Sore Throats Hurt!

This week's guest columnist is Dr. Chris Fontenot, a Family Practice resident at the University Hospital and Clinics here in  Lafayette. Dreaded words at 7 pm on Friday night: "Mommy, Daddy, my throat hurts."  Doctor's closed, nowhere to turn.  It's a common complaint, especially in my house with three girls. You've had sore throats yourself, and know-they hurt! Pharyngitis- doctor talk for throat inflammation- accounts for about 12 million office and ER visits yearly.  Pharyngitis has two main causes- viral (about 85% of cases), and bacterial (about 15%).  Many viruses cause sore throats, like adenovirus, rhinovirus, and influenza ("the flu").  The most common bacteria is Group A Streptococcus, a.k.a. Strep Throat. It's hard to tell the difference between strep and viral pharyngitis.  Besides throat pain, both cause headache, fever, and fatigue.  However, viruses tend to have more cough and runny nose.  But having those doesn't exclude strep! There's a few rules for doctors to separate the two.  First, strep throat happens mostly after age 3- red throats in babies and toddlers are rarely bacterial.  Second, if the child has a fine-bumpy, sand-papery rash on the trunk and face, that's the "scarlet fever" of strep. The most important rule is that, according to the US Centers for Disease Control (CDC), it's tough to differentiate the two without a strep test. The test is a throat swab that indicates if strep bacteria is present. It's a good test, but not perfect, catching about 85% of strep throats.  Thus your doctor must weigh the symptoms, the exam, AND the strep test to decide if your child has strep.  If it's strep, he needs an antibiotic.  If it's viral, antibiotics don't kill viruses. This is the kicker for parents.  Sore throats hurt, and everyone wants them gone. Many want antibiotics, thinking they will help.  But they won't stop viruses, and we don't give unnecessary antibiotics for good reasons.  Antibiotics have side effects- yeast infections, stomach upset, and possibly allergic reactions.  Most importantly, when your body is exposed to antibiotics, bacteria can develop resistance to the antibiotics, and when you do need them to fight that bacteria, they won't work. We've all had throat pain, and it's miserable.  Dr. Hamilton tells of having yearly sore throats as a teenager.  When he got them, he remembers praying for the pain to go, counting the days of misery, and vowing to never again take feeling good for granted! Like we mentioned above, there's no cure for viral sore throats.  The virus must run it's course, typically 2 to 4 days.  If it's a bacterial strep throat, which again is the minority of cases, only then will an antibiotic help.  So how to treat those viral illnesses that your child must "ride out?" Dr. Hamilton doesn't remember taking medicine for his sore throats, besides throat sprays and lozenges.  And often when we see kids in the Emergency Department, parents haven't given anything for pain either.  For your child's sake, please do! There's two medicines for pain and fever, perfectly safe for kids: Acetaminophen (brand name Tylenol) and Ibuprofen (Advil and Motrin).  These come in many forms and flavors to make them easier for kids to take- liquids, chewable tabs; and for toddlers who spit out medicine instead of swallowing, acetaminophen rectal suppositories. No prescription necessary. Many parents, afraid to overdose their kids, don't give enough medicine for the pain or fever.  Again, it's quite safe to give what's advised on the box for your child's age or weight.  Still unsure?  Call your doctor's office to double-check dosing. Give lots of fluids to help your kid feel better.  She may not eat much, and that's okay. Fluids are more important, and she's not going to starve in a few days.  If she does want food, light meals are best, like grits, oatmeal, or soup.  Popsicles and ice cream can soothe throats too. Keep your child out of school or daycare- don't let them spread the illness to others. They won't feel like learning anyway.  If your child has strep, they must stay out of school for at least 24 hours after starting antibiotics, since it's highly contagious. If your kid keeps getting strep after strep infection, your doctor can refer him to an ENT surgeon for tonsillectomy.  For the vast majority of sore throats though, 2 to 4 days and things will pass.  Push fluids, give pain medicine, and don't take feeling good for granted again.