Is that sore throat Strep? How to know…

It’s spring time, which means it’s the season for Strep Throat! Not that strep has to be in season, but spring is the most common time for strep. I’ve gotten a call today from a parent asking me if I would call in an antibiotic because her daughter has a sore throat and stomach ache. This child may very well have strep throat, but of course, I said “No.” The only way to determine if a child has strep throat is to have them evaluated, and 99.9% of the time a throat culture is needed for confirmation. I’m grateful the mom was understanding and planned on going to an urgent care facility after I spoke to her.

Symptoms of strep are sore throat, fever, headache, stomach ache, nausea, vomiting, rash, muscle aches, and petechiae on the palate.

Petechiae on the palate is usually diagnostic of strep.

Does the child always have a fever- No. Does the child always have a sore throat – No. Some kids will have no symptoms, but have a rash that presents with little red spots that are raised and feel like sandpaper. This sandpaper like rash is one of the symptoms that will cause me to forgo the culture. When children have lots of petechiae on the palate, and an extremely red throat, and usually really swollen tonsils, I don’t feel the need for a throat culture. When the throat looks this bad, it is strep and hurts to do a culture. When the throat has swollen tonsils with white spots, this is frequently, but not always strep, and a culture is needed.

I’m going to ask a favor of you – please help us! Children do not like throat cultures, but it is very important to obtain for proper diagnosis. When the parent is helpful, the culture is much easier for the child. I have had children beg their mom or dad “Don’t make me do it!!” This is when it is important as a parent to show some strength and be firm. Yes, the throat culture is necessary, please back me up!! Most kids really dislike having a throat culture done. I can’t say that I blame them, but it is a necessary evil. I often say that you would think we could figure out a better way to diagnose strep with all of the technology that we have nowadays. But, the bacteria that causes strep throat is hanging out on those tonsils.

Joshua has had strep throat twice. The last time he threw up so much I would have assumed it was a stomach virus if we hadn’t done a throat culture. The poor kid threw up for almost 8 hours, how miserable when you already have a sore throat. The first time he had strep he also had pneumonia. The poor guy had a high fever, was achy all over and was absolutely miserable! He didn’t even want to move. When he gets sick with strep, he really gets sick!

If you are worried that your child may have strep throat, please have them evaluated. Please do not ask your medical provider to just call in an antibiotic. Do not give your child an antibiotic that you have left over from a previous illness. If I child is on an antibiotic the throat culture will be negative even if they had strep throat. Also, you shouldn’t have antibiotics left over from other illnesses. When antibiotics are prescribed, they are usually meant be be given until the medication is all gone to properly treat the infection.

So, if it’s not strep, what could it be? It could be a URI, it could be allergies, it could also be mononucleosis. How do you know the difference, it’s not always easy to differentiate. It is very common for most upper respiratory infections (URI or cold) to present with a fever and sore throat. How do we know it is a virus and not strep?? Proper assessment, evaluation and culture. How do you know if it’s mono? Mono is confirmed by a blood test. Most sore throats (including mono) will go away without any treatment.

Sometimes a child can have more that one illness at a time. I spoke to a mom today that was wondering why her daughter wasn’t getting better after being on an antibiotic for strep throat (confirmed by culture) after 4 days on an antibiotic. The child started feeling worse 2 days ago. At the same time, she started with coughing and congestion. It sounds like she has a URI now, on top of strep throat, how miserable!!

Strep throat can sometimes go away without treatment, but could cause complications if not treated appropriately. Some of the complications of strep throat could be quite serious, such as rheumatic fever, scarlet fever, and glomerulonephritis. This is why it is very important for proper diagnosis and treatment.

If your child has strep, 10 days of Amoxicillin is the best treatment. Strep throat is contagious for 24 hours after starting the antibiotic. Sometime it takes a few days for the sore throat to feel better. Treat your child with Tylenol or Motrin for fever and pain relief. You can find the links to Tyelnol and Motrin dosing in the sidebar on this page.

So, the next time your pride and joy has a sore throat, make an appointment with your doctor or nurse practitioner, and ask for a throat culture. Hopefully, I have helped you understand why we need to gag your child when we suspect strep.

As challenging as it can be, I hope you are enjoying the journey!

It’s just a “cold”…so now what??

We have all suffered with colds throughout our lifetime.  A cold or URI/upper respiratory infection can be miserable. URI symptoms are cough, congestion, runny nose (clear or yellowish), low-grade fevers (<102F), sore throat, decreased appetite, disturbed sleep and overall just miserable feeling.  If fevers accompany the cough and congestion, a day off to rest isn’t a bad idea no matter what your age. If there is no fever with the cold symptoms,  most people just continue on through their daily routine.

I know what you are thinking… Yes, children do get colds more frequently than adults!  Fortunately and unfortunately, childhood is a time of building  immunity; good in the long run, but growing pains along the way.  It is true that the more organisms you are exposed to, the stronger your immune system gets.

