High fever? Chills? Cough? Body aches? Glassy, filmy, reddish eyes? Sore throat? Runny nose? If you have all or quite a few of these symptoms you might have "the flu." Flu, or "influenza" is a respiratory illness that makes people feel really sick. It is not to be confused with gastroenteritis (what many people call "stomach flu"), a completely different kind of infection. Flu shots help protect against influenza, but not against gastroenteritis.
Influenza is "going around" right now. We have seen quite a few cases in our office in the last two weeks. Children look miserable, listless, flushed, and weak. They cough, have high fevers, and complain of sore throats, body aches, and chills. The infection comes on pretty suddenly and hits hard. Most of the cases we have seen in the office have been in children who did not receive a flu vaccine. However, this week I have had two patients with confirmed influenza A who were vaccinated last fall. While this does not seem fair, it does happen sometimes.
The treatment for flu is almost always supportive care, which means making your child as comfortable as possible by controlling the fever and ensuring adequate fluid intake. In addition, monitoring for signs of bacterial complications of flu (such as an ear infection or pneumonia) is important. A high fever can persist for 5 to 7 days. Sometimes there is nausea and vomiting, although these are not the main symptoms of influenza.
Clear liquids, especially Pedialyte given 1 tsp at a time every ten minutes, are the best home treatment to prevent dehydration when a child is vomiting. Acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) will help keep a fever more manageable and a feverish child more comfortable. In my experience these medications often do not bring a high fever down to normal. Remember that the fever is not harmful to your child and is actually helping her body fight the infection. However, it makes the sick person feel awful and look terrible, so it is usually worth the effort to treat a fever.
In general it is safest to use one medication to control a fever--either acetaminophen OR ibuprofen. For a limited period of time (less than 24 hours) and a very high fever (over 103) I sometimes recommend alternating these two medications. However, too much medicine on an empty stomach CAN make things worse (nausea and vomiting, for example).
Cough and cold medications (especially decongestants such as pseudoephedrine or phenylephrine, as well as cough suppressants such as dextromethorphan) are NOT recommended for children under age six because research shows they do not work any better than placebo (fake medication), and because there have been a number of overdose cases due to the use of combination products (medicines with acetaminophen plus cough and cold products) in young children.
I sometimes recommend the night time use of the antihistamine diphenhydramine (Benadryl) alone for a smaller child with a bad runny nose and cough. Even this can cause problems such as irritability and wakefulness. At my own home I am likely to use home "remedies" to clear a congested nose and make sleep easier. These would include a steamy shower, saline nose drops, elevating the head of the bed a bit, and clear liquids to drink.
If your child looks really ill, and ibuprofen or acetaminophen do not "perk him up", then we should evaluate him in the office. Similarly if he is appearing dehydrated, (with a dry mouth, lack of tears, sunken eyes, absent or severely decreased urine output, cold hands and feet) then we should also evaluate in the office. If the high fever persists beyond 7 days, we need to see your child. And if you are very worried about your child, or there are concerning symptoms other than those I have described then you should call or bring your child in to be checked. Please remember that my blog is intended to be informational, and cannot take into account every individual situation, or replace the personal attention of your own doctor.
There are medications to treat influenza (not stomach "flu", remember?). In reality we use these only sometimes, as they carry their own risks of side effects, are not palatable (Tamiflu liquid tastes terrible), must be started very early in the illness, and are not extremely effective. Primarily we use medications like Tamiflu for children with underlying medical conditions (at risk for severe complications of flu) to either treat flu in the early stages or prevent flu in cases of household exposure. Hopefully all of these children with severe underlying illness have already been vaccinated for flu!
How do you distinguish influenza from strep throat? Strep is the other illness that is "going around" right now. The classic symptoms of strep throat are sudden onset of fever, sore throat, headache, and stomachache, usually in the absence of cold symptoms such as cough or runny nose.
I have previously written blogs about both strep throat and flu, so you could check those out for more information. And remember, you are the expert when it comes to your child. This blog is here to be helpful in providing general information to you, it is not designed or intended to diagnose or make treatment recommendations for specific children, illnesses, or situations. That kind of individual attention can only come from your own personal pediatrician!
Showing posts with label strep throat. Show all posts
Showing posts with label strep throat. Show all posts
Saturday, March 12, 2011
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.
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.
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