Seventh Kid

This past week my older son has been unwell with a fever but no other symptoms.  Maybe he had a mild cough but otherwise seemed okay.  A few nights found him coming into our room and the heat raging of him indicated to me he’d had a fever.  The inevitable phone call from the school telling us that he was sick came and he ended up staying home just one day and actually seemed pretty good that day except for not having much of an appetite.

So imagine my surprise when I go to pick him up from school the other day and his teacher (who knows that I am a physician) tells me that six children are away with strep throat.  Six!  I thank her for the information and immediately turn to my son, take out my phone, turn the flashlight on and look in his throat.

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The white spots on his tonsils are pus, or exudate. Probably from a strep infection.  He hadn’t had much of a fever in 24 hours so I decided to wait to get him tested.  This morning he woke up with no fever, but complained of his tummy hurting every time he tried to eat something.  Husband and I wondered if it was his throat that was actually causing him pain.  Kids are kind of dumb when it comes to being able to tell you where it hurts, I find.

Anyway, husband worried that our son had already had the infection for a few days and would be more susceptible to complications (post-streptococcus auto-immune diseases) so I took him to my office in the hopes of getting a rapid strep culture done.

Now, it’s hard enough to take a throat swab for a 4.5 year-old patient in the office, imagine trying to do it on your own son? I had to bribe him with a cookie his grandmother made.  When he saw the how long the “Q-tip” swab was he panicked and covered his mouth.  I told him it would be really fast and that we had to do it or he wouldn’t get the cookie.  “Oh fine,” he said.  So he opened his mouth and I was able to get a really, really, really quick swab of that tonsil.  After lots of crying and “Ow! Mommy, that hurt!” there was no way he was going to comply again.  Looking at the swab, I could see I had gotten a bit of that junk off, so I proceeded with the test.

The rapid strep kit really helpful in the office.  Normally a throat swab takes 48 hours to get results.  With these rapid kits I can have an answer in 5 minutes. I also really like doing them because it’s like a little science experiment I can do right in the office!  It definitely makes a typical day more interesting.

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Very much like a pregnancy test, one line is negative for strep and two lines is positive.

My son’s test had a very faint second line.  Given the history of six other children in his class with strep infections, his on and off again fever, lethargy and lack of appetite, not to mention the tonsils looking the way they did, I elected to treat him.  Yes, I should have taken him to his own pediatrician but I didn’t.  After a couple of doses of Amoxicillin, he is already looking better.

Sometimes it’s really convenient being a doctor mom.

3 thoughts on “Seventh Kid

    • Abdominal pain can be a symptom of strep infections in children. The following is from UpToDate:

      “Group A Streptococcus — GAS accounts for 15 to 30 percent of all cases of pharyngitis in children between the ages of 5 and 15 years [1-4]. In temperate climates, the incidence peaks during the winter and early spring [5]. GAS pharyngitis is seen most frequently in school-age children but may occur in younger children, especially if they have contact with school-age children [5,6]. In a meta-analysis, the pooled prevalence of GAS among children (<18 years) who presented to an outpatient clinic or emergency department with sore throat was 37 percent (95% CI 32-43 percent) [7]. The prevalence among children <5 years was 24 percent (95% CI 21-26 percent).

      Unfortunately, there is no single sign or symptom that reliably identifies GAS pharyngitis [3,8-10]. In children older than three years, GAS pharyngitis typically has an abrupt onset. Fever, headache, abdominal pain, nausea, and vomiting may accompany the sore throat, which can lead to poor oral intake [3,9,11]. Additional features may include exudative pharyngitis, enlarged tender anterior cervical lymph nodes, palatal petechiae, an inflamed uvula, and scarlatiniform rash (picture 1) [3,9,10]. Symptoms usually resolve spontaneously in three to five days.

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