Common back-to-school illnesses: Strep throat

Back to school is a time filled with mixed emotions. Children may be sad to leave their relaxed and fun summer memories behind, while parents may be glad to have their child back to a regular routine. Adding to the stress, parents frequently report that back-to-school time presents illnesses and more trips to the doctor for treatment of strep throat, as well as pink eye and the common cold. This week, I will share what’s important to know when you think your child may have strep throat. In upcoming PediaPath blog posts, I will share similar details on the common cold and pink eye.

Strep Throat Symptoms

Strep throat is a bacterial infection with a sudden onset of some, but usually not all, of the following symptoms: fever, sore throat, headache and stomachache, possibly to the point that a child becomes nauseated and vomits. In some cases, a rash can occur. This may be the classic scarlet fever rash – sandpapery, reddish, and more prominent in the skin folds – or it can even be hives. Strep is not an illness that is usually accompanied by runny nose, cough or congestion. Also in many cases, a classmate or friend recently has been diagnosed with strep throat.

Course of Action


If your child shows symptoms for strep throat, a visit to the doctor’s office is warranted. What is not warranted is bringing your child in showing no symptoms and just out of concern because a case of strep has been reported in the classroom. Visiting the doctor “just-in-case” can cause two problems. First, it can lead to your child being tested too early for strep, in which case you will end up back at the doctor’s office anyway. Second, it can lead to increased and possibly unnecessary anxiety for your child and you.


When your child shows symptoms, it is best to observe him at home for at least 24 hours. This permits the symptoms to become clearer. Often a sore throat and fever presenting themselves on day one can develop by day two into a different illness with a different treatment, such as a viral upper respiratory infection. Viruses are not treated with antibiotics.


Upon a pediatrician’s examination of a patient with strep throat, the doctor can sometimes observe an inflamed throat with small red spots. In some cases, there will be pus on the tonsils. A neck exam of the patient often reveals swollen lymph nodes. A rapid strep test can be performed in the office to diagnose strep. If the strep test is positive, antibiotics such as amoxicillin or cephalosporins will often be prescribed. Your child typically is contagious for the first 24 hours after she starts antibiotics, so she should stay out of school, extracurricular activities and social gatherings during that period. It also is important to complete the entire course of antibiotics as directed by your pediatrician. Failure to do so can prevent the antibiotic from being effective in wiping out all of the bacteria that caused the strep infection in the first place. Also, often doctors will instruct patients to get a new toothbrush and use separate bath towels and utensils to help reduce the risk of spreading the bacteria to other members of the family. If the strep test is negative, in many cases, the doctor will send out a long term throat culture, and offer families other suggestions to keep the patient comfortable, such as fluids, rest, fever reducers and medications for pain.


After the first 48 hours, the patient should feel markedly better, be fever-free and be generally ready to return to school. If your child has not markedly improved within two days, it is important to touch base with your doctor to see if she may need a different antibiotic or he or she has another illness at the same time she has strep throat.

In cases where a patient has had numerous cases of strep throat, parents often wonder whether their child is a candidate for tonsillectomy. In general, a child may be referred for a consultation for a tonsillectomy if they have had four to six strep throat infections in one season, or if they seem to have a difficult time clearing their strep infections with standard antibiotics. It is best to discuss these and other concerns with your child’s pediatrician.

Stay tuned for future PediaPath posts where I similarly will cover how to manage pink eye and the common cold.

Happy new school year!

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