to participate. Staff members determine whether they are able to care for the child without compromising their ability to care for the health and safety of the other children in the group.
For More information see Health Advisory - 571 - Lyme Disease and Other Tickborne Diseases in Pennsylvania
For questions, please call 1-877-PA-HEALTH (1-877-724-3258) or your local health department for more information.
Shared by ECELS, Healthy Child Care PA/PA Chapter, American Academy of Pediatrics 484/446-3003
Reviewed by Amy Requa: Senior Health Manager, The Pennsylvania Key 6/2021