But, unfortunately, we also are in the midst of the COVID-19 pandemic.

Since the beginning of the pandemic, the Centers for Disease Control and Prevention (CDC) has listed fever, cough and shortness of breath as the primary symptoms of COVID-19. Recently the CDC updated its list of possible symptoms of COVID to include: chills, shaking chills, muscle pain, headache, sore throat and loss of taste or smell.

In addition, I continue to see cases of strep throat here and there in the office as well.

I know right now nothing is routine and it’s understandable to be worried at the first sign of a sneeze. So let’s take a look at the COVID symptoms and how they compare with either allergies or strep:

So, how do we know the difference?

COVID-19 generally presents with fever, cough and shortness of breath. In addition, as testing becomes more prevalent, a known exposure raises the risk significantly.

Allergies can cause cough and sore throat, but usually also cause runny nose and watery, itchy eyes. If fever is present, infections such as strep, sinus, ear infections and yes, COVID-19 would be considered.

Strep throat usually presents with fever and sore throat but, if cough and congestion are present, it is very unlikely.

Sometimes it’s not obvious at first glance what is causing your symptoms, and in these uncertain times it’s important to contact your pediatrician if you have concerns.

We look forward to hearing from you.

Stay safe,

Doc Smitty

2. Fifteen-20 percent of kids WITH NO SYMPTOMS AT ALL will be POSITIVE FOR STREP if tested. This means 15-20 perecent of kids are strep “carriers.” A tiny amount of strep lives in their throat all the time, and it doesn’t make them sick. Let that sink in a moment. Think about all the unnecessary antibiotics kids are getting!

3. The most common symptoms of strep throat are a sore throat, fever and swollen glands in the neck. I also see kids get nauseous, have stomach aches and headaches. It’s odd – sometimes their only signs are fever and vomiting or nausea and a headache.

4. Sometimes, strep comes with a rash. We then call it “Scarlet Fever” and it is no more dangerous than just plain strep throat. Someone just gave it a cool name and then we get to feel like we are living in that computer game “Oregon Trail.”

5. Most people look at the back of the throat to see if their kiddo has strep. I don’t look there – that’s typically where drainage from the nose causes bumps and other changes. When I look for strep, I look at the tonsils and the ROOF of the mouth – the arch over that dangly thing (the uvula) to see if there are dark red spots.

6. If your child has congestion, coughing, a runny nose, watery eyes and/or diarrhea, she most likely doesn’t have strep. Chances are it’s just a cold or some allergies – and postnasal snot drip is the most common cause of sore throats in my office.

7. Strep is passed from kids to kid through “large respiratory droplets.” Yum. This means kissing, sharing drinks or food, or a sneeze or a cough either lands directly on another kid’s hand which then they put that hand in their mouth, nose, or eyes. Or, the drops land on a surface and another child touches it and touches their face somehow.

8. If you are a strep carrier, you don’t have much strep in your throat. It’s enough to catch on a strep swab, but not enough to fly out of your kid’s mouth and onto things and people (ew). Also, these bacteria aren’t as “mean” as typical strep bacteria are. So you aren’t really very contagious at all. And with 15-20 percent of kids being carriers, many of us live with them on a daily basis and are just fine.

9. I always talk with incredulous parents in the office about how “the strep came right back” after finishing antibiotics. They finished treatment and then the fever and sore throat hit again, and the test is positive again. I call these kids “strep bounce-backs” and it’s more common than you think. It doesn’t mean anything went wrong, and there are lots of explanations. Sometimes there are a lot of kids in the class passing it back and forth, and getting treated at different times. Sometimes, it is because the bacteria is hiding deep inside the tonsil folds and the antibiotic had a hard time reaching it. Changing up the antibiotic, or just repeating a course, can help it go away.

10. You can get over strep on your own, without antibiotics. Isn’t that amazing? Our immune systems are awesome. BUT, we like to treat strep with antibiotics anyway. Why? Because it makes you feel better sooner. It makes you less contagious to others (you are no longer contagious 12 hours after the first dose of Amoxicillin). And it can prevent the VERY rare complications we see with strep – when strep attacks the heart (acute rheumatic fever).

Hope this helps you to better understand strep!

❤️Dr. Diane

Halley Hogan, M.D., a pediatrician at Cook Children’s newest location in Prosper, Texas, took some time to answer our questions about what’s going around.

What kind of bugs are you seeing in your office right now?

We’re seeing cases of Influenza B, norovirus and group A strep.

Is the flu season still in full swing or are we nearing the end? 

We are begining to see flu activity throughout the state of Texas. Flu activity will likely remain high for several more weeks.

What should parents know about the difference between the flu, norovirus and rotavirus? 

Norovirus is the virus that causes the “stomach bug.” It causes vomiting and diarrhea and can affect anyone.

Rotavirus most often affects infants and young children. It can cause fever, watery diarrhea and vomiting. What we worry about most with rotavirus is infants/young children becoming dehydrated. It is recommended that children get the rotavirus vaccine at 2 months, 4 months, and 6 months of age. Vaccinated kids are less likely to get sick from rotavirus and can have less severe symptoms if they do get rotavirus.

Flu is caused by the influenza virus. Flu affects the respiratory system, and can cause fever, chills, cough, sore throat, runny/stuffy nose, body aches, headache, and fatigue.

With many schools back in session after spring break last week, what does that mean for these illnesses? Are kinds more at risk being in school?

