As school starts in and kids spend more and more time inside in close groups we start thinking about school time illnesses.  One of the most common is strep.

Strep throat is a bacterial infection that causes some combination of fever, sore throat, white patches in the throat, stomach ache, throwing up, and rash.  Most people have a few of these, such as fever and sore throat, or throwing up and stomach ache. Fever isn’t an absolute-I’ve had many kids with strep without fever.  

It’s harder for little kids to communicate their symptoms, but you might notice a fever, decrease in eating or drinking, rubbing their stomach.  Some kids complain of “neck” or “tongue” pain, and point to the front of the neck, or the mouth. And finally, once in a while, I have kids come in complaining of ear pain, and while their ears are perfect, their throats are not.

Things like cough, runny nose, and red eyes are generally not seen in someone with strep.  However, especially in areas with bad allergies (where I am), someone can have these symptoms from allergies at the same time that they have strep.  

Kids catch strep from other kids who have it via cough, sneezing, or sharing their saliva-drinks, kissing, water fountains, etc.  It can take up to five days for strep to show up once someone has been infected. Adults are much less likely to ever get strep because most adults don’t spend a lot of time about children.    

If left untreated, strep can last around ten days.  Most of the time, however, strep is treated. Antibiotics for strep often make the sick kid feel better within a day so they can get back to school, and the parents can get back to work.  Honestly, though, that’s not the biggest reason we generally treat it – it’s because of the possibility of a rare complication called rheumatic fever.

Rheumatic fever, can cause damage to certain organs, especially the heart.  It is rare enough that most people need never worry about it, but happens enough that we try to make sure those with strep are treated with antibiotics.

 Scarlet fever is a somewhat common rash that scares some people because it is bright red, and covers a large portion of the child’s body.  Like many rashes, however, it just looks spectacular. It just comes from a version of the strep bacteria that causes the body to do this. Otherwise it is just like regular strep.

So what will happen when I bring my kid in for suspected strep?

*Ideally you child should be swabbed.  A study was done several years ago which proved that even ENTs and pediatricians cannot tell strep just by looking.  Yes, there can be gross white patches in their throat and it not be strep. Viruses can also do this. Also, tonsil debris can be mistaken for pus.  It takes a few extra minutes, and feels uncomfortable, but you want to be swabbed.

*If the initial test in the clinic comes back negative, there are a few different things that can happen.  First, many clinics will send a second swab for culture. This takes 48 hours, and can occasionally come back positive.  This is because the quick tests are always correct when they’re positive, but sometimes wrong when they’re negative. The second possibility is that no second swab is sent.  The accuracy of negative tests are getting much better, so some doctors think that is accurate enough.

*If the initial test comes back positive, then your child will be treated for strep.  There are many different antibiotic options – the most common involving some variation on penicillin.  Make sure if you choose a medicine to take by mouth, that you give every dose. I know it’s hard when they’re feeling better, but finish it all. They are usually fever free and ready to start school within 24 hours of starting antibiotics.  Also, have them change their toothbrushes the next day to keep from reinfecting themselves.

Bottom line: Strep is a common cause of illness in school aged children and those that are around them.  It is diagnosed with a swab, and treated with an antibiotic. Easy peasy.