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Daily Dose

Strep Throat

1:30 to read

During the “sick season” a common complaint among children (and their worried parents) is that a chid has a sore throat. While all children will at some point complain of a sore throat, most sore throats are due to a virus and are often the first sign of a cold.  

 

Many parents worry that their child may have strep throat which is a bacterial infection and requires treatment with antibiotics.  In fact, only about 10-20% of children with a sore throat will have strep.  More and more parents are bringing their children in to the office right after they “hear” that someone is their child’s class has strep (thank you social media).  In fact, their child may have not even complained about their throat until they were asked, “does your throat hurt”, or they may have only been sick for an hour or two.

 

How can you decide if your child might need to be seen at the pediatricians office if they have complained of a sore throat?

 

Strep throat is most common in school aged children 3-14 years of age.  It it typically not seen in young children (who cannot even tell you that they have a sore throat) or in adults over the age of 45.  With the advent of urgent care centers on every corner I am hearing more and more parents tell me “I have strep throat so I am worried about my child”, but when asked if they the parent are better on their medicine the majority say “not really”, and I am coughing and congested and not getting better. Their “strep throat” is more likely to have been the beginning of a cold. 

 

Children with strep throat typically do not have a cough, but do have swollen or tender lymph nodes in their neck (just under their jaw), have a temperature over 100.4 and have swollen inflamed tonsils that may or may not have exudate (white patches), and are between 3 - 14 years of age. 

 

By using these guidelines which are called the Centor Criteria your doctor is also deciding which patients should have a rapid (in office) strep test. Over testing (swabbing) with an in office rapid strep screen may lead to false positive results due to picking up the bacteria in a child’s (or adult’s) throat when they are simply carriers and do not have strep throat. Why is this important?   Over testing, may lead to over prescribing antibiotics and no one wants their child to be taking antibiotics unnecessarily. 

 

So, it is typically best to wait 24 hours or so after your child complains of a sore throat to take them to the pediatrician.  History of the illness and clinical findings are the two things that will determine if your child needs a “strep test” and should not be decided simply because “there is strep in their class”. In our office all children are examined by the physician prior to having a throat swab.

 

 

 

 

 

 

 

Daily Dose

Is It A Viral Sore Throat Or Strep Throat?

1.30 to read

It only takes the winter season to usher in an array of illnesses in the pediatrician's office. As you know, we are smack in the middle of flu season, with cases and deaths being reported daily. To review (again), flu like symptoms for all influenza strains are typically similar with fever, sore throat, cough, congestion, headaches and body aches. Occasionally there may be some nausea or vomiting but that is not seen as often. Flu like symptoms seem to begin with general malaise and then develop over the next 12–24 hours and you just feel miserable. Some of the confusion now is about sore throats and the difference between a sore throat with the flu, which is due to a viral infection, and strep throat, which is a bacterial infection. As for most things in life, nothing is 100 percent and the same goes for viral and bacterial sore throats. But, with that being said, there are certain things that might make a parent think more about a viral sore throat than strep throat and vice versa. Viral sore throats, which we are seeing a ton of with the flu right now, are typically associated with other viral symptoms which include cough, and upper respiratory symptoms like congestion or runny nose. A viral sore throat may or may not be accompanied by a fever. In the case of flu, there is usually a fever over 100 degrees. With a viral sore throat you often do not see swollen lymph nodes in the neck (feel along the jaw line) and it doesn’t hurt to palpate the neck. If you can get your child to open their mouth and say “AHHH” you can see the back of their throat and their tonsils, and despite your child having pain, the tonsils do not really look red, inflamed or “pussy”. Even though it hurts every time you swallow, to look at the throat really is not very impressive. Strep throat on the other hand, typically occurs in winter and spring (that is when we see widespread strep), but there are always some strep throats lurking in the community, so it is not unusual to hear that “so and so” has strep, but you don’t hear a lot of that right now. Over the next 2 months, there will be a lot more strep throat. Strep throat most often affects the school-aged child from five to 15 years. Children get a sudden sore throat, usually have fever, and do not typically have other upper respiratory symptoms (cough, congestion). This is another opportunity to feel your child’s neck and see if their lymph nodes are swollen, as strep usually gives you large tender nodes along the jaw line. When you look at the throats of kids with strep they usually have big, red, beefy tonsils (looks like raw meat) and may have red dots (called petechia) on the roof of the mouth. The throat just looks “angry”. Sometimes a child will complain of headache and abdominal pain with strep throat. Some children vomit with strep throat. The only way to confirm strep throat, again, a bacterial infection, is to do a swab of the back of the throat to detect the presence of the bacteria. There are both rapid strep tests and overnight cultures for strep. Most doctors use the rapid strep test in their offices. If your child is found to have strep throat they will be treated with an antibiotic that they will take for 10 days. Again, antibiotics are not useful for a viral sore throat and that is why strep tests are performed. I’m sure we’ll talk more about sore throats, but in the meantime, get those flashlights out and start asking your kids to say "ahhh". That's your daily dose for today. We'll chat again tomorrow.

Daily Dose

All About Tonsils

When it comes to tonsils, no two are the same. Over the span of my pediatric career, I literally have looked in thousands of throats and one thing that I do know: tonsils come in many shapes and sizes.  Scroll down and check out the photos I just took in my office.

Tonsillar tissue is considered a “secondary lymphoid organ” and is most active in children between the ages of 4–10 years.  As children go through puberty, the tonsils begin to shrink , as I like to say,” some things get bigger while tonsils get smaller” and by adulthood the tonsils are so small that they are often difficult to visualize. The most common complaint about tonsils relates to sore throats and pain with swallowing.  While many parents say their child was diagnosed with “tonsillitis” that does not really tell you what caused the inflammation of the tonsils, in other words it is not a diagnosis. Respiratory viruses are one of the most common causes of viral tonsillitis (and you know there are tons of those) with Group A strep being the most common cause of a bacterial tonsillitis.  Mononucleosis caused by Epstein Barr virus also causes a painful tonsillitis and is often seen in the teenage population (this is why mono is called the kissing disease), although mono is not exclusive to the teen age group. Recurrent “tonsillitis” associated with painful sore throats and large tonsils is often the reason parents ask about tonsillectomy for their child. While tonsillectomy was “almost routine” 30-40 years ago, the recommendations for tonsillectomy have continued to change since the 1970’s.  Even so there are still over a half a million tonsillectomies performed each year in the U.S.  The newest guidelines published in January by the American Academy of Otolaryngology, provide updated recommendations as to when tonsillectomy might be recommended. The new guidelines state that children should have at least seven episodes of throat infections in a year (both viral and/or bacterial) or at least five episodes each year for two years, or three episodes annually for three years before they are surgical candidates. All of these infections should be documented by a physician and not just by parental report.  The expert physicians who worked to draw up the new guidelines stress that “children who have fewer episodes really aren’t going to see a lot of benefit” and these new recommendations help to minimize the risks (infection and bleeding) and pain of the procedure in children. As with many things in medicine, things change, hopefully always to improve the outcome of the patient. These recommendations also included guidelines for tonsillectomy for sleep disordered breathing, more on that another day. That’s your daily dose for today.  We’ll chat again tomorrow. 

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DR SUE'S DAILY DOSE

Do antacids work for babies?

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