Here’s a startling fact: Lyme disease doesn’t take a break just because summer’s over. Even in the fall, ticks remain a threat, and young children playing in grassy or wooded areas are particularly at risk. But here’s where it gets controversial: despite updated guidelines, many clinicians still hesitate to prescribe doxycycline—a proven preventive measure—to kids under 8. Why? Let’s dive in.
The American Academy of Pediatrics (AAP) made waves in 2018 by updating its guidelines to allow doxycycline as a post-exposure prophylaxis (PEP) for Lyme disease in young children. This was a game-changer, as doxycycline was long considered off-limits for this age group. Wesley Kufel, PharmD, BCPS, BCIDP, FCCP, FIDSA, a clinical associate professor of Pharmacy Practice at Binghamton University, explains, ‘This update was significant because, for many tick-borne infections, there simply aren’t better alternatives.’ The AAP’s recommendation is backed by compelling data, including a New England Journal of Medicine study showing an 87% efficacy rate for doxycycline PEP in preventing Lyme disease.
Ticks are most active from March to mid-May and mid-August to November, but they can remain a threat any time temperatures are above freezing. Both adult ticks and nymphs can transmit Lyme disease, making year-round vigilance crucial. Yet, despite the AAP’s update, many healthcare providers remain unaware of this option, sticking to outdated recommendations. ‘As an infectious disease community, we need to do better at educating clinicians,’ Kufel emphasizes. ‘This treatment has been available for seven years, yet its use in children remains limited.’
And this is the part most people miss: the fear of using doxycycline in young children often stems from concerns about side effects, such as tooth discoloration or gastrointestinal issues. However, the AAP’s recommendation balances these risks against the severe consequences of untreated Lyme disease, especially in children. Kufel argues, ‘The benefits far outweigh the risks, particularly when you consider the lack of effective alternatives.’
So, why isn’t this treatment more widely adopted? One reason could be the lingering stigma against doxycycline in pediatric care. Another might be the reluctance to deviate from long-standing practices. Here’s a thought-provoking question: Are we prioritizing outdated fears over evidence-based solutions? Let’s open the floor for discussion—do you think doxycycline PEP should become the standard for young children at risk of Lyme disease? Share your thoughts in the comments.
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References:
1. Be Tick Free—A Guide for Preventing Lyme Disease. NY Department of Health. Accessed November 6, 2025. https://www.health.ny.gov/publications/2825
2. Zhou G, Xu X, Zhang Y, et al. Antibiotic prophylaxis for prevention against Lyme disease following tick bite: an updated systematic review and meta-analysis. BMC Infect Dis. 2021;21(1):1141. doi:10.1186/s12879-021-06837-7
