Strep throat is one of the most common complaints seen in the pediatric office. It is usually an illness that occurs during the winter months into early spring but, with school back in session, it is something we are seeing even now. The most common pathogen that causes strep throat in children and adolescents is the Group A Streptococcus (GAS) bacteria and accounts for about 30 percent of all cases of pharyngitis or sore throats. It is an illness with an abrupt onset, usually. This means that symptoms generally occur quickly. Your child may develop symptoms overnight or in just a few hours time.
Common symptoms of strep throat for children older than 3 and adolescents include fevers, headaches, abdominal discomfort with or without nausea, and vomiting that accompanies a sore throat. If you look in the back of the throat you might see that it’s very erythematous, or red, and enlarged tonsils that have exudate, or white patches, on them. It is also common to see little red, pinpoint spots on the roof of the mouth, these are called petechiae. Another common symptom of strep throat is a fine, lacey, slightly red or pink rash that develops. It is generally seen on the chest and abdomen but can also be on the back, arms and armpit areas, and even the groin. Symptoms in children younger than 3 are generally not that well defined meaning they may not present with a “typical” group of strep throat symptoms. They may have nasal congestion, low grade fevers, poor appetites and tender lymph nodes in the neck area. Strep throat is not common in younger children and infants, especially those younger than one year of age. However, if they show any concerning signs or have been exposed to strep throat they should be evaluated.
Complications of strep throat range from minor to severe. A common complication of the illness includes dehydration from vomiting or refusing to eat or drink due to the sore throat. A more serious and severe complication, especially if the illness goes untreated, includes rheumatic fever which can lead to joint issues and pain as well as heart valve damage due to inflammation. Additionally, there can be inflammation to the kidneys. The good news is that these are less common problems today because strep can easily be treated with antibiotics.
Most commonly your pediatrician will prescribe amoxicillin twice a day for 10 days. Cephalexin, a great choice for those with allergies to penicillin antibiotics, is also routinely used. Tylenol and ibuprofen are great for the discomfort and fevers associated with strep throat as well. I often suggest ibuprofen with my patients because it has some anti-inflammatory properties with may help the throat feel better during the course of illness. It is extremely important to keep up on fluids to prevent dehydration. Cool fluids may help to soothe the throat. It is always important to remember that during the acute phase of illness when the throat hurts the worst that it is OK if your child is not eating solid foods well. As long as they are drinking and keeping hydrated, solid food intake is not necessary even for a couple of days.
After 2-3 days of antibiotic treatment make sure you get your child a brand new toothbrush. This will help prevent them from giving strep back to themselves. It is important to not share drinks or food as well. Finally, make sure you are practicing good hand hygiene. Good hand washing is one of the best ways to prevent getting and spreading any illness.
If you suspect your child has been exposed to or has strep throat it is important to keep them out of school and have them evaluated by their pediatrician. This will hopefully prevent the spread of illness to other children at school and protect your child from those more severe complications of untreated strep infections.