We’ve all been there, staring into the tip of a long swab that’s about to plunge down our throats. Parents have probably also had the experience of holding on to a small, squirming human being who is crying at the prospect of this routine medical test.
Most of us are aware that a persistent sore throat and a fever are telltale signs of a strep infection, and that they warrant a trip to the doctor for testing, as well as treatment with antibiotics if necessary.
But many parents aren’t aware that vomiting, when accompanied by a sore throat, can also be a indicator of strep in kids — though it’s generally not one in adults.
“Vomiting is a sign of strep throat, especially in children,” Dr. Jen Trachtenberg, a board-certified pediatrician based in New York City, told HuffPost.
Symptoms of strep
Strep throat is a bacterial infection of Streptococcus pyogenes, also called group A streptococcus. Confusingly, the signs of strep infection are the same as many other viral infections, which is why doctors run a test before prescribing antibiotics. Strep infections are more common in children than adults.
Trachtenberg said that in her practice, she regularly sees the following symptoms of strep:
- fever
- sore throat, which in addition to pain can involve reds dots on the back of the throat, swollen tonsils or white patches on the back of the mouth
- swollen lymph nodes (glands in the neck)
- headache
- stomach pain and vomiting
The Mayo Clinic notes that the throat pain of a strep infection tends to come on quickly, and children may complain of difficulty swallowing.
Because these are all common symptoms of a variety of other viral illnesses, your doctor will run a test if they suspect strep.
Interestingly, Trachtenberg noted that physicians often don’t test children under age 3 for strep, since it’s uncommon for them to get this infection and they’re less likely to have complications from it if they do. Symptoms in a child this age are more likely the result of a viral infection, but your provider will decide if there is a reason to test your child.
When to see the doctor
If the symptoms are the same as many viral infections, which don’t require treatment with antibiotics, how does a parent know when to bring their child to the doctor?
Most sore throats aren’t strep, and most vomiting isn’t strep — though those two symptoms in combination might be a sign of it.
Other potential presentations of strep that warrant a call or visit to the pediatrician include:
- sore throat and swollen lymph nodes
- sore throat and fever
- sore throat and rash
- sore throat for over 48 hours
- any combination of the symptoms listed above
Dr. Janine Zee-Cheng, a board-certified pediatrician in Indiana, told HuffPost that sometimes a child will come in with a headache, a stomachache and a fever and test positive for strep without ever complaining of a sore throat. Coughing and a runny nose, on the other hand, usually signal a viral infection and not strep.
Zee-Cheng said that after years of working with children, they can often tell just by looking at a child’s face that a strep test is going to turn positive. They described this “strep face” as “pale and droopy.”
As always, if your child has a very high fever or a fever that lasts for five days, it’s a good idea to contact your pediatrician. And if your child is having difficulty breathing, they should be seen by a medical provider right away.
Helpfully, some day care centers and schools now send an email to parents when a child in the class tests positive for strep. This way, parents of the other children who may have been exposed know to be on the lookout for symptoms.
Why it’s important to treat a strep infection
Doctors don’t always agree on when to prescribe antibiotics for an ear infection, but antibiotics are always used to treat strep throat after a positive test.
When left untreated, strep throat can lead to serious complications. These include “rheumatic fever, which can lead to swollen painful joints, a specific rash, and also heart valve damage,” Trachtenberg explained. There is also the possibility of kidney inflammation or disease, called poststreptococcal glomerulonephritis, Trachtenberg said.
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But don’t panic — antibiotics don’t need to be prescribed immediately in order to prevent these complications. Even if your child has been having symptoms for a number of days, their strep infection can be effectively treated, and complications averted, with a round of antibiotics.
Zee-Cheng also noted that a rapid strep test in a doctor’s office can sometimes give a false negative result when done too early in the course of an illness, so they generally recommend that families wait a day or so before bringing their child in.
Vomiting, on its own, doesn’t usually indicate strep, and it might be the result of a virus, food poisoning, motion sickness or something as simple as “too many Cheetos, or a large popcorn when they went to the movies,” Zee-Cheng said. But any suspicious combination of symptoms is worth a call to your doctor.