Flu is spread when people with the virus talk, sneeze, or cough, sending flu droplets to the people close to them. It can also be spread by touching a surface that has flu virus on it and then touching your nose, mouth, or eyes. If you have the flu, you are contagious one day before symptoms start and up to 7 days after becoming sick.

Norovirus can also spread easily. Kids can get norovirus by sharing food or drinks with someone who is sick, or by touching surfaces contaminated with norovirus and then touching their mouths. You are most contagious with norovirus while you have vomiting/diarrhea, but you can still spread it for two weeks after you are better.

Many times, children with flu or norovirus return to school while they are still contagious and this increases the spread of these illnesses and can cause outbreaks in schools.

Are there any questions or concerns you’re hearing from parents?

Yes, parents often ask “How can we decrease the chances of siblings/other family members/friends getting the flu?”

The best way to decrease your risk of flu is getting the flu vaccine every year. It is recommended for everyone 6 months of age and older. Wash your hands often with soap and water or an alcohol-based hand rub. Try not to touch your eyes, nose, and mouth. Cover your nose and mouth with a tissue when you cough or sneeze, and wash your hands after.

Meet Halley Hogan, M.D., Prosper Trail's Pediatrician

 

Dr. Hogan was raised in the Dallas area. After earning a Bachelor of Science degree in biochemistry from SMU, she attended the University of Texas Medical Branch in Galveston for her medical degree. She then completed her pediatric residency at University of Texas Southwestern in Austin. Dr. Hogan is board certified by the American Board of Pediatrics and a fellow of the American Academy of Pediatrics.

Dr. Hogan provides comprehensive health care to children of all ages. She has a passion for pediatrics and loves getting to know families, with the philosophy that providing the best primary care depends on developing personal relationships with her patients and their families. She has a special interest in preventative medicine and promoting healthy, happy childhoods for all children. Outside of work, she enjoys spending time with her husband and their two young sons, as well as reading and traveling. Make an appointment with Dr. Hogan here. 

“Well, umm, uhhh, ummm, yeah I guess that is what I’m saying….And, now that I think about it, I will definitely be calling it that for the rest of my career.”

Group A beta-hemolytic stroptoccal pharyngitis is probably something you have heard of before…well, you might have heard it called strep throat.

But, what you probably didn’t know is that that same bacteria can cause other infections. One of the most common is an infection of the skin just around a child’s anus.

The infection can cause significant pain, itching and when you look you will see a bright red, moist rash right around the anus. You can also sometimes see some blood in the stool from scratching and skin breakdown. Some parents confuse it with a really severe form of diaper rash.

The infection is most common in children 6 months through elementary school. How do kids get it? Spoiler alert: they often scratch and touch themselves…so, if they are around someone with strep throat, they can get it on their hands and infect themselves.

If you believe your child has perianal streptococcus, your baby should be seen by a pediatrician because prescription antibiotics are required.

Related:

Is it Strep Throat or the Flu?

Along with this goal of each child’s attendance, we have to balance the goal of keeping others safe from infectious diseases. Our contagious students need to stay home when they are sick to keep the rest of their classmates safe. (This is why I don’t really care for perfect attendance bike raffles. I prefer responsible attendance.)

Balancing these tensions is often hard for the parent, the school and the pediatrician because we often don’t know exactly when a child is no longer contagious. This is why I got so geeky excited last week to see a new study released in the Pediatric Infectious Disease Journal about the contagiousness of strep throat.

The study looked at 111 children with strep throat over two days.

Day 1: Children who tested positive for strep were given their first dose of amoxicillin before 5 p.m. (They also had cultures taken which allow to see if bacteria will grow from a swab of their throats.)

Day 2: Children were retested and cultured for strep in the morning to determine if they still carried the bacteria in their throats.

Here is what they found:

• 101 children tested negative for strep on the morning of day 2.
• 7 children had significantly decreased growth of bacteria from their throat cultures.
• 2 children continued to have high loads of bacteria.

The author’s conclusion: “all children treated with amoxicillin for streptococcal pharyngitis (strep throat) by 5 p.m. can, if afebrile (fever free) and improved, may be permitted to return to attend school on day 2.”

I’m pretty sure you’re not as excited as I am, but THIS IS HUGE!

Based on current guidelines, children must be treated for 24 hours before being allowed to return to school. If we treated according to the results of this study, it would allow for the child to be back in school and for the parent to be back at work a whole day earlier.

I feel like there is a lot of work to be done in this area and this type of study, along with other models of health care delivery, are good examples of the work that will be necessary.

Because I value education and our school districts so much, I want to be constantly thinking about ways we can do this better. As a general pediatrician, I can really boil down the goals of my job to these:

1.Keep kids growing and healthy.

2.Keep kids developing and learning.

Early in your baby’s life, this looks like frequent checkups for preventing illness, monitoring growth (and talking about diet) and teaching ways that parents can help their child with development. (Read: Everyone should homeschool.)

As your child gets older and starts school, my role changes a little bit. I don’t ask my elementary age patients about fractions or my high school students about “The Great Gatsby.” Instead, I might ask, “How is school going?” “Any problems I need to know about?” “Any way I can help?”

On a practical level, this means offering school aged children after school appointments when possible. It means getting sick kids in the same day so that we can start treatment and get them back in their desks as soon as possible.

In the future, this may mean totally different modes of delivering health care and working with the school and school nurses in order to decrease missed class time.

But I’m getting ahead of my geeky self again. I’ll save that discussion for later.