Strep throat in children

Your child’s throat has been hurting… really bad. If that’s not the only thing going on – maybe they also have a headache or upset tummy – you might start to wonder, “Could this be strep throat?”

There are several viral infections that share the exact same symptoms as strep throat so how can we tell when is a sore throat strep throat? What makes us feel better? What is the role of antibiotics?
 

What is strep throat?

Strep throat is a mild infection, but it can be very painful – especially when swallowing. Strep throat is like any other infection. A person needs to be exposed to the bacteria that cause strep throat. Strep is most common in school age children, and rare for children under 3. If someone is exposed to strep, it usually takes two to five days for them to become ill.

How can you tell if a child has strep throat?
Classic symptoms of strep throat include a very sore throat, headache, neck stiffness, stomachache or nausea, fever and swollen tender glands.

With an exam, more symptoms may be found, but most children with strep throats often have:

• Fever and look ill.
• Very red throats. Their throats may look “beefy red” or the like color of raw hamburger as a result of small broken blood vessels in the roof of their mouths.
• Bad smelling breath.
• Swollen lymph nodes (found around the jaw and various locations around the neck).

 

Ruling out strep

If a child only has one or two of the above symptoms, the likelihood they have strep drops quickly. In addition, uncommon symptoms of strep throat are a runny, stuffy nose and cough. Typically, if a child has a cough and a runny or stuffy nose with the common strep throat symptoms, they most likely do not have strep.
When in doubt, contact your child’s doctor for an exam. If left untreated, complications from strep can include rheumatic fever with heart disease or kidney disease (known as glomerulonephritis). Either of these illnesses can be devastating.

Diagnosing and treating strep

We routinely suggest having a rapid strep test or strep PCR done. Before testing; however, it’s important your child comes in for a physical exam to accurately diagnose if they have strep. Healthy children can actually grow the strep bacteria from their throats without showing any symptoms or feeling sick. This is also true for children who may have a virus with similar symptoms to strep, but they may not be clinically sick from the strep bacteria. If children are not clinically sick from strep, they don’t need to be treated with antibiotics to get rid of the bacteria. That’s why throats need to be looked at in order to determine if they need to be strep-tested.

When a rapid strep test comes back negative, it can miss a few cases of strep so we may suggest a backup strep PCR test. This may take a day or so to become positive.

If the rapid strep or strep PCR is positive, we will want to treat with antibiotics. Amoxicillin is the first line drug of choice. There is no known resistance to amoxicillin. If amoxicillin “fails,” it is usually due to a reinfection from an exposure to someone who has strep but was not treated.  Recurrent infection can also happen because the antibioticnot taken correctly or not taken for a long enough period of time. Strep that reoccurs after another exposure can usually still be treated with amoxicillin.

Normally, a child with strep throat will have symptoms for three to five days. Antibiotics do not necessarily treat the symptoms or shorten the course of strep throat. In order to reduce pain and help your child feel a little better, comfort measures can be taken while taking antibiotics in the middle of the night, or while you’re waiting to hear back from your child’s doctor.

Note: Children will need to be on an antibiotic for 12 hours before they will be allowed to return to daycare or school.
 

Comfort measures for strep throat

• Constantly offer liquids to stay hydrated.
• Water and Pedialyte® are great options.
• Sipping warm liquids like apple juice and chicken broth can help soothe the throat.
• For children who are old enough, offering them something to suck on can also help soothe the throat.
• Suckers and hard candy offer a good distraction and great way to relieve the pain.
• Cough drops are not necessary for kids.
• Children older than one year can also have throat soothing honey on a spoon.
• Humidifiers may help as well.
• Pain reducers
• For children under 6 months, we recommend only giving them acetaminophen to soothe their throat.
• We do not recommend giving children of any age aspirin, as it can cause Reye’s syndrome.

A strep test not only provides the most accurate diagnosis, but also documents the frequency of strep. When a patient has frequent strep throat, it can be treated by the removal of tonsils (tonsillectomy). Tonsillectomy is considered when children have had 7 episodes in the past year, more than 5 episodes per year in the past 2 years, or more than 3 episodes per year in the past 3 years Tonsillectomy does not prevent strep from occurring again, but should dramatically decrease the occurrence.