The winter months are a time of sharing germs in the classroom and at home and the season of sore throats and runny noses. How can a parent tell if they need to bring their child to the pediatrician for a sore throat. Here are some of the basic facts you will need to know…

What causes a sore throat ?
There are a variety of causes. Most are caused by viral or bacterial infections that invade the throat and cause redness and swelling of the tonsils and surrounding tissue, causing pain. A sore throat can also be caused by allergies with an associated post-nasal drip that irritates the throat. A bacterial sinus infection also can cause similar problems, as infected mucous drips into the throat. Other potential causes include irritation from cigarette smoke or dry air in a home.

What is “strep” throat?
Although most sore throats are viral and not caused by bacteria, strep throat is the exception. It is caused by the streptococcus bacteria and is the most common bacterial infection of this area. It requires treatment with antibiotics.

How can I tell if my child has strep throat or just a cold?
The signs and symptoms of strep throat infection are a painful throat, usually accompanied by fever and swollen, enlarged tonsils and lymph nodes that you often can feel on the side of the child’s neck. Other symptoms can include headache, abdominal pain, vomiting, pain in the back of the neck, joint pain, muscle pain or a fine red rash. Other rashes that strep can cause are hives and a very red swelling of the groin area.

Why does the doctor do a throat culture?
The strep test or throat culture is needed because even to the best examiner, many illnesses can look similar to strep throat. Many viruses-especially mononucleosis or adenovirus-can produce a red throat with swollen tonsils covered with a white coat of infected pus. Many more viruses can produce a red throat and fever. Not all of these illnesses require treatment with antibiotics, and in fact antibiotics may make things worse.

My children hate strep tests. Isn’t there an easier way?
The only way to test for strep is to obtain a swab of the secretions on the tonsils. The only way doctors can do that at present is to use a long Q-tip to obtain the material. Even with the best technique it can still cause your child to gag or even vomit after the procedure. Your support during the procedure can really help a child tolerate the swab.

What’s the difference between the short and long strep tests?
The quick strep or rapid strep test is a screening test. Using a reaction between the antigens taken from the throat swab and the antibodies for strep in the kit, we can find a positive strep infection 85% of the time. However, this method is not fool proof and should always be backed up by an overnight culture of the throat swab material.

How do I know if I need to bring my child in for a throat culture?
If your child has a sore throat with a fever and any of the symptoms listed above, she or he should be tested for strep. If your child has a cold, cough, laryngitis or hoarse voice, it is less likely that he or she has strep. However, if your child continues to complain for more than 3-4 days about the throat please call your doctor to discuss whether or not your child needs to be seen.

If it’s so obvious, why do we have to bring our children in for a strep test?
The strep test or throat culture is needed because even to the best examiner, many illnesses can look similar to strep throat. Many viruses-especially mononucleosis or adenovirus-can produce a red throat with swollen tonsils covered with a white coat of infected pus. Many more viruses can produce a red throat and fever. Not all of these illnesses require treatment with antibiotics, and in fact antibiotics may make things worse.

I have heard that babies can’t get strep. Is this true?
For unexplained reasons, babies and young toddlers rarely get strep. No one is exactly sure why this is so, however, there may be age differences in our immune systems. It is not impossible for infants to get strep infections, however, and your doctor may test for it, especially if there is a close family member with a strep infection or an outbreak in a day care center.

If my one child has strep, why not treat all my children?
It is not thought to be a good idea to treat asymptomatic children for strep. For one thing it may be unnecessary use of antibiotics, as not all children exposed will get the strep infection.

Why does my child get repeated strep infections?
The strep bacteria remain sensitive to most penicillin or erythromycin antibiotics. True resistance is rare. If treatment failures occur, it may not be that the antibiotics aren’t working, but rather because, after a strep infection is treated, the enlargement of the tonsils continues for some time. These enlarged tonsils are like “catcher’s mitts” for whenever the next child in class coughs the strep bacteria nearby. Some researchers also believe that other bacteria that live in our throats may act to decrease the strength of the antibiotic. If your child is having repeated strep infections, your pediatrician will discuss the treatment options with you.

What can I do to make my child feel better?
Regardless of the cause of the sore throat, the pain can be treated with acetaminophen (Tylenol) or ibuprofen (Motrin or Advil). Depending on the age of the child, lozenges or ice pops can also be helpful to ease the pain. Providing a humidifier or cool mist vaporizer in your child’s bedroom is also helpful in reducing the dry air which can aggravate any sore throat. If the doctor prescribes antibiotics, follow the directions completely. It’s important to treat strep infections for a full ten days to prevent rheumatic fever, a rare complication of strep infections.