So, what can you do to make life a little less miserable for your child with a cold??

There are a few simple rules….

Rule #1 – HYDRATION, HYDRATION, HYDRATION!!!  Drink plenty of fluids.  Adding Pedialyte or Gatorade can help, this helps to replace any loss of electrolytes, salts, sugars, etc. from the cold and fever.  If you learn nothing else from my post, you will learn about how important it is to be hydrated!

Rule #2 – Blow your nose.  This is hard for young children, but can be accomplished with continued practice and effort. For babies, use saline drops and a bulb syringe to help with the nasal drainage.

Rule #3 – Increase your Vitamin C intake.  I recommend 500-1000mg to my young patients, 1000-1500mg to the adolescents.  Vitamin C is great for boosting the immune system into gear, helping it fight off the cold.  We like the chewable Vitamin C in my house, they taste like sweet-tarts, just a little more tart.  Josh ate 8 of them one day (500mg each x 8 = 4000mg), and then told me how good they were!  I told him that he really shouldn’t have that many, although Vitamin C is not toxic.  Crazy kid! (You will start seeing a pattern with this kid, he keeps us on our toes around here.)

Rule #4 – Use a cool-mist humidifier in your child’s room while they are sleeping.  Don’t forget to pull the door closed, leaving a few inches for ventilation. Keeping the child’s head elevated is helpful too. Infants should have their mattress elevated on an angle, a pillow should never be used under an infant to elevate his head.

Rule #5 – Get plenty of REST! Children and adults need to take time to rest and let their body fight off the cold.  Our bodies heal during sleep, sleep is so important to maintaining good health.  (I will address sleep soon.)

All of the above can help your child be more comfortable.  There are some other helpful hints that may or may not be useful for you.  Keep in mind, all children are different, and have similar but different needs.  Some children will be more clingy and want to be with you 24/7.

Some children just need you to hold and love them because they don’t feel good.  It makes them fell better to have your hugs and kisses.  There is nothing like the love of a parent to make you feel better!

Other helpful hints:

• Take Motrin (Ibuprofen) for comfort.  It can also be helpful with the swelling and inflammation in the upper respiratory tract.  Nasal congestion is not just a runny nose.  Most of the little noses I see are so swollen inside,  some of them hardly have any room to breath, and many are breathing through their mouth.   I’m sure this sounds familiar, most children will breath through their mouth when they have a cold, and this is exactly why!
• The latest research shows that giving a spoonful of honey is more helpful than a spoonful of cough medicine!  I advise my patients to use Honey for that daytime cough.  Honey tastes good, isn’t full of chemicals, and you cannot overdose on it!  I think it is great that we are getting back to natural vs. chemical!!
• Taking an antihistamine or decongestant is helpful for some people.  I frequently recommend Benadryl (Diphenhydramine) at bedtime. I think this helps the child get some sleep and also helps to dry up some of the congestion. I think Benadryl is too sedating to give more than 1-2x a day, and don’t recommend daytime dosing unless the child is home and can nap. For Drew Elizabeth I use Claritin (Loratadine) instead of Benadryl. I do this because she has mild allergies and takes Claritin on a daily basis anyway. Also, I can give her the Claritin in the morning and it doesn’t make her sleepy. Although, I did forget this morning; Sorry, sweetheart! :-/ DO NOT use 2 allergy medications at the same time! Some decongestants such as Dimetapp and Robitussin can be helpful, but usually do little more than treat the cough for a few hours. DO NOT give Dimetapp Cold and Allergy with another allergy medication.  Dimetapp makes a Cold and Cough and a Cold and Allergy. Please read labels carefully!!
• I think cough drops can be helpful too. I personally like Ricola.  No, I don’t get paid by Ricola. Do you hear the horn in the background, Riiicooolaaaa ! The natural herbs just seem to be helpful for the sore throat and cough that accompany most colds.  Please keep in mind any hard object like cough drops can be a choking hazard for young children.
• Another helpful tip that a friend reminded me of after I wrote the cough post, was sinus rinses.  Thanks, Ami Jo! If you have never tried it, don’t knock it.  Most people will say yuck, until they have tried it.  A sinus rinse is a great way to help with a cold or allergies. I have parents that report back to me and swear by them.  Sinus rinses can be really helpful for allergy sufferers.

Please visit your child’s pediatric provider if they have a high fever, are uncomfortable when laying down (can be a sign of an ear infection because the pressure increases when they lay down), aren’t drinking and eating, or exhibit any signs of breathing problems.  Colds should get worse for a few days (3-5), then start to gradually get better.

Well, that is enough information for now, this was supposed to be a short post! Oops.  Too many helpful tips, I guess.

Keep in mind, all children are different!!  Some need more intervention then others while they suffer through yet another cold along this journey we call Life. Hope this information is helpful for all of you Moms and Dads out there! (Yes, this one’s for you, Ryan!) Thanks for reading.

I hope you are taking time to enjoy the journey!