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Why downplaying strep throat in children can be a mistake

LITTLE BOY,SICK,FEVER,HOME
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Illnesses like PANDAS are helping doctors recognize the link between the body and the brain.

You know that scene in Little Women when Beth goes to take a lone potato to the sick Hubble children and then comes home with scarlet fever? I always thought that particular scene was so poignant, and so tragic. The German mother’s helplessness, her desperation … the baby’s plaintive wailing … Beth’s pinched expression when she lifts her head from the piano. And all from something so easily treatable for us! Strep throat, such a common childhood infection, easily treated with antibiotics. No big deal anymore.

I was three kids in before I realized that strep is still a big deal, particularly if it goes untreated. Some kids are asymptomatic and never complain of a sore throat or develop a fever. When my third child was a toddler, it wasn’t until he sprouted the telltale scarlet fever rash a few weeks later that I knew he had had strep at all. The doctor prescribed an antibiotic but I protested.

“He already had strep and fought it off though, right? Why does he need antibiotics for a rash?” I asked, concerned about the growing reports of antibiotic overuse.

“Oh, no. That’s not how strep works. This is still strep, it’s just manifesting in a rash now,” the doctor explained. “Strep does wonky things in the body when it goes untreated, and can even damage the heart. He needs the antibiotics — strep is serious business.”

I gulped, remembering how I had dithered about taking him in at all. We filled the prescription and dutifully gave Liam the antibiotics, newly respectful of the power of strep. I became overly vigilant about taking all my kids to the doctor when even one had a sore throat, always aware that “wonky things” could happen with strep. What those might be (aside from heart damage), I had no clue. But I sure didn’t want to find out.

Lately, my news feed has been full of accounts of parents finding out just what wonky things untreated strep can do, and it’s both frightening and unexpected. Illnesses like strep throat can suddenly bring on a complicated disorder with perplexing symptoms. Lisa Swint shared her story of her daughter’s perplexing descent into “excruciating madness” at Scary Mommy, which started with a rash in her vaginal area before mutating into OCD-like behaviors, anxiety, and rage. Her pediatrician’s office recommended a pediatric psychiatrist when she first called to make an appointment, but the waiting list was months long. Lisa finally called the pediatrician and got a same-day appointment under the guise that her daughter had a sore throat:

I was tripping over my words trying to explain to the pediatrician that my daughter did not have a sore throat, but had experienced these bizarre behavioral changes when she interrupted me, “PANDAS. This sounds like PANDAS.” Simply put, in PANDAS/PANS, antibodies made in response to an infectious trigger mistakenly attack healthy brain tissue, causing a host of neuropsychiatric symptoms.

The treatment for PANDAS can be complicated. The goal is to reduce inflammation, fight the infection, and rebuild the immune system. Most kids require counseling for lingering anxiety and OCD behaviors. And any exposure to strep can cause the symptoms to flare up and treatment to start all over again.

I know how awful it sounds, but something about the growing recognition of PANDAS is a sign of hope to me. Not only can we treat complex medical mysteries, but we are at last beginning to recognize the link between mental and physical health. Rather than treating the brain as isolated from the body, the PANDAS phenomenon is forcing doctors across multiple fields to treat the body as a whole and to recognize that the health of the body impacts the brain, and vice versa. This is a huge step forward in medical advancement and heralds a better future and better health for our children, and their children.

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