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Claire McCarthy

Five important things you might not know about strep throat

by Claire McCarthy on March 20, 2012

On the Richter Scale of childhood illness, strep throat ranks pretty low, but its little tremors can wreak a fair bit of havoc on the day-to-day lives of parents and children. It’s also one of those illnesses that’s so common that people often think they know everything there is to know about it. But as a pediatrician I’ve discovered that parents really don’t know everything about this pesky and painful illness.

Here are five important things you might not know about strep–but should:

Not all sore throats are strep. In fact, at most 30 percent of sore throats are caused by group A streptococcus, the bacteria that causes strep throat. The vast majority of sore throats are caused by viruses. And while you may think you know it’s strep from how it looks or your past experience, studies have shown that it simply isn’t as easy as it might seem; viruses and strep can look remarkably similar. To make the diagnosis, we need to do a rapid strep test or a throat culture. So if your pediatrician insists on seeing your child instead of calling in a prescription, they are doing the right thing.
Not all strep throats are sore. Kids with strep throat can have headaches, stomachaches, vomiting and rash, or some combination of these symptoms—and sometimes these symptoms can bother them more than their throat does. I’ve seen lot of kids in the office with vomiting or headache and no sore throat who turned out to have strep, much to the surprise of their parents.
Strep usually gets better without antibiotics, but we treat it anyway. This one often surprises people. Our immune system is actually pretty good at fighting group A streptococcus, and will generally get rid of it in a few days. But we give antibiotics, for three reasons:
- To make kids feel better faster. If you’ve ever had strep, you know how miserable it can feel.
- To prevent complications. Although it’s rare, strep throat can lead to problems in the heart, kidney and even the brain. By treating the infection, we make those complications far less likely.
- To prevent spread of the infection. Strep is very contagious, as many parents and teachers will tell you. Once someone has been treated with antibiotics for 24 hours, the chances that they will give it to someone else go way down.
Having a positive culture doesn’t necessarily mean you have an infection. Strep can live in our noses, mouths and throats and not make us sick. This is called being a carrier, and it’s more common than people realize. Sometimes it’s hard to tell whether someone actually has strep throat or whether they are sick with a virus and happen to be a carrier! Because of this, we don’t recommend doing another test after treatment unless the person is still feeling sick. Most of the time being a carrier doesn’t cause trouble. If it seems to be causing recurrent infections, stronger antibiotics can be used, and sometimes a tonsillectomy is recommended.
Even though you may feel better after a day or two, it’s important to take the full course of antibiotics. It really can be tempting to stop once that fever is gone and your child is happy and eating again—after all, they look completely better, and most kids don’t like taking medicine—but if you do, there’s a good chance the infection won’t really be gone and in a few days you’ll be right back where you started.

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My embarrassing admission as a doctor: my son doesn’t have a healthy diet

by Claire McCarthy on March 13, 2012

Dr. Claire McCarthy is a primary care physician and the Medical Communications Editor at Children’s Hospital Boston. Along with her blogs here on Thriving, you can find her at the Huffington Post and Boston.com. Follow her on Twitter @drClaire.

As a pediatrician I am embarrassed to admit this, but my 6-year-old son has a terrible diet.

Well, not terribly terrible. He doesn’t live on chips and soda. But it’s remarkably lacking in the things I always tell my patients to eat, like fruits, vegetables, low-fat dairy and whole grains.

It’s not for lack of trying on my part. I serve these foods to him regularly, including in the snack I pack him for school. As I encourage parents in my practice to do, I pack things like grapes and string cheese—which often come back uneaten. I think it was out of sheer exasperation that he wrote the note to us (in his best kindergarten spelling) that I found in his backpack. Full story »

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Boston Children’s joins with Harvard Medical School to transform primary care

by Claire McCarthy on March 6, 2012

Those of us who do primary care often feel like Rodney Dangerfield: we get no respect. Compared to the specialists, our job is thought of as, well, lowly and ordinary.

But that’s changing—and Children’s Hospital Boston is leading the way. The primary care departments of Children’s, Children’s Hospital Primary Care Center (CHPCC) and Martha Eliot Health Center (MEHC), have been chosen by Harvard Medical School to take part in its Center for Primary Care’s Academic Innovation Collaborative. They have been awarded $900,000 over two years, to be matched by the hospital, to work with the Collaborative to transform primary care delivery and education. Full story »

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So much for quick fixes: active video games don’t make kids more active

by Claire McCarthy on February 28, 2012

It seemed like such a great idea.

We need kids to be more active. With a third of US kids overweight or obese, and studies showing that childhood obesity leads to adult obesity, getting the recommended hour a day of activity is more important than ever. Problem is, kids aren’t doing it. For all sorts of reasons, some good and most bad, our kids are turning into couch potatoes.

