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Strep Throat: What Do Parents Need to Know?

Show of hands. Who would like to have strep throat right now? 

Not one hand went up. Why? 

Because strep throat brings up thoughts of several days of absolute misery, and rightly so.

Unfortunately, strep throat is always out there, no matter the time of year. Although, it is more common in winter. During the peak of COVID, we didn’t see much strep throat. This was most likely because wearing masks prevented the spread. Since a majority of people have tossed their masks aside, strep throat is back with a vengeance.

While most everyone thinks of strep throat as fever and bad sore throat with huge tonsils covered with white patches, that only occurs in some kids.

Fun fact: Many kids with strep throat don’t even have a sore throat and may have a normal-looking throat with only mild redness.

Many kids with strep have a fever with a headache, nausea, vomiting, or only a stomach ache.

Most kids with strep throat will have swollen lymph nodes along the front of their neck and decreased appetite.

Some will have a distinctive sandpaper rash called a scarlatiniform rash. The combination of confirmed strep throat with fever and rash is called “scarlet fever.”

Some will have palatal petechiae, which looks like someone dotted the roof of their mouth with a red Sharpie marker.

Kids can get more than one infection at the same time (if you are a parent, you know this). At KidMed, we see kids with strep throat and cold virus infections all the time. This is why our providers will recommend testing for strep throat for kids with suspicious symptoms, even if the child does not complain of a sore throat.

The newest COVID-19 vaccines can be given at the same as other age-appropriate vaccines, including the yearly flu vaccine.

Most throat infections in kids and teens are due to viruses. But strep accounts for about 20-30% of all throat infections. Several other lesser-known bacteria account for the rest. Many illnesses are caused by “strep” bacteria, such as pneumonia and skin infections. Still, strep throat is caused by one particular strain of strep known as group A strep (streptococcus pyogenes). 

Why is this important? Because currently, group A strep is always sensitive to penicillin medications such as amoxicillin, meaning your child with strep throat will always get better with amoxicillin. This is regardless of the number of times they have been treated with amoxicillin for other infections already. The Centers for Disease Control (CDC)  Surveillance for Group A Strep Disease | CDC recently confirmed this information.

Is your child allergic to penicillin? Don’t worry. Other related cephalosporin antibiotics, such as cefdinir or cephalexin, can be used instead.

Most parents do not know that strep throat is actually…wait for it…self-limited. That means symptoms can resolve spontaneously over five days without antibiotic treatment.

For one, your child will usually feel better sooner (1-2 days) with antibiotic treatment, and they are not contagious to others as soon as 12 hours after the start of treatment. Some kids diagnosed with strep throat by mid-day can usually return to school the next day if they do not have a fever! Crazy, right?

The most important reason we treat strep throat is to prevent a condition known as rheumatic fever. This is a generally rare but potentially dangerous condition where a child’s immune system gets pushed into overdrive by the group A strep bacteria. It begins to attack the infection (this is good) but can also attack the heart valves, joints, skin, and brain (this is bad). Luckily, treating strep throat with antibiotics eliminates the risk.

Interestingly, because children under age two still have an immature immune system, there is virtually no risk of rheumatic fever in those kids. This is why we do not routinely test for strep throat in kids younger than two.

  1. The symptoms of strep throat vary greatly, and it is difficult to diagnose accurately without appropriate testing.
  2. Strep throat is not fun but is easily treatable and can even improve without antibiotics.
  3. Kids treated with antibiotics for strep throat will get better faster and will not get rheumatic fever.
  4. Kids treated with antibiotics for strep throat are not contagious to others after 12 hours of antibiotics.
  5. You can trust the providers at KidMed to make the right decision about whether or not your child needs to be tested for strep throat based on their symptoms and their age.

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