| FAQ-Sore Throats | ||||||
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Strep Throat Sore throats are one of the more common complaints among children. Although the thought of Strep throat is often one of the first things that enters a parent’s mind when her child complains of sore throat, in reality, most of the time sore throat are not Strep throat–only about 20% of kids thought to have Strep throat actually do. Because of this is fairly low and because of rising resistance to antibiotics, doctors really shouldn’t be asked to call out antibiotics unless there is a very strong exposure history.
The last two signs–the lack of runny nose and cough–are important. Most sore throats associated with upper respiratory symptoms are not Strep throat. There are exceptions but this is a general rule of thumb to use if you are trying to decide whether to take your child in to the doctor. Strep throat is treated with antibiotics that prevent the occurrence of rheumatic fever, shorten the illness and render a child no longer contagious and able to return to school after 24 hours on medication. Some kids get recurrent Strep throat. There are a number of reasons for this. One may just be a bad spell with several new strains coming into the community to which the child is susceptible. Some children are genetically more susceptible to Strep that others. Tonsillectomy was once a very common procedure for recurrent sore throats. It is no longer so common but is occasionally done for recurrent sore throats, enlarged tonsils that obstruct the airway when awake or asleep, and can be done under very special circumstances for children with recurrent Strep throat. If a child has Strep throat very frequently the tonsillectomy will decrease the number of times a child has Strep, however, most kids with recurrent Strep improve over time and after two years there is not a significant difference between kids who have had their tonsils out and those who haven't. MONO Mono or Mononucleosis is a cause of sore throats caused by the Epstein Barr Virus. Although most parents think of it as an affliction of teenagers (the "kissing disease"), mono can affect people of all ages from young children through adulthood and about 50% of infected individuals do not know that they have it. Sore throat, swollen tonsils with exudates (or pus on the tonsils), swollen neck lymph nodes, prolonged fever, fatigue, and an enlarged spleen is the presentation known to most parents. In addition to these symptoms, marked nasal obstruction due to enlarged adenoids is also common. Yet mono can present in many different ways including just prolonged fever, a sore throat that lasts longer than expected, swollen neck nodes alone or just a swollen spleen alone. Sometimes individuals are co-infected with Strep--so a child with a positive throat culture for Strep who does not get better very quickly may turn out to have mono, particularly if he breaks out in a rash while taking amoxicillin. . Mono can be diagnosed is several ways. Clinically, a child with sore throat, tonsillar exudates and a negative throat culture probably has mono or a mono like illness caused by CMV or perhaps adenovirus. To be certain of the diagnosis, laboratory tests of a CBC (Complete Blood Count) and a Monospot may be ordered. The Monospot is not always positive, especially in younger children or in individuals sick less than a week. Specific labs tests for the virus that causes mono provides better diagnostic sensitivity and accuracy. There is not specific treatment for mono. Under very special conditions antibiotics may be used for secondary infections and also under selected conditions steroids may be used that shrink the adenoids and make a child feel better but do not shorten the duration of the illness. Mono can have complications, the most common being a prolonged illness of fatigue and weight loss. The most feared, however, is rupture of an enlarged spleen which can be fatal. Although this can occur spontaneously, if it is enlarged it may be more prone to injury. Because of this, all children with enlarged spleens from mono (and sometimes any patient with mono regardless of whether the spleen is enlarged at the time of diagnosis) often have their activities limited for several weeks. In addition to this problems with the spleen, there is the potential for a number of other complications. With this in mind, if your child has recently been diagnosed with mono and is complaining of something unusual, then it is best to have him or her examined.
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