Your child wakes up with a sore throat. You know that strep is going around at school. What do you do? How do you know if it's strep throat or just a cold?
As a parent, it is difficult to tell strep throat from the common cold. Both colds and strep can be associated with headaches, body aches, nasal congestion, post nasal discharge, sore throat and fever. In strep throat, the sore throat is often the dominating feature. Children often get headaches and stomach aches. Nausea, vomiting and diarrhea are less common. However, the key feature is how the throat appears on examination. Typically, in strep throat, the throat is not just red. There are often pearly white plaques on the tonsils. These plaques are colonies of the strep bacteria. There may also be a red rash on the soft palate, or a strawberry tongue. However, strep throat isn't the only infection that can cause white plaques on the tonsils or a rash inside the mouth. This is why the diagnosis of strep throat can only be confirmed by testing.
If your child has a severe sore throat, of if they have a sore throat that lasts 3 or more days, see your physician. He or she will order a strep test if strep throat is suspected. This is a rapid test that can be run in just a few minutes. (Though your doctor may not get the results for a couple of hours). If the rapid strep test is negative, a culture will be done. Antibiotics should not be started if the rapid test is negative. I know it is hard to be patient, but please wait for the culture results. Unnecessary antibiotics will not help your child, and can be harmful. If either the rapid test or the culture are positive for strep bacteria, antibiotics should be started. Penicillin and amoxicillin are the antibiotics of choice for strep bacteria (http://buff.ly/SqQK0G). Your child should not be placed on a different antibiotic unless they are allergic to penicillin and amoxicillin. This is incredibly important. If your doctor suggests a different antibiotic, ask why. Antibiotics should be started within 7 days of the onset of the sore throat, and the entire course of antibiotics should be taken as directed.
Strep throat will actually get better without antibiotics. However, the strep bacteria in your child's body can lead to other diseases if antibiotics are not given or are not completed. These diseases include rheumatic fever and Goodpasture disease. Rheumatic fever can lead to heart disease and arthritis. Goodpasture disease attacks the kidneys and the lungs. These disease are much more difficult to treat than strep throat.
Many parents have heard the term scarlet fever. This term used to be reserved for the rash associated with rheumatic fever. However, now it is used much more often to refer to scarlatina. Scarlatina is simply strep throat with a rash. It is a fine red rash with a sandpapery feeling to it. It often starts on the chest, abdomen or back and quickly spreads to the face and extremities. This rash usually lasts only a few days, but can persist for months. Sometimes it peels like a sunburn before going away.
Now, your child has been diagnosed with strep throat. Amoxicillin has been started. She still feels miserable. You can help her by making sure she drinks plenty of fluids and gets lots of rest. Honey can help alleviate the sore throat. There are many homeopathic remedies available for strep throat, but I wouldn't use them without also having your child on an appropriate antibiotic. She should stay home from school for at least 24 hours. The school doesn't want her back, exposing other children, until she has been on antibiotics for at least 24 hours. If she still has a fever of 100.4 or more, she needs to stay home for another day. Most children feel dramatically better in 2-3 days. Please make sure they complete all of the antibiotic. If she doesn't finish the antibiotic, she may not have adequate protection from rheumatic fever, Goodpasture disease or some of the other diseases associated with strep throat.
As always, if you have questions let us know or contact your primary care physician.
~Dr Nan N~