Is it strep or the flu? Maybe, both?

Strep and flu are two very different things, although they may have similar symptoms at times.

First, let’s distinguish between the two.

The flu is a viral infection that impacts the nose, throat and lungs. A flu, or cold, can make the throat sore and scratchy

Strep is a bacterial infection. Strep causes the throat to be very sore and it becomes very painful to swallow and they typically don’t eat, or only eat very soft things. With a cold or flu, children usually eat fine or if not the reason is appetite not pain with swallowing.

They both can cause a fever, sore throat, chills, muscle aches and even nausea.

So how do you tell the difference?

Even for a pediatrician, it’s difficult to distinguish strep from the flu by a quick look inside a child’s throat. Studies have been done that shows that without the proper tests, physicians can’t tell the difference half the time.

Strep can cause white spots, but rarely does. Usually the throat is somewhat red and can have the red spots which are petechia. The body aches in strep are also less severe in strep and one of the defining symptoms of flu.

The only accurate way to diagnose strep is through a strep screen or a throat culture.

Strep throat symptoms include:

• Red, sore throat with white patches
• Headache
• Swollen, sore glands in the neck
• Fever
• Red spots on the roof of the mouth
• Painful, difficult swallowing
• Chills
• Fatigue
• Nausea and possibly vomiting
• Decreased appetite
• Rash
• Muscle aches, especially in the neck, and abdominal pains, especially in younger children
• Swelling in back of mouth

We will take more tests to confirm the diagnosis that may include a throat culture, rapid DNA test or rapid antigen strep throat.

Most strep will get better in about a week to 10 days.

Your doctor will prescribe antibiotics to treat the infection. Although the symptoms may fade, the infection may remain. Please make sure to take all the antibiotics prescribed.

You may be surprised to find out that about 30 percent of people have strep in their throat at all times and it does not cause symptoms. To help reduce your child’s chances of strep, follow these tips:

• Wash your hands
• Don’t share food or drink
• Avoid exposure to other people with strep
• Replace your child’s toothbrush after starting antibiotics

Flu symptoms include:

• Fever
• Cough
• Sore throat
• Runny or stuffy nose
• Body aches
• Headache
• Chills
• Fatigue
• Sometimes diarrhea and vomiting

We advise everyone to get the flu shot. However, if you or your child are sick with the flu, stay home, rest and avoid contact with other people. The Centers for Disease Control and Prevention recommends staying home for at least 24 hours after the fever is gone (except for medical care or other necessities). The fever should be gone without the use of fever-reducing medicine.

In some cases of the flu, you may be prescribed antiviral drugs that are prescription medicines. These aren’t sold over-the-counter and you can only get them with a prescription. The drugs aren’t antibiotics which fight against bacterial infections (strep for instance), but they fight against the virus.

You may hear someone say that their child got strep and flu at the same time. This can happen, but it’s very uncommon. Both are increase in the winter months, and symptoms such as sore throat, fever, etc. can overlap, which is likely why children are being treated for both.

Strep and flu two are entirely different things. Colds and flu always cause a sore throat, but strep is never the cause of cold symptoms.

So if your child has cold symptoms and a sore throat and gets tested for strep, it could be a false positive or it could just be a coincidence. For instance if your child has a cold or flu, then they go to the doctor or to school and are exposed to someone with strep throat. Now he or she has both. But they aren’t related.

And remember because they are different, they would each have to be treated differently and separately.

I hope this helps. We’ve been asked a lot about it lately. Stay healthy.

Dr. Bradley Mercer is pediatrician at Cook Children's Pediatrics (Fort Worth). To learn more about him and his practice, click here.

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

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.