by Dr. Heather Larson, MD, FAAP
Strep throat is a contagious bacterial infection that affects the throat and tonsils. Caused by group A streptococcus, the infection is most likely to cause a sore throat and extreme discomfort while swallowing, often accompanied by fever. Children between the ages of 5 and 15 are at the highest risk of succumbing to a strep throat infection, most often during the late fall through early spring.
PANW’s Answers to Patients’ FAQs About Strep Throat
Access to accurate information about strep throat – its symptoms, cure, and how to stop the spread of infection – is important to ensure children are accurately diagnosed and treated. Because strep throat symptoms mimic other common colds and flus, and it can progress rapidly, we like to keep our parent community informed.
Always feel free to reach out via your Patient Portal to connect with your PANW pediatrician whenever you suspect your child might have strep or any illness requiring treatment.
1) What symptoms would make me suspect my child has strep throat?
Strep throat is known for its rapid onset. One minute, your child might be fine, the next, they complain about a sore throat or may even wince, whine, or cry when swallowing. They may even begin refusing food and drinks because swallowing is so painful. A fever and a drop in energy levels may accompany their sore throat.
Additional signs of strep throat include:
- A red or inflamed throat/tonsils.
- White patches on the throat/tonsils.
- Their tongue may become slightly swollen and bumpy, making it look like a strawberry.
- Swollen lymph nodes in the neck.
- Headache.
- Abdominal pain or nausea.
However, unlike other common colds and flus, strep throat doesn’t cause sinus congestion or a cough.
2) If my child has white patches on their tonsils/throat, does that mean they have strep throat?
Not necessarily, often white and silver patches are due to a viral illness. Only 30% of sore throats in children are due to strep. However, if they have white patches and are 3 years old or older, we’ll probably advise you to come in for an accurate diagnosis.
Children 2 years old and younger are less likely to experience more serious complications of strep throat. For this reason, we may not recommend testing or treatment. Based on your baby or toddler’s symptoms and other household factors (like whether other susceptible children are in the home), your pediatrician will discuss if a strep test makes sense or not.
Getting an Accurate diagnosis
To obtain an accurate strep diagnosis, we perform something called a “PCR strep test.” Using a sterile applicator that looks like a long Q-tip, we swab your child’s throat and tonsils. The results of this test take about 20 minutes. If it’s positive, we prescribe antibiotics. We no longer have to send the test to the lab to confirm it’s group A strep since the PCR is a much more accurate test.
3. Can my child have strep throat even if I don’t see any white patches on their tonsils?
The problem with strep is that it can vary in how it shows up in the body, which is why a quick check in with a pediatrician makes sense, especially if you’re aware of strep throat outbreaks in your child’s daycare, school, or extracurricular teams or groups.
Even without the white patches, the throat can appear red and swollen. And, as mentioned above, their tongue can look like the outside of a strawberry.
4. What is the best course of treatment for a child with strep throat?
A positive result for strep throat always requires an antibiotic prescription, as complications from strep throat can range from mild to very severe. In most cases, amoxicillin or penicillin for 10 days is the first line of treatment for children and adults if there is no allergy.
As with any time a child is prescribed an antibiotic, it is very important to complete the full course, even after they feel better. If your child is allergic to amoxicillin or penicillin, other antibiotic options are available.
5. If I know my child has strep, why do I have to come in for a culture or strep test first before getting a prescription? Wouldn’t it be easier to just send the Rx to the pharmacy for us?
Great question. Parents can become very good at determining when a child has strep throat based on prior experience. However, many things can mimic strep, and it can present with different symptoms and appear different in different people (even between siblings).
Only 30% of sore throats are due to strep. All others are viral, and antibiotics will only cause unwanted side effects (upset tummies, rashes, potential allergic reactions). In addition, using antibiotics for viruses reduces their effectiveness because bacteria start to become resistant to the medications.
6. What’s the best thing to do to keep the infection from spreading to our other kids or to us?
Strep throat is highly contagious. It’s spread in a variety of ways, including inhaling infected respiratory droplets or direct contact with an infected person’s saliva or nasal fluids. Also, group A strep bacteria can last on surfaces for hours or multiple days. Therefore, stopping the spread requires the same diligent protocols we recommend to prevent the spread of common colds and flus:
- Wash your hands frequently.
- Don’t share food or drinks.
- Clean the bathroom well a couple of days after starting the antibiotics.
- Have the sick individual replace their toothbrush after being on the medication for three days.
It’s also a good idea to let their school know that your child has strep so they can take proper precautions in the classroom.
7. I’ve heard that antibiotics are overprescribed. Shouldn’t my child be able to get over strep without antibiotics if they have a healthy immune system?
Yes, people can and do clear strep without medication. However, the problem with strep throat is the potential for post-infectious complications. Group A strep can trigger a post-infectious autoimmune response that can affect the heart and kidneys, making it more serious than other throat infections.
If your child develops those complications, they can cause irreversible organ damage and can even be fatal.
8. Are there risk factors that might make my child more prone to getting strep?
Not necessarily. Being a child aged 5-15 puts them at risk. Also, strep is most commonly spread through coughing and sneezing. Therefore, people are most likely to spread it to those with whom they are in close contact. In your child’s case, daycare and classroom environments make them more likely candidates to catch it.
Of course, healthy lifestyle habits boost immune system responses, which can help. However, even those with healthy immune systems can still contract strep throat.
9. Do they still remove people’s tonsils if they get repeated strep infections? If so, how would I know if my child should have their tonsils out or not?
Yes, removing tonsils (tonsillectomy) is still a common, long-term preventative treatment for children who have repeated cases of strep throat.
Any child or adult with 7 or more cases of strep throat in a single year should consider getting their tonsils out. If you are a patient at PANW, your pediatrician would bring this up during your sixth appointment in a year to begin exploring whether a tonsillectomy is worth it.
10. Is strep throat more serious for older children or adults?
Children are the most likely to catch strep throat, and those between the ages of 3 and 18 are the most at risk for developing the post-infectious complications (effects on the heart & kidneys) than adults.
11. What is scarlet fever? Does everyone who has strep throat get scarlet fever without antibiotics?
Scarlet fever is a sore throat with fever, a fine pink/red rash all over, and often a tongue that looks like a strawberry. It is treated just like strep. Not everyone with strep throat develops symptoms of scarlet fever.
12. I’ve heard there is something called asymptomatic strep throat. What is that, and is it infectious? How is asymptomatic strep treated?
Some people carry the bacteria that cause strep throat, even if they’re not sick or exhibiting any symptoms. This means every time they get a strep test, it comes up positive. As a result, they end up with more rounds of antibiotics than necessary. However, asymptomatic strep A carriers tend to be less contagious than those who are sick with the infection.
For most people who are asymptomatic, there is no need to take antibiotic courses to eradicate bacterial colonization, as colonization/carriers have not been shown to be at increased risk of developing rheumatic heart disease or kidney effects. Just as with anyone, healthy or ill, individuals who are strep carriers should wash their hands regularly, avoid putting their fingers in their mouths, and not share drinks or food.
PANW Tests & Treats Strep Throat 7 Days a Week
Does your child have symptoms of strep throat? Call our office for 24/7 nurse advice or schedule a same-day urgent care appointment (available every day, including holidays and weekends!).
And due to our new in-house pharmacy services, children who test positive for strep have immediate access to the most common antibiotic treatments. Quick, accurate diagnosis and treatment are the keys to getting kids with strep comfortable, healed, and back to their regularly scheduled activities.
