If your child develops rheumatic fever then it is likely that your GP will refer you to a paediatrician.
Due to the very rare nature of rheumatic fever in England, you may also be referred to a doctor with previous experience of treating this condition so a treatment plan can be drawn up.
This may involve visiting a hospital or specialist clinic in one of the larger cities in England.
Most people with rheumatic fever are well enough to be treated at home but they may need to make regular hospital visits so the state of their heart can be monitored.
Treatment plan
There is currently no cure for rheumatic fever but it is possible to make your child feel as comfortable as possible while reducing the risk of serious complications.
This can be achieved by:
- using anti-inflammatory medications to relieve symptoms
- using antibiotics to clear out any remaining streptococcus bacteria in your child’s body
plenty of bed rest
Anti-inflammatory medications
Anti-inflammatory medications can be used to relieve symptoms of joint pain and swelling (arthritis), and in severe cases, reduce inflammation of the heart.
A common type of anti-inflammatory medicine used to relieve arthritis include the non-steroidal anti-inflammatory drugs (NSAIDs) type of painkillers such as ibuprofen, and aspirin.
The use of aspirin is not usually recommended in children under the age of 16 as it carries a very small risk of causing Reye’s syndrome, a potentially fatal condition that can cause liver and brain damage.
However, an exception is usually made in cases of rheumatic fever as most children are only required to take a low-dose aspirin for one to two weeks and it has proved extremely successful in relieving symptoms. Most health professionals feel that the benefits of aspirin in the treatment of rheumatic fever far outweigh the risks.
If the results of your electrocardiogram (ECG) show inflammation of the heart, a type of steroid medication called prednisolone will usually be recommended.
Prednisolone is usually given in tablet form for a course of two to six weeks.
Side effects of prednisolone include headache, dizziness, problems sleeping and weight gain.
These side effects should pass once the course is finished.
Antibiotics
It is important to get rid of any streptococcus bacteria left in your child’s body is because further throat infections they may lead to another episode of rheumatic fever.
Repeated episodes of rheumatic fever carry an increased risk of causing permanent damage to their heart.
It is usually recommended that they are given injections of antibiotics (intravenous antibiotics) every two to three weeks over the course of many years.
The current recommendations are:
- if your child did not experience any inflammation of the heart the course should last for five years or until your child is 18 (whichever is longer)
- if your child did experience inflammation of the heart but their heart recovered, the course should last for 10 years or until your child is 25 (whichever is longer)
- if your child had inflammation of the heart which caused significant persistent heart disease, the course should last until they age at least 40-45 (some doctors have recommended that the course should last for the rest of their life)
Bed rest
Plenty of bed rest is recommended as this will help reduce the strain on the heart and help ease some of the symptoms, such as shortness of breath and feeling tired all the time.
As your child begins to recover, they can slowly increase their activities levels.
The doctor in charge of your child’s care will be able to make more detailed recommendations.
Sydenham chorea
If your child is experiencing episodes of Sydenham chorea (uncontrollable physical jerking and emotional outbursts) then often moving them into a calm, quite environments, such as a darkened bedroom can help improve symptoms.
If these episodes are more severe then medication may be recommended. Medicines originally designed to treat epilepsy, such as carbamazepine and valproic acid) are usually effective in treating Sydenham chorea.
If the dose is too high these medicines can cause side effects similar to being drunk, including unstediness, double vision and vomiting.
If your child experiences any of these symptoms, contact the doctor in charge of your child’s care so that the dosage can be revised.
