Scarlet Fever and invasive Group A strep: advice for parents and carers

There are lots of viruses that cause sore throats, colds and coughs circulating, especially over winter. These usually resolve without needing any special medical treatment or medicines. However, children can occasionally develop a bacterial infection on top of a virus and that can make them more unwell.

One of these bacteria is called Group A Strep (GAS). You may have heard this in the news as it has been found in some children who have become very sick, very quickly. Fortunately, this is still rare.

There is much more GAS around this winter than in recent years, causing a lot of children to be unwell. We think this is because there is much more mixing now and these bugs are new to many young children, so they are more likely to catch and spread them.

GAS usually causes a mild illness with fever and a sore throat (Strep throat) but not a runny nose or too much of a cough. Your child may be poorly for a few days but will usually recover. Antibiotics may help them recover quicker.

Signs that suggest your child might have Strep throat are:

  • Fever within the last 24 hours
  • White spots at the back of their throat (pus on their tonsils)
  • Very large or red tonsils
  • Sore (tender) lumps under their chin
  • If they have become poorly quickly over the past couple of days
  • No cough or runny nose

If you are concerned that your child might have these contact 111, your GP Surgery, or Walk-in Centre for advice. 

GAS and Scarlet Fever

Sometimes, GAS can cause Scarlet Fever.

Symptoms include a sore throat, headache, and fever, along with a fine, pinkish or red body rash with a tiny, rough pimples (“sandpapery” feel). On darker skin the rash can be more difficult to see but the skin will have a sandpapery feel. They might have a very red tongue or lips. Contact NHS 111 or your GP if you are worried your child has Scarlet Fever, because early treatment of Scarlet Fever with antibiotics is important to reduce the risk of complications such as pneumonia or a bloodstream infection. If your child is not too sick, these antibiotics can safely be given by you at home. If your child has Scarlet Fever, keep them at home until at least 24 hours after the start of antibiotic treatment to avoid spreading the infection to others.

Most children with GAS throat infection or Scarlet Fever will get better with antibiotics. Unfortunately, very occasionally some children become unwell later because their body produces an exaggerated immune response, or the bacteria gets into the blood stream and causes a more severe infection (called “invasive GAS” or iGAS).

As a parent, if you feel that your child seems seriously unwell, or is becoming more unwell even if they are on treatment or have recently finished antibiotics, you should trust your own judgement.

Contact NHS 111 or your GP if your child is getting worse despite paracetamol or ibuprofen if:

  • the temperature has lasted more than 5 days
  • your child is feeding or eating much less than normal, especially if they are drooling or appear in pain when swallowing
  • your baby has had a dry nappy for 12 hours or more, or is crying without tears
  • or your child shows other signs of dehydration
    • feeling thirsty
    • dark yellow, strong-smelling pee
    • peeing less often than usual
    • feeling dizzy or lightheaded
    • feeling tired
    • a dry mouth, lips and tongue
    • sunken eyes (dark circles under eyes)
  • your baby is under 3 months and has a temperature of 38°C, or is older than 3 months and has a temperature of 39°C or higher
  • your baby feels hotter than usual when you touch their back or chest, or feels sweaty
  • your child is drowsy (much more sleepy than normal) or irritable (unable to settle them with cuddles, toys, TV or snacks – especially if they remain drowsy or irritable despite any fever coming down)

Call 999 or go to A&E if:

  • your child is having difficulty breathing – you may notice grunting noises or their tummy sucking under their ribs or using their neck muscles to breathe
  • there are long pauses (more than 10 seconds) when your child breathes
  • your child’s skin, tongue or lips are blue 
  • your child feels very cold or clammy to touch
  • your child is difficult to wake up or keep awake
  • your child has severe pains in their arms, legs neck or back
  • your child has a painful, red area of skin, especially if it is getting bigger quickly

Good hand and respiratory hygiene are important for stopping the spread of many bugs. By teaching your child how to wash their hands properly with soap for 20 seconds, using a tissue to catch coughs and sneezes, and keeping away from others when feeling unwell, they will be able to reduce the risk of picking up, or spreading, infections.

Keep unwell children off school or nursery and away from vulnerable adults and children.

We know that when there are lots of viruses circulating, like flu, more serious infections like GAS can use this to get a hold. Reducing these viruses through vaccination, including Flu and Covid vaccines, can protect against GAS outbreaks. Getting yourself and your child vaccinated is the best way to make sure they are protected from serious illnesses.

With thanks to the team at Alder Hey Children’s Hospital for collating this information.