Strep Throat: Easy Fix, Not Easily Suspected
Well, it finally happened. My kids had their first bout of strep throat. My girly daughter was thrilled with her “pink”-acillin, happy to take a plastic shot glass-sized amount twice a day. My younger son was stoked, thinking he would get the same pink goo. But he ended up with a liquid that he said tasted like “poison cherries,” tortured to take it three times a day. And it only went down hill from there: my older son ended up with amoxicillin capsules, the bitter contents of which we sprinkled in applesauce and he slurped down with nary a breath.
All humor aside, strep is scary. It can have some serious complications. And because viral infections are more common, strep is not always first on the parental radar when kids get sick. So “strep throat,” (also known as streptococcal pharyngitis) is not necessarily a straightforward run to the pediatrician. Many symptoms can be attributed to viral illnesses, so it can be easy to mistake strep for a cold or stomach “flu.” So when to suspect strep? Common symptoms (and what can distinguish strep from viral infections) include:
Sore throat that persists 48 hours or longer
Stomachache (with or without vomiting)**
Fever~101º F or higher
Tiredness
Rash (not generally seen with a common cold or stomach flu)
Swollen neck glands
Trouble swallowing anything…even saliva
[Note that runny nose, nasal congestion and diarrhea are not usually seen with strep.]
But even the sore throat component, considered a logical hallmark of strep infection, isn’t always clear cut. A friend once described having strep as “trying to swallow razor blades under water.” Recalling my own experience with this infection, I couldn’t agree with her more. However, whether it comes down to pain perception or stage in the infection, not everyone feels like they are drowning in a sea of sharp objects. I learned that lesson repeatedly when I examined patients and my sons reinforced it: neither of them complained of a nasty sore throat. In fact, after three days of insisting he didn’t have a sore throat (but feeling feverish and saying his tummy hurt), my husband and I finally made our son say “ahh.” And what we found was legendary: big, red tonsils with white patches…two signs he needed to go to the doctor.
Signs ( the clues to an illness that a medical professional finds on exam) of strep include:
Red, swollen tonsils, with or without white streaks and patches
Red dots on the palate (roof of the mouth)
Fever and swollen glands
As mentioned above, strep can have some serious complications: scarlet fever, rheumatic fever, and kidney infection and even kidney failure. Some red flags include:
Skin rash (scarlet fever or rheumatic fever)
A fever with painful, swollen joints and difficulty breathing, which can occur up to three weeks after strep infection and indicate rheumatic fever
Dark or “cola-“colored urine more than a week after strep infection, signaling inflammation of the kidneys
A parent I know had been told by a doctor, “We don’t need to treat strep.” as he wrote her daughter a prescription for amoxicillin, one of the common treatments. Why a physician would confuse the issue like this is beyond me because
strep throat MUST be treated, in each and every circumstance.
The reason is this: if left untreated a strep infection can lead to the much more serious diseases described above. Perhaps this doctor meant the throat infection itself doesn’t cause a problem. But still…DON’T BE CONFUSED. Strep is serious and must be treated. And the treatment is an easy, quick fix: Penicillin V (I’m told the liquid tastes like poisoned cherries) or Amoxicillin (the lovely “pink”acillin that well-meaning chemists tried to flavor like bubble gum.) And rest assured that if your child is allergic to the “cillin” family of antibiotics, there are alternatives that are just as effective. Then after 24 hours, or approximately a day’s worth of treatment, a patient is no longer considered contagious.
Strep throat can take a high degree of suspicion, given it shares many symptoms with the more common viral illnesses. Be aware of the infections circulating not just in your children’s school, but also in your community as this can prevent waiting “just one more day” to see how your child’s symptoms progress and your child potentially spreading strep or developing complications. As always, never hesitate to consult your pediatrician.
**[I was prepared to write that nausea without vomiting as a symptom of strep but further research said that throwing up can occur with younger children and perhaps older kids as well. My ten-year-old son got sick in science class…and when I brought him home he had a high fever and a reddened tonsils.]
Interested in more information? Click on this link to mayoclinic.org.
