Strep Throat

Dear Lisa,

What are the signs of Strep throat? My 9 year old daughter frequently tells me that her throat hurts, but I know that she is just doing this to get my attention. I used to bring her to the Pediatrician’s office every time she complained, and it turned out that she never had an infection. After the Doctor’s visit she would run around and play like there was nothing wrong. Now I prefer to wait a little while before I bring her to the Doctor’s to make sure she really has a sore throat. Are there other signs of Strep besides a sore throat that I should be looking for? I don’t want to ignore her symptoms if there is really something wrong, but on the other hand, it doesn’t make sense to run to the Doctor’s office for every little complaint.

“Daughter is Faking Strep”

Dear “Daughter Faking Strep”,

The symptoms of Strep Throat or Strep Pharyngitis include throat pain, decrease in appetite, fever, runny nose, halitosis (bad breath), swollen lymph nodes in the neck, headache, nausea, vomiting, and abdominal pain. (1,2) Although Strep Pharyngitis is usually associated with fever, some children with Strep have little or no fever at all. (1)


Many of the symptoms of Strep Pharyngitis are also found in children with throat infections caused by a virus. Sometimes it is difficult to determine if a child’s symptoms are due to a virus or Strep from the physical examination alone. The only way to be sure if a throat infection is due to Strep is to perform a throat culture in the doctor’s office. (1)

Symptoms that are specific for Strep Pharyngitis include pettechiae on the soft palate (red marks on top of the mouth toward the back of the mouth) or a sandpapery like rash on the torso. (1,2) A Strep infection in another part of the body is sometimes the first sign that a child has Strep throat. It is possible to develop a Strep infection on the skin (Impetigo), on the rectum or in the vagina. (2)

An open wound or bug bite can become infected with Group A beta hemolytic Streptococcus when a child with Strep Pharyngitis scratches her skin after having her hand in her mouth. Spreading of germs to the rectal area can occur the same way. When a child with Strep Pharyngitis puts her hand in her mouth and then touches her bottom she can end up with Rectal Strep or Perianal Streptococcal Dermatitis. ( 3) Signs of Rectal Strep include rectal pain with defecation, rectal itching, redness, and rectal bleeding. (3). Signs of Vaginal Strep include itching, redness, or discomfort with urination. If necessary, your Doctor can perform a culture of these sites in order to determine if the symptoms are due to Strep.

Other signs of Strep that I frequently encountered in my practice include pimples around the mouth, impetigo around the nose and mouth, younger children who cry when drinking from their bottle, a coating on the tongue, peeling of the hands and paleness around the mouth.

Deciphering which childhood complaints are true and which ones are not is quite difficult. As a child matures she becomes more in tuned with her body and more interested in how the body works. It's common for a school aged child to be interested in every little bump and movement, and many times exaggerate the slightest symptom. During this period of growth it is important to reassure your daughter what is normal and what is not.

For children who frequently complain of a sore throat, it is important to determine if the complaints are a method of getting their mother's attention. I can’t tell you how many times a school aged child came into the office with the complaint of a sore throat and it turned out absolutely nothing was wrong with the child. I found many children telling their parents that there was nothing wrong and admitting that they just didn’t want to go to school that day or they didn’t want their mom to go to work.

It is a good idea to seriously consider a complaint of a sore throat if it is accompanied by a fever or if the child appears ill. In this situation having your daughter checked by your Doctor would be time well spent. If there is a history of close contact with a friend infected with Strep or a family member with Strep, then a complaint of a sore throat should be evaluated.

It would also be concerning if a child with a sore throat opted not to participate in activities that she previously enjoyed or if she was sleeping longer than usual. On the other hand, if your daughter complains of a sore throat and then proceeds with her normal activities; playing, eating and attending social functions, it would make more sense to wait to see if her symptoms worsen or if other symptoms develop.

It is important to remember that Streptococcal Pharyngitis has a 2 to 5 day incubation period. Therefore, it may take a few days for a child to exhibit symptoms of Strep Pharyngitis after being exposed. (2)

If you find that your daughter is continually using somatic or health complaints as a means to get your attention, it would be a good idea to sit down and talk with her about it. Ask open ended questions about her friends, teachers, school experiences or struggles that she may be having. Her somatic complaints may be a sign that something else is bothering her. She may not know how to express herself or how to get your attention. Addressing these issues can save you a lot of time guessing what is wrong and help your daughter relieve the stress that is in her life.

References:
(1) Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc 1990: 496-498.
(2) American Academy of Pediatrics. Group A Streptococcal Infections. In: Peter G, ed. 1997. Red Book: Report of the Committee on Infectious Disease. 24th ed. Elk Grove Village, IL: American Academy of Pediatrics; 1997:483-485.
(3)Perianal Streptococcal Pharyngitis. Consultant for Pediatricians. 2005. Oct:441.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Childhood Illnesses