Both kids were healthy one day, and severely, fatally ill the next, because of a common and usually very treatable bacteria.
Group A streptococcus is most often the cause of strep throat, which is usually cured by a quick round of antibiotics. On occasion, strep can invade the skin, soft tissue, or bloodstream, leaving the body vulnerable to serious and potentially deadly effects, such as toxic shock or necrotizing fasciitis.
It’s important to note that these cases are rare — of the millions of people infected with strep every year, only 10,000 to 12,000 develop serious problems — but it’s also important to know what to look for and when to take immediate action. Invasive group A strep is a rapidly progressive illness: Often there aren’t any distinct red flags until the infection has already advanced. Parents and doctors can do everything right, but things still may go wrong.
The best thing is be aware and be vigilant. Teach your family about good hygiene (such as frequent handwashing), and always clean cuts and scrapes, no matter how small they appear. Find out your school’s policy on health warnings. In my opinion, parents should be notified if there are clusters of certain conditions in the classroom, such as the stomach flu, conjunctivitis, lice, strep throat, and skin infections from strep or staph. This will help you to identify symptoms in your children and to intervene early when necessary. If you suspect at all that your child has been exposed to strep and has an infection, either in his throat or on his skin, call your pediatrician.
Invasive Strep Red Flags
Most sore throats and scrapes will resolve without a problem, but you can always call your pediatrician’s office if you’re concerned. Most doctors’ offices have a nurse or doctor on-call 24 hours a day, reachable by phone, to answer parents’ questions. They can tell you what to do at home and when you need to be seen.
If your child has a sore throat but is otherwise fine (no fever, vomiting, abdominal pain, or rash), you can generally wait a day or two to see the pediatrician. However, if your child has a bad sore throat along with fever, belly pain, vomiting, or rash, it’s a good idea to have them seen sooner rather than later. Same goes for a wound that looks infected.
Other red flags include:
A sore throat that…
- Isn’t easily relieved by over-the-counter pain medication
- Lasts for more than a few days
- Is causing your child to speak in a muffled voice
Or a wound that…
- Is deep or won’t stop bleeding
- Develops redness around the edges
- Drains pus
- Is becoming more painful over time
- Is not healing
If your pediatrician is not available to address these symptoms, take your child to a local walk-in or urgent care clinic. I work in an urgent care, and we see kids with sore throats and infected wounds all the time. Some pharmacy chains now have walk-in clinics as well.
If your child is ever really sick, meaning she is lethargic, confused, dizzy, vomiting, or has a high fever and/or severe pain, go straight to the emergency room. She will require a higher level of care than a walk-in clinic or pediatric office can provide.
Communicating With Your Child’s Doctor
When talking to your pediatrician, be prepared to provide the following information:
- When your child’s symptoms began
- How your child has been behaving
- If your child has a fever, how high it is (always have a thermometer on hand)
- Whether she has been eating and drinking normally
- Whether she has been urinating normally
- What type of medication you’ve been giving your child at home and the specific dose
Remember: You are your child’s best advocate. Symptoms of strep are not always obvious — the earliest signs are generally sore throat, fever, muscle aches, and nausea — so doctors may first diagnose it as the flu or another virus. But you know your child better than anyone. If you think something isn’t right, let the doctor know. Or if you think that medical personnel are not hearing or addressing your fears, say so.
Trust your instincts, and don’t be afraid to speak up if you think something doesn’t add up. For example, if your doctor’s diagnosis is a cold, but your child doesn’t have a runny nose or a cough, ask questions: Could there be another explanation for his behavior? Do you think his symptoms could be related to his skin condition? Should we check blood tests, like a complete blood count, to make sure it’s not more serious? Shouldn’t you do a culture of my child’s wound? When should I come back to the ER if he does not get better?
A couple of years ago, I was worried about something regarding my son. I was trying to explain my concerns to his doctor, but in the end, I didn’t think he was taking me seriously. Instead of leaving deflated, I told him how I felt. Once I pointed out the problem, he acknowledged it and apologized, and now we have a great relationship.
You should never be uncomfortable talking with your doctor or your child’s pediatrician. You may not always like what she has to say, but you shouldn’t feel as though she isn’t “hearing” you, or that you can’t voice your concerns. If you do, something is wrong.
Mallika Marshall, MD, is medical director for Everyday Health and a practicing physician at the Massachusetts General Hospital Chelsea Urgent Care Clinic. A veteran television correspondent, Dr. Marshall has been a regular medical contributor for CBS' The Early Show and the CBS Evening News. She is currently a contributing medical reporter for New England Cable News. Follow Dr. Marshall on Twitter at@mallikamarshall.