Miriam T. Vincent, MD, PhD
So, your child has a sore throat! Should you worry? How can you tell if it may be Strep throat?
A sore throat is one of the most common medical problems we encounter in caring for our children. The sore throat itself is also the most common symptom of pharyngitis, which is simply an inflammation of the pharynx, the area located the back of the throat. Sore throat is most often caused by direct infection of the back of the throat by germs, viruses and bacteria. Sore throat, especially in children, can also be caused by allergies, postnasal drip secondary to a runny nose, a persistent cough, exposure to smoke, a foreign body or gastroesophageal reflux (acid and food in the stomach moving up into the esophagus or swallowing tube, even as far up as the back of the throat, causing irritation).
The most common causes of sore throat are viral infections. Depending on the time of the year, about half of all of our children's sore throats are caused by viruses. The common viral culprits include:
• Rhinovirus (causes the "common cold")
• Adenovirus (can cause a sore throat with red eyes)
• Epstein Barr virus (causes mononucleosis)
• Influenza virus (the "flu")
• Herpes-simplex virus (causes mouth sores)
• Coxsackie A virus( causes ulcers in the mouth).
When a child has a virus causing the sore throat, the symptoms are red eyes, runny nose, cough, nasal congestion, hoarseness, low-grade fever, a little tiredness with a mild headache, mouth breathing and a sore scratchy throat. Of course, it is unlikely that one child will have every one of these complaints with one episode of a viral sore throat.
Viral pharyngitis is usually benign and self limited in its nature - meaning it will resolve on its own. The treatments used to help your child with this kind of sore throat include rest, lots of fluid intake, giving soft foods that are not too acidic, frequent gargling with warm salt water (just a tiny dash of salt and lukewarm water, please), acetaminophen, ibuprofen and throat lozenges (for older children, younger children can choke on them). Most of these viral sore throats get a lot better in three to five days, although adenovirus takes about seven days and mononucleosis can take weeks. Antibiotics do not help any viral infections! Worse than this, they cost money and have side effects which include diarrhea and rashes. Rarely, some of these allergic reactions to the unnecessary antibiotics are life threatening.
Open and say Ahhh!
By far, the only cause of sore throat requiring antibiotics for treatment is pharyngitis caused by Group A beta-hemolytic streptococcus, also called Streptococcus pyogenes, simply known by all of us as "Strep Throat." Physicians fear missing this diagnosis because of the complication, rarely seen in the United States these days, of acute rheumatic fever which affects mainly the heart and its valves, and joints of the arms and legs (knees, ankles, elbows and wrists). It is important not to miss treating a strep throat. Since only 25% of children's sore throats are caused by strep, it is also important not to treat the other 75% with inappropriate antibiotics.
There is no one symptom your child will have with a sore throat or even one sign found on physical exam that the doctor performs that absolutely lets us know that step is the cause. Studies have shown that there are four signs that will point in the direction of strep and make it a good idea for you to bring that episode of sore throat to your doctor's attention for further evaluation and possible treatment with antibiotics. These include: a temperature higher than 100.4ƒF (38ƒC), swollen, tender glands or lymph nodes in the front part of your child's neck, a lack of a cough, and the presence of exudates (pus) on the tonsils (especially the kind that looks like little white specks). When child appears very ill or has two or more of these signs, it is a good idea to have your doctor "check it out."
In addition to a physical examination, your child's doctor may choose to perform a rapid strep test, a throat culture, or both. The rapid strep test gives rapid results in about 15 minutes. It is a chemical test designed to look for the strep carbohydrate of the bacteria. A throat culture result takes a day or two to get results. This test actually grows out the germ by using microbiology techniques. Both tests are done by using a special cotton swab which will touch your child's tonsil to obtain a specimen for study: open and say Ahhh.....
If you child has or is thought to have strep, studies show they do not need to be treated right away to prevent acute rheumatic fever. It is safe to wait at least two days for the throat culture result. A strep throat should be treated with penicillin, if your child is not allergic to it. There are alternative antibiotics available if he or she is. The amount of penicillin depends on the age and weight of the child (one size does not fit all). Penicillin must be taken as directed by your doctor for the entire length of time, or the strep germ will likely return.
So, what's a parent (or grandparent) to do? Check out the associated symptoms that come along with your child's sore throat. Use a thermometer to evaluate for fever. As always, work closely with your doctor.
The best ways to avoid catching or passing along a sore throat include washing your hands regularly, not touching your eyes or mouth, and, covering your mouth when coughing or sneezing.
Miriam T. Vincent, M.D., Ph.D. is Professor and Chair of the Department of Family Medicine at SUNY-Downstate Medical Center and Islet Cell Biologist She is active in faculty development, patient care, teaching undergraduate, post graduate and CME medical education. Dr. Vincent has published and lectured widely in primary care including pharyngitis.
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