What are the symptoms of strep A infection in a baby or child?

What are the strep A infection signs and symptoms to look out for?

Strep A can cause various different infections such as tonsillitis, pharyngitis and the skin infections impetigo and cellulitis. Generally, the infections are mild and can resolve on their own, but they can be more serious.

Strep A infection can result in scarlet fever, also sometimes known as strep throat. The signs and symptoms of scarlet fever include:

A high temperature
Sore throat
Swollen glands in the neck
A rash, appearing 12 to 48 hours after other symptoms start. This rash looks like small raised bumps generally on the chest and tummy which then spread. On white skin, the rash looks red but, on darker skin, redness may not be seen. The rash feels rough to the touch, like sandpaper.
Red cheeks. The rash doesn't tend to include the face but the cheeks can become red – again, this may be harder to see on darker skin. The area around the mouth is generally clear of the rash.
White coating on the tongue, which peels off leaving the tongue red and swollen and covered in small bumps. This is called 'strawberry tongue' as it make your child's tongue look like a strawberry – red and covered in tiny bumps

Remember that there are lots of viruses around at the moment so if your child is unwell, it may not be related to group A strep.

If my child has these symptoms, do they need to see a doctor?

If your child has symptoms of scarlet fever, as I've described above, yes, do please seek medical advice.

At the moment, because rates of group A strep are high, doctors have been advised to have a lower-than-normal threshold for giving antibiotics for sore throats.

If you are concerned about your child – irrespective of whether or not they have these particular symptoms – please see your doctor. As a parent, you are the expert on your child!

Which symptoms mean my child needs urgent medical help?

If your child seems very unwell – whether or not you think it is related to group A strep – then seek urgent medical help. Signs that your child is more seriously unwell include:

Not drinking and not passing urine (no wet nappies or going to the toilet for 8 hours). Don't worry so much if your child's not eating: appetite often decreases when your child is unwell and comes back when they are better
A fever of 38°C in a baby under 3 months old or a higher fever which doesn’t come down at all with paracetamol/ibuprofen in an older baby/child
Difficulty breathing: faster breathing than normal, nostrils flaring, muscles under and in between the ribs pulling in with each breath, or grunting noises as they breathe.
Blue skin, lips or tongue
Floppiness or more-than-usual sleepiness or being difficult to wake up

How common is it that strep A infection becomes serious?

Thankfully, strep A infections are treatable with antibiotics and it is rare that children become more seriously unwell.

What is iGas – and how do I know if my child has it?

iGAS stands for invasive group A strep and occurs when the strep A bacteria enters areas of the body where it doesn't normally go, such as the blood or the lungs, where it can cause sepsis or pneumonia.

iGAS is rare but, if your child has any of the symptoms described above, under the heading Which symptoms mean my child needs urgent medical help?, please take your child straight to A&E.

What actually is strep A?

Group A streptococcus is a type of bacteria that is extremely common. Many people– of any age –carry the bacteria on their skin and in their throat without it causing illness.

Why is there a rise in cases of strep A infection in children?

At the time of writing this article, there is not any new evidence that this is a new or more virulent strain of group A strep. Instead, it is thought that the rise in cases is due both to increased amounts of viruses circulating and to the social distancing in the past few years ending. As we now mix as normal, there are many children who have not previously been exposed to infections, and so bacteria and viruses can easily spread.

How do you catch strep A and what can I do to stop my child getting infected?

Group A strep is spread from person to person via respiratory transmission, from coughs and sneezes which you then breathe in, and from contact with saliva and snot – so, for example, when your child wipes their nose on their hand and then touches a toy, and then the next child picks the toy up and pops it straight into their mouth!

The guidance given during the pandemic about coronavirus holds true about many other infections: the phrase 'catch it, bin it, kill it' still works! This means coughing or sneezing into a tissue or the crook of your elbow if no tissue is available, disposing of the tissue and then washing your hands properly. If you or your child are unwell, stay at home and away from others.

What should I do if there's a strep A case at my child's nursery or school?

If a child is diagnosed with scarlet fever, they must stay at home for 24 hours after starting the antibiotics.

Scarlet fever is also a notifiable disease, meaning that the doctor who confirms it will have to notify the relevant health protection teams. This is so the spread of infection can be monitored and, if appropriate, other action taken. At the time of writing, one option being discussed is whether to give antibiotics to other children in a class where there is currently an outbreak.

Are there any complications of group A strep?

There can be complications of scarlet fever which include ear infections, throat abscess and pneumonia. In the longer term, more rarely, there is a risk of rheumatic fever which can cause joint pains and heart problems and is thought to be due to the immune response to the infection. These are now much more rare than previously due to the use of antibiotics.

Extremely rarely there is a risk of PANs or PANDAs. PANs stands for paediatric acute onset neuropsychiatric syndrome and PANDAS is a subtype of PANs. PANDAS stands for paediatric autoimmune neuropsychiatric disorder associated with streptococcal infections. These are thought to be related to the immune system attacking parts of the body aside from where the infection was and causes symptoms such as sudden onset of obsessive compulsive disorder and tics.

Does the nasal flu vaccine cause group A strep?

No.

Almost as soon as the news about group A strep cases rising hit the headlines, there has been misinformation spread on social media about the nasal flu vaccination causing group A strep. This is NOT the case
Dr Philippa Kaye, expert family GP and mum of 3

A study¹ did show that the nasal flu vaccine can affect the bacteria in the airways of mice, not humans. The nasal flu vaccination has been used safely for many years and there has not been a significant rise in strep A infections since the use of the vaccine.

The nasal flu vaccine protects your child against flu which can be extremely serious in children and also helps protect other family members as children are very good at spreading flu, even if they aren't unwell with it themselves.

About our expert Dr Philippa Kaye

Dr Philippa Kaye works as a GP in both NHS and private practice. She attended Downing College, Cambridge, then took medical studies at Guy’s, King’s and St Thomas’s medical schools in London, training in paediatrics, gynaecology, care of the elderly, acute medicine, psychiatry and general practice. Dr Philippa has also written a number of books, including ones on child health, diabetes in childhood and adolescence. She is a mum of 3.

References:

^{1. Live attenuated influenza vaccine enhances colonization of Streptococcus pneumoniae and Staphylococcus aureus in mice. Mina et al. M. Bio. 2014 Feb 18;5(1):e01040-13. doi: 10.1128/mBio.01040-13.}

Pic: Getty Images

Dr Philippa KayeGP