What Every Parent Needs To Know About Strep Throat: Mono, Amoxicillin, Rash, And PANDAS

You are likely familiar with Murphy's Law—if anything can go wrong, it will. And it usually happens at the worst time, such as when your child complains of a sore throat and has a fever, indicating strep throat, but the pediatrician's office is closed. Fortunately, there are urgent care clinics available so you can get your little one the medical care they need. However, there are a few important things to understand if your child is treated for strep throat. Here's what you need to know.

Rule Out Mono & Avoid Amoxicillin

Sometimes, healthcare professionals opt to give a clinical diagnosis for strep based on symptoms alone, without running tests to determine whether or not the symptoms are caused by a strep infection. However, a sore throat and fever are also symptoms of infectious mononucleosis, which is more commonly known as mono, and is determined by a blood test. Keep in mind that even if your child is given a clinical diagnosis for strep or the diagnosis is determined through a rapid antigen test or throat culture, you'll also want to rule out mono as another cause of the symptoms if there's a chance that your child has been exposed to it.

If no mono test is ordered, be sure to ask the healthcare professional to prescribe an antibiotic other than Amoxicillin to your child. The reason for this is because Amoxicillin can cause a rash to develop when the person has mono. This rash, which is not an allergic reaction, would be bright red and in small patches. It would have defined edges and be extremely itchy. Since it's not a true allergic reaction, antihistamines might help but may not entirely relieve the itching. Obviously, your child would have to discontinue the antibiotic, which would likely cause their strep infection to continue. If so, a return trip to the urgent care clinic would be necessary. This is why Amoxicillin should be avoided from the beginning. 

Watch for Signs of PANDAS

Another thing to be watchful for is pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. Since that's quite a mouthful, it's shortened to PANDAS. This is a disorder that is caused by the autoimmune system attacking the brain's molecules in addition to the strep bacteria itself. This happens because strep bacterium hide by transforming to look like a molecule in the body. The autoimmune response gets confused and attacks everything it believes is an invader.

This autoimmune response of an attack on the molecules in the brain can cause children to suddenly develop extreme symptoms of obsessive compulsive disorder. For example, your child may wake up one day soon after acquiring strep throat and be incessantly clingy and obsessively needy. He or she may act completely out of their normal character. Or your child could suddenly develop a tic disorder, which would cause twitching in parts of the body, or they could suddenly blurt out sounds.

These symptoms are only short-lived because they are episodic in nature. One important thing to understand about PANDAS is that the episodes come on and go away so suddenly and drastically that you should not mistake the reaction as symptoms of PANDAS, especially now that you know that this disorder actually exists. However, it's also important to understand that your child will be at risk of having subsequent episodes after each strep infection and each episode can cause more damage to his or her brain.

PANDAS children need cognitive behavioral therapy and psychiatric treatment, which should be on-going after a diagnosis is made by a neuropsychiatrist. If your child starts exhibiting signs and symptoms of PANDAS at any time during or after having a strep infection, you'll need to take him or her to the pediatrician or an urgent care center for a referral to a neuropsychiatrist for PANDAS treatment.