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Sometimes hot tea and honey are fine

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The colder weather this time of year heralds the anticipation of things such as winter sports, planning for family get-togethers, kids counting the days to winter break and maybe stocking up on hot tea and honey for that inevitable, annoying sore throat. 

As we enter this season it might be a good idea to have a clearer understanding of what a sore throat, or pharyngitis, actually is and when to be concerned enough to call for an appointment or just treat the symptoms at home.

About 80 percent of all sore throats are caused by a virus and need no prescription treatment. These infections often come with other upper respiratory symptoms such as cough, runny and stuffy nose, sneezing and can often be associated with fever. 

Many viruses can cause a sore throat with cold symptoms, but one of the most common in kids is hand, foot and mouth disease. This is caused by the often snickered at coxsackie virus (There is an idyllic little community called Coxsackie, NY, just south of Albany along the Hudson.) 

The hallmark of this infection is the appearance of small blisters on the back of the throat. A brief rash on the palms and soles is also not uncommon. 

Symptoms may last a week, but it is usually three to five days of feeling pretty poorly and then kids recover just fine. 

It is spread through contact and the contagious period lasts about a week after symptoms first appear. The only real issue is keeping the kids comfortable and hydrated during the illness. Antibiotics are neither indicated nor helpful.

Of the 20 percent or so of sore throats caused by bacteria, the most common is strep throat. The organism that causes this infection is Streptococcus pyogenes and is also classified as group A strep (GAS). 

The common presentation differs from that of viral pharyngitis in that there typically are no cold symptoms like cough or runny nose. 

Instead, we see a sudden onset, painful throat, headache, stomach ache and swollen neck glands in ages generally over three. 

Often there is a history of exposure to a classmate or friend. There may be pus on the tonsils or back of the throat, but more characteristic are tiny, dark red flecks, called petechiae that can be seen way in the back. 

This is why I would ask you to say, “Ah” by the way, to better visualize the posterior pharynx. So will all you teens please stop rolling your eyes when I ask you to do this for the third time. 

Some strep infections also come with a very fine, pink sand paper-like rash over the torso.

Why have special tests just for strep? The throat infection itself will simply resolve on its own in the vast majority of cases. Treating with antibiotics will hasten recovery, though. 

The justification for testing for and treating strep throat in children is to prevent the sequelae that are rare, but can be quite significant. 

Untreated GAS can result in a peritonsillar abscess or acute rheumatic fever (ARF). The incidence of this throat abscess formation in untreated strep is 0.5-3 percent. 

The incidence of ARF is about 7 per 10,000 in untreated strep. Of these, about 10 percent will have complications and 1 percent will result in death.

So, not every sore throat needs a doctor’s appointment and certainly not an emergent one. 

If your child is over 3, has a sudden onset of stomach ache, fever and headache with a bad sore throat, it is reasonable to schedule an appointment for that day or next, but also to provide comfort with Tylenol or ibuprofen, rest and fluids. 

If, instead, your child is playful, has a runny nose, slight cough, mild sore throat without a stomach ache or headache, it is perfectly fine to provide symptomatic treatment and observe at home. Hot tea and honey may be just the thing.

 

Dr. Tom Csanadi

Los Alamos