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It’s November, and that means an increase in respiratory illness among school-age children. In addition to viral colds, another common childhood infection is strep throat.
There are many bacteria in the large strep family, but only one of them, Streptococcus pyogenes, also called Group A strep, causes strep throat. Like common colds, strep spreads from child to child through respiratory secretions, such as when one child coughs in another’s face. Crowded classrooms and other gatherings that bring children together encourage its spread. According to research, if exposed, your child has a 20 percent chance of developing strep.
Within a day or two of infection, strep causes redness, painful swallowing, and swelling of the tonsils and the lymph nodes ("glands") under the jaw and down the front of the neck. There is often whitish pus on the tonsils. Nearly all children have fever, and both headache and abdominal pain are common. Some varieties of strep cause a rash; when this occurs, it is called scarlet fever. Having a scarlet fever rash does not make the case more serious; doctors will treat these cases the same way as those without a rash.
You may recognize the symptoms of strep throat, but the only sure way to diagnose it is for your pediatrician to rub the back of the throat with a cotton swab and then test the material on the swab for Group A strep bacteria.
Most cases of strep throat go away on their own, but they still should be treated with antibiotics. Here’s why:
- First, most experts believe prompt treatment generally makes symptoms go away faster.
- Second, a child with an untreated strep throat remains infectious for many days; however, after 24 hours of antibiotic treatment, the child can return to school without risk.
- Third, antibiotic treatment prevents several possible complications of strep throat.
Potential complications
Untreated strep throat can spread to surrounding neck tissues or other parts of the body. The most serious complication is rheumatic fever, which is an inflammation of the heart and joints. Fortunately, this condition is now very rare in the United States. Antibiotics given even a week or more after the onset of a strep throat will still prevent rheumatic fever, so it’s always worth treating with antibiotics even if your child feels much better by the time the diagnosis is made.
Some children have repeated bouts of strep. Tonsillectomy (removing the tonsils) used to be the standard treatment for recurrent infections. This is still done occasionally, but antibiotics almost always eliminate recurrences. Each child’s case needs to be considered individually, but since tonsillectomy is not without risk and does not remove all the places in the throat where strep can hide, most experts recommend antibiotic therapy, even if this needs to be done multiple times. The standard antibiotic to treat strep throat is penicillin or one of its close cousins. For children who are allergic to penicillin, erythromycin is effective.
Strep throat is a common childhood illness with effective antibiotic treatments. If your child has been exposed to strep, a trip to the pediatrician is in order.
Christopher M. Johnson, MD, MA, is a pediatrician based in Santa Fe, New Mexico. For more information, visit his we site, www.chrisjohnsonmd.com.
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