Does my child have strep throat?

In my pediatric office, I see a patient for possible strep throat nearly every day.

Strep throat is a common infection in school-age kids that can be easily diagnosed and treated. Despite the frequent office visits for throat infections, however, many misconceptions about strep throat remain. And it’s time to set the record straight.

Here’s what every parent needs to know about this often misunderstood ailment:

Most sore throats are not strep throat. Every time a school-age kid has a sore throat, there’s about a 30 percent chance it’s caused by treatable streptococcus bacteria. The majority of sore throats are caused by viral infections and are associated with a runny nose, cough, watery eyes or fever. Viral sore throats last one to two days and go away on their own without any treatment.

[See: 11 Ways to Recover From a Sore Throat.]

A strep throat infection has a characteristic group of symptoms. Classic strep infection can cause tonsillar swelling with white pus pockets, changes to the appearance of the roof of the mouth and tongue, swollen lymph nodes of the neck and fever. Occasionally, strep presents as something called scarlet fever or “strep rash.” This rash is caused by the byproducts of the bacteria and is a physical manifestation of the infection, but it isn’t more or less dangerous than strep without a rash.

You can’t diagnose strep throat with a physical exam alone. Strep throat should only be diagnosed after accurately confirming the presence of strep bacteria. This is done using a simple, in-office test requiring a throat swab.

Be very wary of telehealth services that claim a photo or video conference is adequate for the diagnosis and treatment of strep throat. Although this may seem a convenient or cheap option for care, not confirming the diagnosis with a strep test dramatically increases your child’s risk of getting unnecessary antibiotics and associated complications; and it also makes subsequent testing and follow-up with your pediatrician very difficult. If your child is not improving, for example, additional evaluation may include lab work or imaging. These tests can be avoided with a proper initial diagnosis.

When you go to the doctor for a sore throat, don’t expect — or demand — a strep test. There are criteria we use to determine the best candidates for accurate testing. Talking with your child’s doctor to determine if a test is needed is the best way to do this. We need to work together to decrease unnecessary and unsafe antibiotic use, and discussing all of your child’s symptoms with the doctor before swabbing for strep is the best practice.

A positive rapid strep test does not necessarily mean antibiotics. Here’s where things get tricky. For kids with active strep symptoms that are characteristic of bacterial infection, a positive test means treatment.

If a child has symptoms of a cold or viral illness (a runny nose, cough, mouth ulcers), however, the strep test is likely a false positive. In this case, antibiotics are not needed. What makes this even harder is that up to 25 percent of school-age kids can be positive for strep without being actively infected. These kids are called “strep carriers.” This is why it takes a keen physician-parent team to determine the best course of treatment, using the strep test results in combination with a thorough history and physical exam.

Strep treatment is about more than making kids comfortable. Treating strep can decrease discomfort, but the medical reason we treat strep is more critical. Untreated strep can cause rare but serious complications that can affect the heart or kidneys. Specifically, rheumatic fever and acute glomerulonephritis can occur if strep bacteria attack the cells of these critical organs. So, the reason we offer antibiotics for strep throat is to avoid these complications. Treatment also decreases the transmission of the bacteria to others.

[See: 10 Concerns Parents Have About Their Kids’ Health.]

Kids under 3 years don’t need to be tested. I see a few parents every year that bring in their toddlers because strep is “going around.” Although that may be true, it still does not mean that your toddler (or other kids in this age group your child comes in contact with) needs to be tested or treated. The risk of severe complications due to untreated strep in this age group is incredibly small, and a toddler’s body can fight strep without antibiotics.

Strep throat is not an emergency. Since we are treating strep throat to prevent complications and not for comfort, there is rarely a need to seek emergency care for a sore throat. Antibiotic treatment can start many days after the onset of symptoms and still be protective against heart and kidney problems. If your child complains of a sore throat, offer pain medication like acetaminophen or ibuprofen and fluids until you’re able to get into your pediatrician’s office.

Home strep kits aren’t recommended. It’s no secret that strep kits are commercially available. Although purchasing a strep kit for the home may seem like a good idea, the kits are not recommended because of high false-positive rates. Most physicians will still require an additional positive test in the office with a properly collected throat culture for backup before prescribing any antibiotics.

Strep is not as contagious as you think. Strep bacteria are spread through large respiratory droplets, like spit and snot. Strep throat can pass in areas of close contact — dorms, schools, day care centers, contact sports — but is significantly decreased with routine hygiene precautions. Most kids will begin to be symptomatic about two to five days after getting infected, and infected individuals are most contagious at the height of symptomatic illness. The good news is that strep is not spread by household pets, so Fido is safe.

Strep throat can be recurrent. Back-to-back strep throat infections can be a frustration for families. These “bounce back” infections are thought to happen for a few reasons.

Strep could recur after incomplete treatment, so always make sure your child takes the full course of antibiotic prescribed. Strep bacteria can get into pockets or folds of the tonsils, decreasing the antibiotic’s effectiveness and requiring an additional course. Studies have also shown that multiple strains of strep can be infecting kids within the same classroom. So, if your child happens to catch a different strain, he or she could get infected and need treatment again. That’s just bad luck.

It’s OK to go to school the next day. The most current treatment guidelines state that after being on antibiotics for 12 hours, your child may return to school. If your child still has a fever and isn’t eating well, however, it may be smart to have them rest for one more day before their return. Commonsense rules apply.

[See: The 5 Latest Poison Control Threats Kids Face.]

Bottom line: During the winter months, kids get sore throats. Most of these sore throats are caused by a viral illness that will resolve on its own. If you’re worried that your child may have strep throat, talk to your doctor about your child’s symptoms and ask if a test is a good idea. That way, your child will get the best care to prevent potential complications while avoiding unnecessary treatments.

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