Lyme disease presents a new challenge to school nursing. It has an impact on children's physical health and the cognitive processing required for learning. School nurses are faced with caring for these children in the school setting. In order to provide that care, school nurses must become familiar with the pathophysiology of the disease and understand the body's immune response to the infection. They need to be cognizant of the environments known to have a high geographic distribution of Lyme disease. Assessment of the child's present living environment or travel history may indicate exposure to Lyme disease in a particular endemic area. Planning to meet the health needs of children with Lyme disease is not limited to the school setting. Opportunities await school nursing expertise in community education, medical treatment regimens, health insurance coverage, implementation of the Americans with Disabilities Act (504), and political action to bring public awareness to this potentially debilitating disease.