Thursday, January 13, 2011

Strep throat?

How can you tell if your child has "strep throat?" I'll give you some things to look for, and some information for you to think about in determining when your child should be evaluated by a doctor.

As always, please keep in mind that I intend my blog, and this information, for general and informational use. It cannot, and is not intended to replace the attention of your own personal pediatrician. You should not try to diagnose your child or expect treatment based upon what I am writing in my blog! If your child is ill and you need more information or evaluation then you should contact your child's doctor.

Strep throat is a bacterial infection caused by a bacteria called Streptococcus pyogenes. It is contagious through respiratory secretions or saliva, has an incubation period of three to six days (that's how long it takes to get sick after being exposed to the germ), and is treated with antibiotics. After a person has taken antibiotics for 24 hours they are no longer consider contagious to others. A quick test can be done in a doctor's office to detect strep, or a culture can be done over several days in a laboratory.

The classic symptoms of strep throat are the sudden onset of a sore throat, headache, stomachache, and fever, without any symptoms of a cold such as a runny nose or cough. Sometimes there is a stuffy nose, but it is not usually runny. Some people do not have a fever with strep throat. The location of the throat pain tends to be more in the back of the mouth, not as much in the front of the neck. It hurts to swallow. Sometimes the voice sounds as if there is some swelling in the back of the throat--not like you are losing your voice or have laryngitis, but more of a sound of fullness there.

In strep throat the throat is often very red, with swollen tonsils. Sometimes there are red dots on the back of the palate, near the uvula. Sometimes there are whitish spots on the tonsils. "Glands" (actually lymph nodes) in the neck can be swollen and hurt to touch. If you are checking your child's throat and neck at home it is good to have some experience looking at your child when she is not ill. Healthy children have throats that are normally somewhat red, and many children who are not ill have tonsils that can look big, or lymph nodes that can be felt during an exam.

A sore throat that is pretty significantly associated with cold symptoms such as a runny nose or cough is less likely to be caused by strep. This kind of non-strep sore throat is often located in the front of the neck, lower in the neck, worse in the morning, and is improved after drinking fluids or being out of bed for a while. Coughing can make this kind of sore throat worse.

Infants and toddlers can get strep throat, and may not have classic symptoms. In younger children like these there can be prominent cold symptoms along with the fever. There is often a history of exposure to strep throat from an older sibling or in daycare.

In general I tell my patients' families they should have their child checked at the doctor's office during regular office hours if they think she has strep throat. Antibiotics for strep throat will help your child recover more quickly, and reduce how contagious your child will be to others. Rarely, an untreated strep infection can affect the heart or the kidneys. Antibiotics can help prevent these complications.

Strep throat is not usually an emergency. Treating the infection within seven days of the start of the symptoms is the goal in order to help prevent complications from strep. Confirming the diagnosis with a strep test before treating with antibiotics is best for your child. An evaluation in the doctor's office is the best way to ensure your child is treated properly, that he does not receive unnecessary antibiotics and risk the development of bacterial resistance to antibiotics, that the correct antibiotic at the right dose is chosen for your child, and that there is no other explanation for your child's symptoms that could be better treated in a different way.

Making an appointment for your child to be evaluated for strep throat within a day or two of the onset of symptoms usually "catches" the infection early enough to keep your child comfortable. If your child is very ill (repeated vomiting, appears very ill, is dehydrated, has a "stiff" neck, seems delirious, or has other symptoms that really worry you) then you should not wait to contact the office. It would be unlikely that an antibiotic would simply be "called in" for your child, more likely an evaluation in some type of health care setting will be recommended.

Another interesting tidbit about strep throat is that, even though it is a contagious illness, at least 75% of family members will not become ill from strep throat when someone at home has the condition. For that reason we do not automatically treat exposed family members with antibiotics.

Even if someone has all the symptoms sometimes they do not have strep throat. There is a virus called Adenovirus that can appear very much like strep throat. "Mono" (more correctly termed infectious mononucleosis) can look a lot like strep throat, too. "Mono" is caused by the Epstein Barr virus. You may remember that viruses like these cannot be cured with antibiotics. Instead your child's own immune system will fight off the germ and treatment will involve rest, fluids, and symptom relief--but not an antibiotic.

What does it mean to be a member of your family?

As we counted down to midnight on December 31st my girls got excited talking about New Year's resolutions. Remember those? Usually they are things like exercise, spending less money, going on a diet, saving, or not eating out as much. As the ball dropped on Times Square in New York I still couldn't think of a resolution that seemed very important to me. The result was that I have been thinking about it for the last two weeks.

I want to talk about family values, and I don't want it to be a cliche. I want to reflect on what helps our children figure out what is important, and what it means to be a member of their family. What can they fall back on when times are tough? What thought makes them stand up a little straighter as they walk through the halls at school? What is something they know is true, that can give them more insight into themselves and others?

What I mean when I say family values is probably a little different that the phrase used in the media. I am asking you to think about the principles by which you are raising your children. I want you to consider what kind of person you hope they will be as adults. What would you, or they, say if asked what it means to be a Smith, a Jones, a Roberts?

I really started thinking about this when talking to a friend who had to advocate for his daughter about a school/peer-related problem. When I asked him why he intervened, knowing that there was potential for things to backfire, his answer to me (probably paraphrased) was "What I want my daughter to know is that it means something to be a _________. We stick up for ourselves. We don't take things lying down."

That conversation has stayed with me. It made me think about what it means to be a member of my own family. What kinds of things do I say to my daughters when we are reflecting on the day, or looking forward to a new school year? What will be foremost in their minds when they are in a tricky situation, trying to make friends, watching how others interact with each other, taking a test, behaving in a classroom? If it was at all possible, what influence would I want my daughters to have on others?

One guiding principle that is important to me is that my daughters try to treat other people as they would like to be treated. Without getting all religious on you, I have to tell you that this is definitely based on the "extra" commandment given to us by Christ (Do to others as you would have them do to you, Luke 6:31, NIV) that is also known as the golden rule. My husband tries to help our girls respond to others (and each other) "in a loving way." None of us are perfect at this, but I know we all think about it and talk about it.

Instilling the sense of what it means to be a member of your family also includes the way you live your life each day. What fills your time? What takes priority? How do you spend money? Your children are living it, too. The way they grow up will become their "comfort zone."

I need to think about this part more for my own family. Are we (and I am speaking personally, of my own family, here) living daily (or at least weekly, monthly?) in a thoughtful way that is caring, will foster a healthy mind, body, and spirit, and will help our daughters become responsible, independent adults? I think I might have trouble sleeping now that I have put into words what a huge responsibility this is!

My resolution for 2011 is to think more carefully about what it means to be a member of my family. I want to better define what we stand for, what gives us reason to get up each day, and what will get us through when things don't happen as expected. I want to make sure that my daily life reflects these values, and make adjustments when I find discrepancies. I only have one chance to parent my children, and to live the way I want to be. I want to think about this.

And just to make you smile as you consider these thoughts: