Strep Throat
When kids come into the office with a sore throat, the vast majority of these are caused by viral coughs and colds that irritate the entire upper airway. But we do always have to be on the lookout for strep throat, though, which is a bacterial infection of the throat (caused by group A streptococci) that we do want to treat with antibiotics to get rid of posthaste (within 10 days of symptoms). Why posthaste? Because if strep bacteria is allowed to hang out in the back of the throat for too long, some people’s immune systems will actually make antibodies to strep that will not just attack strep but also their heart valves causing rheumatic heart disease.
So how do docs figure out if it is strep throat or a viral throat infection? Well, we test for it with a rapid or PCR-based test (PCR stands for polymerase chain reaction and tests for the bacteria’s genetic material). If we don’t trust those results, we can also send for a culture that will see what bacteria grows over 48-72 hours.
How do you know who to test? Excellent question. Over the years, there have been great studies to help pediatricians weed out those kids with sore throat that need a test and those that don’t. From those studies we got what is called the Centor Criteria: a group of questions/physical exam findings that give us an idea of how likely it is that a kiddo has strep throat.
And it goes like this:
Is the child over the age of 3? (under the age of 3 is super rare for strep throat)
Is there exudate or swelling of the tonsils? (the more junk on the tonsils, the more likely strep)
Are there tender or swollen neck lymph nodes?
Have we had a fever above 100.4 °F with the sore throat? (the more fever, the more likely strep)
Is there a cough? (strep usually does not come with a cough)
If you answer these questions yielding a score of 2 or above, your kiddo is probably getting a strep test. If you answer the questions with a 4 or above, some docs may not even test and just start treatment due to the high probability that your kiddo has strep.
If your kiddo scores high on this test, then your doc will either just treat with penicillin-based antibiotics straight away or opt for a confirmatory test by doing a throat/tonsil swab to test with either a PCR or culture test looking for the specific type of bad strep bacteria before starting antibiotics.