Mom Sara Hartley, of Canton, Connecticut, was understandably freaked out when her 3-year-old daughter Tess had a 105-degree fever. It was nighttime and earlier that morning, Tess had been diagnosed with strep throat, an infection of the throat and tonsils caused by bacteria called A Streptococcus (group A strep), and she had started antibiotics. But what was this super-high fever?
“I was having a panic attack,” recalls Hartley. The distraught mom called her pediatrician and was prepared to take Tess to the hospital.
“‘Breathe, Sara,’” Hartley recalls her doctor reassuring her. “‘You know it’s the strep.”
After giving her daughter ibuprofen and a bath to cool her down, Hartley says Tess’s fever decreased within half an hour. “Having your child with that temperature, it was very stressful,” she says.
Though the most obvious symptom of strep is throat pain, it can manifest itself in many ways.
What are the signs and symptoms of strep throat in kids?
Strep causes 20% of throat infections in school-age kids from the age of 5 to 15, according to the American Academy of Pediatrics. But many parents are often confused about when a sore throat symptom is a virus or strep.
“We have certain criteria that allows us to differentiate between a bacterial strep throat and just a regular viral throat infection,” clarifies Dr. Omid Mehdizadeh, an otolaryngologist (ENT) and laryngologist at Providence Saint John’s Health Center in Santa Monica, California.
The Centers for Disease Control and Protection (CDC) list among the symptoms of strep throat:
- Sore throat that can start very quickly.
- Pain when swallowing.
- Red and swollen tonsils, sometimes with white patches or streaks of pus.
- Tiny, red spots on the roof of the mouth (the soft or hard palate).
- Swollen lymph nodes in the front of the neck.
- Fever.
- Headache.
- Nausea.
- Vomiting.
Mehdizadeh also notes that other specific signs of strep include:
- Enlarged tonsils.
- Often a fever greater than 101 degrees.
- Sometimes chills or a rash.
“Toddlers who get strep usually have cold-like symptoms like cough and runny nose,” says Dr. Ivanya L. Alpert, a clinical assistant professor of pediatrics at Mount Sinai School of Medicine and attending physician at Uptown Pediatrics in New York City.
When strep has unexpected symptoms
Because the symptoms are varied, sometimes parents don’t suspect strep. Chappaqua, New York mom of two Kira Hersch recalls when her then-3-year-old son Clark first got strep, he complained about stomach pain.
“He was just saying, ‘Ouchie tummy, ouchie tummy.’ I never correlated a stomachache with strep throat,” she says. “When we went to the doctor, I remember saying, ‘Maybe there’s some sort of stomach virus going around’.”
“Abdominal pain is more likely in younger children and may represent general illness due to fever,” says Mehdizadeh. “Its incidence is quite low — less than 10% — and not very specific. The pronounced throat and neck symptoms are better indicators of a strep infection.”
Unpleasant breath (or “dragon breath,” as Hersch jokes) was another symptom she noticed.
“That’s the bacteria and the pus,” explains Mehdizadeh. “It’s an active infection inside someone’s throat, and it can generally just cause some bad breath.”
How is strep diagnosed?
If those telltale signs of strep throat present themselves, go to the doctor. He or she will do a strep test to sample the fluids in the throat.
“The doctor will take a cotton-tipped swab — basically an extra long Q-tip — and rub it along the back of your child’s throat,” says Alpert. “This takes less than five seconds. Some children will cough or gag during the test. While it can be unpleasant, it is usually not painful.”
Though the rapid strep test gives results in 10 minutes, “it can yield false negative results, so we always do a second test — a bacterial culture,” adds Alpert. “The bacterial swab and the strep test are done the same way.”
And most doctors use two swabs at the same time — one for the rapid strep test, one for the bacterial culture.
It can take between 2 to 5 days for strep bacteria to grow and provide results on a bacterial culture.
If symptoms persist for more than five days despite a negative rapid strep test, “That’s generally when we go ahead and we treat those patients with antibiotics as well,” says Mehdizadeh.
What causes strep and how long is it contagious?
How strep spreads
Day cares and schools are a hotbed for infections because there’s close contact, which is why kids are more prone to getting strep throat.
“The typical route of spread is either through mucus or nasal secretions, and they can be present in airborne droplets,” says Mehdizadeh.
How to prevent strep
The best way to prevent your child from getting strep? Through “handwashing and limiting contact when kids are contagious,” says Alpert.
How long after exposure does strep appear?
The incubation period from being exposed to an infection to the appearance of first symptoms can be between two to seven days.
How to contain strep once your child gets it
- Limit contact with family members when kids are contagious.
- Avoid sharing drinking glasses or utensils.
- Wash their dishes in hot, soapy water.
- Replace their toothbrush. It takes 24 hours on antibiotics before you’re no longer contagious, so change your child’s toothbrush to avoid reinfection. It’s a step that’s easy to forget but important to remember.
Are antibiotics necessary to get rid of strep?
Besides treating the infection, antibiotics like penicillin or amoxicillin are prescribed (or for those who are allergic to those two drugs, antibiotics like cephalexin, clindamycin, or zithromax are given).
“In cases where children simply will not take oral medication, the doctor can give them a shot of penicillin or Ceftriaxone instead,” says Alpert.
Kids older than 3
An untreated strep infection can lead to less common but more serious conditions.
“In kids older than 3, you must treat with antibiotics to prevent the complications of strep like rheumatic fever,” says Alpert.
Rheumatic fever — more common in children from 5 to 15 — is a disease thought to be caused by a response of the immune system to the earlier strep infection and can affect the heart, joints, brain and skin, according to the CDC.
Kids younger than 3
Though kids younger than 3 rarely get rheumatic fever, “they can get other complications of strep such as bacteremia, sepsis and infection in their joints or their skin,” adds Alpert. That’s why antibiotics are prescribed. Bacteremia is when live bacteria enters the bloodstream while sepsis is a life-threatening condition where an infection triggers a body’s extreme response to an infection, according to the CDC.
Recovering from strep
If your child has been diagnosed and is recovering from strep throat, try these helpful remedies for common discomforts:
- Offer warm liquids and broths or cold food (like ices) to ease the pain, especially if eating is the last thing your child wants to do.
- Provide Ibuprofen for pain relief, but be sure to ask your pediatrician about the right dose for your child.
- Try probiotics, which Alpert says help “decrease the incidence of antibiotic-induced diarrhea.”
Luckily, if your child does get diagnosed with strep and antibiotics are started, symptoms tend to improve relatively quickly.
For Hartley, whose daughter had recurring strep throat for several years, “Within 24 hours of the antibiotics, you would see a drastic change in her. Tess would start feeling better because she was very sleepy and just didn’t really want to do much beforehand,” she explains.
Agrees Hersch: “When I do get that strep-positive test, I almost take a deep breath knowing that after 24 hours, he’s going to have the medicine kick in and start feeling better, not be contagious and be able to get right back to feeling better and on the right track.”
