Is that sore throat Strep? How to know…

It’s spring time, which means it’s the season for Strep Throat! Not that strep has to be in season, but spring is the most common time for strep. I’ve gotten a call today from a parent asking me if I would call in an antibiotic because her daughter has a sore throat and stomach ache. This child may very well have strep throat, but of course, I said “No.” The only way to determine if a child has strep throat is to have them evaluated, and 99.9% of the time a throat culture is needed for confirmation. I’m grateful the mom was understanding and planned on going to an urgent care facility after I spoke to her.

Symptoms of strep are sore throat, fever, headache, stomach ache, nausea, vomiting, rash, muscle aches, and petechiae on the palate.

Petechiae on the palate is usually diagnostic of strep.

Does the child always have a fever- No. Does the child always have a sore throat – No. Some kids will have no symptoms, but have a rash that presents with little red spots that are raised and feel like sandpaper. This sandpaper like rash is one of the symptoms that will cause me to forgo the culture. When children have lots of petechiae on the palate, and an extremely red throat, and usually really swollen tonsils, I don’t feel the need for a throat culture. When the throat looks this bad, it is strep and hurts to do a culture. When the throat has swollen tonsils with white spots, this is frequently, but not always strep, and a culture is needed.

I’m going to ask a favor of you – please help us! Children do not like throat cultures, but it is very important to obtain for proper diagnosis. When the parent is helpful, the culture is much easier for the child. I have had children beg their mom or dad “Don’t make me do it!!” This is when it is important as a parent to show some strength and be firm. Yes, the throat culture is necessary, please back me up!! Most kids really dislike having a throat culture done. I can’t say that I blame them, but it is a necessary evil. I often say that you would think we could figure out a better way to diagnose strep with all of the technology that we have nowadays. But, the bacteria that causes strep throat is hanging out on those tonsils.

Joshua has had strep throat twice. The last time he threw up so much I would have assumed it was a stomach virus if we hadn’t done a throat culture. The poor kid threw up for almost 8 hours, how miserable when you already have a sore throat. The first time he had strep he also had pneumonia. The poor guy had a high fever, was achy all over and was absolutely miserable! He didn’t even want to move. When he gets sick with strep, he really gets sick!

If you are worried that your child may have strep throat, please have them evaluated. Please do not ask your medical provider to just call in an antibiotic. Do not give your child an antibiotic that you have left over from a previous illness. If I child is on an antibiotic the throat culture will be negative even if they had strep throat. Also, you shouldn’t have antibiotics left over from other illnesses. When antibiotics are prescribed, they are usually meant be be given until the medication is all gone to properly treat the infection.

So, if it’s not strep, what could it be? It could be a URI, it could be allergies, it could also be mononucleosis. How do you know the difference, it’s not always easy to differentiate. It is very common for most upper respiratory infections (URI or cold) to present with a fever and sore throat. How do we know it is a virus and not strep?? Proper assessment, evaluation and culture. How do you know if it’s mono? Mono is confirmed by a blood test. Most sore throats (including mono) will go away without any treatment.

Sometimes a child can have more that one illness at a time. I spoke to a mom today that was wondering why her daughter wasn’t getting better after being on an antibiotic for strep throat (confirmed by culture) after 4 days on an antibiotic. The child started feeling worse 2 days ago. At the same time, she started with coughing and congestion. It sounds like she has a URI now, on top of strep throat, how miserable!!

(Update): This year, it seems like there are a good amount of kids testing positive for strep and the flu. That really is a double whammy! Miserable! Keep them as comfortable as you can, keep them hydrated, and have them rest as much as possible.

Strep throat can sometimes go away without treatment, but could cause complications if not treated appropriately. Some of the complications of strep throat could be quite serious, such as rheumatic fever, scarlet fever, and glomerulonephritis. This is why it is very important for proper diagnosis and treatment.

If your child has strep, 10 days of Amoxicillin is the best treatment. Traditionally speaking, strep throat is contagious for 24 hours after starting the antibiotic. More recent information states that it is contagious as long as the child has fever and/or a sore throat. Sometime it takes a few days for the sore throat to feel better. Treat your child with Tylenol or Motrin for fever and pain relief. You can find the links to Tyelnol and Motrin dosing in the sidebar on this page.

So, the next time your pride and joy has a sore throat, make an appointment with your doctor or nurse practitioner, and ask for a throat culture. Hopefully, I have helped you understand why we need to gag your child when we suspect strep. 😉

As challenging as it can be, I hope you are enjoying the journey! 🙂


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