When Your Child Has Rheumatic Fever

Rheumatic fever is a complex disease that can affect the joints, skin, heart, blood vessels, and brain. It occurs mainly in children between ages 5 and 15. It's an autoimmune disease that occurs most often after a throat infection with strep (streptococcus) bacteria. Rheumatic fever happens more often in the winter and spring. That's because strep throat infections occur more often then. Strep is contagious. This means it can be spread from child to child. But rheumatic fever isn't contagious.

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Rheumatic fever is an autoimmune reaction to the strep bacteria. An autoimmune reaction is when the body attacks its own tissues. It can be prevented if strep throat is diagnosed right away and treated correctly with antibiotics. But many cases of rheumatic fever occur because strep throat isn't treated right away. Despite this, rheumatic fever isn't common in the United States.

Children ages 5 to 15 are most at risk. They're more at risk if they:

• Have strep throat infections often.
• Have strep infections that weren't treated, or not treated adequately.
• Have a family history of rheumatic fever.

The symptoms usually start about 1 to 5 weeks after a child has been infected with strep bacteria. Each child's symptoms may vary. Common symptoms can include:

• Inflammation in joints such as the knees or ankles that causes swelling, soreness, and redness.
• Small, painless, hard bumps (nodules) under the skin, often over bony areas.
• Abnormal jerky movements, most often of the face and hands. This is often noted by a change in a child's handwriting.
• Red rash with odd edges on the torso, arms, or legs.
• Fever.
• Weight loss.
• Severe tiredness (fatigue).
• Stomach pains.

The doctor will take your child's health history and give them a physical exam. Your child may also have tests such as:

• Blood tests. These are done to look for signs of inflammation, recent strep infection, and other related problems.
• Electrocardiogram (ECG). This is a test that records the electrical activity of the heart. It shows abnormal rhythms and finds heart muscle damage.
• Echocardiogram (ECHO). Anultrasound test that uses sound waves to create moving pictures of your heart’s structure and pumping function to look for any abnormalities.
• Throat culture. A swab is wiped on the throat. This is done to look for the strep bacteria.

Your child's doctor will look for:

• Inflammation of the heart.
• Inflammation of more than one joint.
• Abnormal jerky movements.
• Small, hard bumps under the skin.
• Red, irregular rash.
• Fever.
• Pain in one or more joints.
• Past inflammation of the heart.
• Changes in the ECG pattern.
• Abnormal blood tests.

Treatment will depend on your child's symptoms, age, and general health. It will also depend on how bad the condition is. Treatment often combines these three things:

• Treatment for strep. The first step is to treat the strep infection with antibiotics. This is done even if a throat culture is negative. Your child may need to take monthly doses of antibiotics. If your child's heart was affected they'll need to take antibiotics for a longer time. This is to help prevent other problems.
• Anti-inflammatory medicines. Your child may take medicines to help decrease the swelling that occurs in the heart muscle. These medicines also help ease joint pain.
• Bed rest. The length of bed rest will depend on how severe your child's illness is. Bed rest may range from 2 to 12 weeks.

Talk with your child's doctor about the risks, benefits, and possible side effects of all medicines.

Having rheumatic fever increases your child's chances of having the disease again. Your child is at highest risk in the first 3 years after the first illness. The chance of having it again reduces with age and time. After having rheumatic fever, your child will need to take antibiotics every month. These are to help reduce the chance of having rheumatic fever again. Treatment length varies depending on the severity. They can last until the child is 21. In some cases they may need to take antibiotics for life. Close follow-up with your child's doctor is needed.

If the illness severely attacks a child's heart, this may damage heart valves and cause heart disease. In this case, your child may not be able to do some kinds of physical activity and sports.

If the heart was damaged by the fever, your child will need to take special care when going to the dentist. They may need to take antibiotics before having dental work done. This helps lower the chance of an infection traveling to the heart during a dental procedure. Talk with your child's doctor for more information.

Contact the doctor if your child has any of these:

• Symptoms that don't get better or that get worse
• New symptoms