Ticks are a big problem in Vermont. As a result of climate change, the so-called "tick line" has steadily moved north over the past few years to include the whole state. About half the state's deer ticks now carry Lyme disease, according to Lyndon State College biology professor Alan Geise. In 2013, Vermont had more Lyme disease cases per capita than any other state in the country. In the past few months, Vermont's tick activity has been at the top of the national charts, according to WebMD.

Dr. Lewis First, head of pediatrics at the University of Vermont Children's Hospital, recommends ways to keep ticks away and describes symptoms that may indicate the onset of Lyme disease.

Kids VT: How prevalent is Lyme disease in Vermont?

DR. LEWIS FIRST: In the past five years Lyme has spread pretty widely throughout Vermont. Every county in the state has reported a case. We've gone from maybe 200 cases per year five years ago to an expected 500 cases this year.

KVT: What's the best way to avoid Lyme?

LF: I recommend a three-step prevention strategy: Avoid the ticks, repel the ticks and remove the ticks if you find one of them. Who's not going to be in a wooded area this summer? When you are, stay in the middle of trails and be careful around shady, moist ground, tall grasses, brush, shrubs and low tree branches. Lawns and gardens at the edge of woods are rife with ticks. They also hang around stone walls because often that's where deer, mice and chipmunks deposit them.

Deer ticks (also known as blacklegged ticks), which carry Lyme disease, are so tiny — as small as a sesame seed or pencil point — that many times people don't even realize they've been bitten. Often doctors have to make a diagnosis based on a combination of patient's symptoms, medical history and where he or she has been.

KVT: Can certain clothing keep ticks at bay?

LF: It's a good idea to wear light-colored clothing so you can spot ticks. I know it's hot in the summer, but when kids are in the woods or grassy areas, they should wear pants tucked into their shoes or socks to prevent ticks from crawling up their legs. Kids should get into the shower within two hours of playing outside to wash any potential ticks off of them. Parents should check for ticks behind their children's ears, in the groin, behind their knees, along their waistband and in other skin folds where they may hide.

KVT: What's the best tick repellent?

LF: Use an insect repellent that contains no more than 30 percent of the chemical DEET. I wouldn't go higher than that due to its potential toxicity. Apply sparingly to exposed skin no more than every six hours. Avoid putting it on the hands of young kids who put their fingers in their mouths.

KVT: What if parents find a tick on their child?

LF: Get a pair of tweezers and pinch the tick around its head, where the tick latches to the skin, and pull steadily upward to disengage it. If part of the tick stays in, it will eventually come out on its own. Or take a cotton ball dipped in liquid soap and hold it against the tick for 30 seconds. The tick will stick to the cotton ball and pull off. If the tick is burrowed in, you can use a sterile needle to dislodge it. Do not use petroleum jelly to smother the tick, or a lit match to kill it. The tick will just burrow in farther or release more saliva, which contains the bacteria that causes Lyme. Once the tick is removed, swab the affected area with rubbing alcohol.

KVT: How likely are kids to get Lyme once they're bitten?

LF: The chance of getting bitten by a tick and then contracting Lyme disease ranges probably from 1 to 5 percent. That means kids have a 95 percent chance of being bitten by a deer tick and not getting Lyme disease. (The larger dog tick does not carry Lyme.) It takes the deer tick anywhere from 36 to 48 hours to inject the bacteria into the skin. By that point the tick has usually dislodged itself and fallen off the body, thus usually preventing the disease from occurring.

KVT: What symptoms should parents watch for?

LF: Lyme symptoms generally appear one to two weeks after a bite. The telltale symptom is the "bull's-eye" rash: redness in the center, then clearing, then another ring of redness spreading outward. The rash, which is typically flat and painless but may itch, goes away over a period of weeks. That — combined with muscle aches, a low-grade fever, headaches and swollen glands — points to Lyme. I recommend that pediatricians lean on the side of caution because Lyme, when caught early, is easily treated in children with a simple, low-risk antibiotic like amoxicillin for two to four weeks.

KVT: Does Lyme always cause a bull's-eye rash?

LF: You should find it 70 to 80 percent of the time, meaning in one out of every four or five cases, you won't. A blood test can result in a lot of false positives and false negatives — and it won't show up as positive unless you're four to eight weeks into the disease so it is not usually used to make the diagnosis. It is important to note that a bull's-eye rash could also be caused by fungal diseases, such as ringworm, and autoimmune diseases so the history and other symptoms can help your child's health care professional determine if Lyme disease is occurring in your child.

KVT: What if parents mistake Lyme symptoms for another illness and don't treat it right away?

LF: If you miss the early symptoms, four to eight weeks later, a child may develop a rapid heartbeat, dizziness, palpitations, paralysis of the face (Bell's palsy) and possibly more severe neurological symptoms. If it goes untreated for six months, you can get joint aches. Even then, though, you can still successfully treat Lyme disease in children with antibiotics.

Interview compiled and condensed by Ken Picard