Strep Throat (Children)

What is strep throat?

Strep throat is a bacterial throat infection marked by swelling and extreme soreness of the back of the throat, or pharynx. It can hurt so much your child doesn't want to swallow. (The name "strep throat" is a shorthand term for the throat infection, which is caused by Group A streptococcus bacteria.) Other symptoms of strep are fever (often above 101 degrees), chills, decreased appetite, and swollen lymph glands in the neck. Children can also develop symptoms of stomach distress such as nausea and vomiting.

Only a small number of sore throats are strep infections in children: Viruses, not bacteria, cause most sore throats. A sore throat that comes with other cold symptoms like a runny nose, or which causes hoarseness or laryngitis, is probably not a streptococcal infection.

How will my doctor know if it's strep?

Your child's symptoms are important clues. If your pediatrician sees a very red throat with streaks of pus when the child "opens wide," the diagnosis is likely to be strep. To make certain, the doctor may use a cotton swab to collect a sample of cells from the back of the throat and do a rapid strep test, which can identify a case in a matter of minutes. Some doctors may also do a throat culture to send to a lab to see whether streptococci bacteria grow in it.

Why is strep throat considered so serious?

The main reason your doctor will want to diagnose whenever strep is suspected is that your child could develop rare but serious complications if it's not treated. Left alone, the streptococcal infection in the throat can grow into a pocket of pus called an abscess, which usually requires surgery. The streptococcal bacteria can also sensitize the body's immune system in such a way that it starts to attack its own organs. About 3 percent of people with untreated strep throat develop rheumatic fever, which affects the heart and joints, lasts for months, and can cause permanent damage to the heart valves. Rheumatic fever is still a common cause of heart trouble in young adults worldwide.

What are my child's treatment options?

If your child has strep, antibiotics will help the sore throat go away quickly and will prevent complications like rheumatic fever from developing. (Without antibiotics, the throat pain would eventually go away, but the child would risk serious complications.) That's why pediatricians recommend a full 10-day course of oral antibiotics even if your child is feeling better. Throat lozenges, gargling with warm salt water, popsicles and acetaminophen for fever should ease symptoms. You may also want to try vitamin C and Echinacea, but none of these home remedies provide the protection the antibiotics give.

Why don't doctors give antibiotics for all sore throats, just to be safe?

If antibiotics were prescribed for everyone with a sore throat, as much as two-thirds of patients would be spending money and risking side effects for a medicine that wouldn't help them. Scientists also think that overuse of antibiotics encourages the growth of bacteria that can resist them.

Is strep throat contagious?

Yes. Your child should stay home from school for 24 hours after starting antibiotics. Family members or classmates who develop a sore throat should tell their doctor they were exposed to strep; they'll probably start feeling sick two to seven days after exposure. Except during an epidemic, people without symptoms do not require treatment.

Further Resources

National Institute of Child Health & Human Development
http://www.nichd.nih.gov/default.htm

References

Robert H. Pantell M.D., James F. Fries M.D., Donald M. Vickery M.D., Taking Care of Your Child: A Parent's Illustrated Guide to Complete Medical Care. 8th Edition. Da Capo Lifelong Books.

American Academy of Pediatrics, Caring for Your Baby and Young Child: Birth to Age 5

Mayo Clinic. Strep Throat. http://www.mayoclinic.com/health/strep-throat/DS00260

American Academy of Pediatrics, HealthyChildren.org. When a Sore Throat Is a More Serious Infection. http://www.healthychildren.org/English/health-issues/conditions/ear-nose-throat/pages/When-a-Sore-Thoat-is-a-More-Serious-Infection.aspx