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Rocky Mountain Spotted Fever: Another Illness from Ticks

RMSF in child RMSF in child

Rocky Mountain spotted fever is a bacterial infection first discovered in the western mountains of the United States. That's how the disease got its name, but it occurs throughout the country--especially in mid-Atlantic and southern states.

Who is at risk?

The disease most often affects children and teens younger than 15 years old. Those who spend time outdoors or who have pets that may carry infected ticks, are at higher risk. Most cases of Rocky Mountain spotted fever happen between April and September, when ticks are most active, or whenever the weather is warm.

How does Rocky Mountain spotted fever spread?

Children usually get Rocky Mountain spotted fever from the bite of ticks that are infected with bacteria called Rickettsia rickettsii. Ticks that most commonly spread this bacteria include the American dog tick, Rocky Mountain wood tick and the brown dog tick.

Signs and symptoms:

Symptoms of Rocky Mountain spotted fever usually appear about 1 week after the tick bite, but it can range from 2 days to 2 weeks.

  • Flu-like symptoms. Children infected with RMSF first have symptoms common to many other infectious diseases, including flu-like symptoms such as fever, muscle pain, severe headaches, vomiting, nausea, and loss of appetite.

  • Rash. In addition, a rash usually develops, by the sixth day of the illness. This rash tends to appear first on a child's wrists and ankles, but within hours it can spread to the torso. It also may spread to the palms of the hands and soles of the feet. Often, it starts out as flat red splotches or pinpoint dots but may change and become bumpy or purplish.

  • Other symptoms. Other symptoms can include joint pain, stomach pain, and diarrhea. In severe cases, blood pressure can drop and cause the child to act confused. As the infection spreads, many organs, including the brain, can be affected.

When to call your pediatrician:

If your child has been exposed to ticks has been bitten by a tick and develops any of these symptoms, contact your pediatrician right away. The doctor will examine your child and run tests to confirm the diagnosis of Rocky Mountain spotted fever.

How is Rocky Mountain spotted fever treated?

If your pediatrician suspects your child has Rocky Mountain spotted fever, the doctor will prescribe antibiotic medicine right away. Treatment with this medication usually continues for 7 to 10 days or until the child's fever has been gone for at least 3 days. Be sure your child takes the medicine for the whole time prescribed to make sure the infection is fully treated.

What is the prognosis?

With early treatment, nearly all children recover completely. In rare cases, Rocky Mountain spotted fever can make a child very sick and even become life-threatening. If left untreated, there can be risk of damage to blood vessels, nerves, and organs such as the heart, lungs and kidneys. Other possible complications can include hearing or vision loss, and gangrene in the fingers and toes that in severe cases can lead to amputation.


  • Avoid contact. The best way to prevent Rocky Mountain spotted fever is to avoid direct contact with places ticks prefer, such as wooded and brushy areas with tall grass and leaf litter. Stay in cleared spaces and walk on sidewalks and near the center of trails. Have your child wear a long-sleeved shirt, pants, and hat, ideally in lighter colors that make ticks easier to spot. Avoid wearing sandals in tick-infested areas.

  • Repellents. Products containing Environmental Protection Agency-registered insect repellents can be used on skin, but look for family-friendly concentrations and always follow directions. DEET, in concentrations of no more than 30% for children, currently is considered the best defense against ticks. Other repellents that may be effective include picaridin, soy oil, and oil of lemon eucalyptus (although oil of lemon eucalyptus should not be used on children under age 3). Don't use any insect repellents on babies younger than 2 months old.

  • Wash up. Wash the insect repellent off with soap and water when your child comes inside. Taking a bath or shower can also help remove loose ticks, which can take 4 to 6 hours to firmly attach to skin.

  • Tick checks. Regularly inspect your child's clothes and body for ticks, including the scalp and hair. Don't forget to check your pets too. Ticks can be brought in to the house on a dog's fur. After coming indoors, check for ticks on your child's skin—they often hide behind the ears or along the hairline. If you think your child came in contact with ticks, check every day. If you were in an area known to have ticks, check twice a day until you are sure no ticks attached.

  • Removing ticks. If you find a tick on your child's skin, the sooner it comes off the less likely it will spread infection it may carry. But it's important to remove it carefully. See How to Remove a Tick for details and instructions.


Rocky Mountain spotted fever is relatively rare but can be serious if not treated early. Especially if you live in a tick-infested area, take steps to prevent it, know the symptoms and call your pediatrician promptly with any concerns.  

RMSF Can Be Deadly Infographic

Additional Information:

Last Updated
Section on Infectious Diseases (Copyright © 2018 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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