I was getting really frustrated with my inability to get my patients moving. Then I heard about active video games, like Wii Fit and Just Dance and Dance Dance Revolution, and I thought: this is perfect. Kids love video games. Full story »

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Translating medicine into real life

by Claire McCarthy on February 21, 2012

Claire McCarthy, MD

The Boston Globe recently reported on a Children’s Hospital Boston study that shows a preventative approach to treating asthma can keep kids out of the Emergency Department (ED) and save money on health care spending. Here, Dr. Claire talks about the medical professionals whose commitment to keeping children healthy supports these innovative approaches to medicine.

I have known Susan Sommer, a nurse in the Community Asthma Initiative (CAI) at Boston Children’s, for nearly twenty years—we met at Martha Eliot Health Center when we were both working there. I was so happy when she started working with CAI, because she is the perfect person to do that kind of work. There are three things that are undeniably true about Susan. First, she really cares about people. I mean really cares, as if each and every one of us were family. Second, she’s really smart. Third, she gets real life.

That last one isn’t to be taken for granted, especially when we’re talking about medical professionals. Sadly, it can be said about us that we often have our heads up in the clouds. We prescribe things based on science and studies—which is good, don’t get me wrong, medical treatments should be based in science and studies. But when patients leave the hospital and go home, real life has a way of, well, getting in the way. Full story »

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Five ways you can help your child have a healthy heart for life

by Claire McCarthy on February 14, 2012

February is American Heart Month, which is a really good time to think not just about Valentine’s Day, but your child’s heart.

Chances are, that heart is healthy. But here’s the thing: what you do now has everything to do with whether it stays healthy. The changes in the heart that lead to disease can start in childhood—and habits we learn as children have a way of sticking with us (we old dogs are very familiar with the new tricks problem). After all, our job as parents is to raise our children to have a good and healthy future. Full story »

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Preteens and cell phones: my change of heart

by Claire McCarthy on February 7, 2012

One evening last May, I came home to the note below.

Natasha's treatise, page 1

My daughter Natasha, 10 years old and in 4^thgrade at the time, wanted a cell phone bad. She’d been asking and asking and essentially being ignored, so she decided to put her argument in writing (with, I found out later, the support of my husband). She went through all the reasons she should have one (you can’t tell from the picture, but it was on really big paper), figuring it would be irrefutable.

It didn’t work. We said no, you have to wait until middle school like your older siblings did. She really didn’t need one—she never strayed far from home, we didn’t need it for school pick-up planning (she always knows if she should walk home), and we were pretty good at estimating when we should pick her up from swim practice (there are phones at the YMCA to call us if there is a problem). More importantly, we were concerned about the downsides of cell phones. We didn’t want her distracted (it was the image of Tash texting as she walked in the street that changed my husband’s mind), we didn’t want to deal with the possibilities of things like sexting or bullying via cell phone, and the World Health Organization had just come out with a statement saying that cell phone usage could possibly increase the risk of cancer (they put it in the same group as coffee, but whatever, risk is risk).

Natasha's treatise, page 2

And, it turned out, the real reason she wanted one was that her friends had them. It wasn’t about needing one, it was about wanting to be cool. She kept up the campaign for a long time. Finally, after several months, she gave up (I have to say, although it was a relief not to be fighting with her, part of me that felt sad that we’d squelched her feistiness.)

Then something happened: I started wishing Tash had a cell phone.

Mostly, it was the darn swim practice thing. Who knows, maybe it was on purpose, but she got more social with the girls on the team and sometimes (unpredictably, of course) took literally forever showering and getting dressed. Because we don’t want her waiting outside on the street long, especially in winter, we err on the side of getting there early (leaving dinner on the stove or work undone)—and sometimes wait for a frustratingly long time.

But it was more than that. Tash started venturing out into the world more—going on bike rides alone, walking further to friends’ houses, going with friends to the park. Although we have all sorts of rules about routes and contacting us, I couldn’t help wishing there was a way for us to reach her—or her us—immediately if necessary.

I’m not alone in wanting my preteen kid to have a phone. According to a 2010 Mediamark Research Intelligence study, from 2005-2009 the percentage of 10-11-year-olds with a cell phone went from 20% to 36%, an 80% increase. Given the exponential nature of this rise, we are probably at around 50% now.

Cell phones are simply becoming part of life for our youth. In a 2009 Pew Internet survey, none of the 17-year-olds surveyed had cell phones when they were 11—but 16% of 14-year-olds and 20% of 13-year-olds did. I get that evolution. When my oldest two got their phones 7 years ago at 13 and 12, I had no idea how it was going to affect our lives. Now I have a better idea. Yes, there are dangers and downsides. We’ve learned to manage most of those with safety and usage rules (no texting while walking on the street and phone off at bedtime, for example.) We talk about bullying and other ways phone usage can go bad.

But we’ve also found that there are real upsides. The convenience and safety stuff is huge, but the ability to connect is really wonderful too. The other day my son called mid-afternoon to say he’d just walked within 5 feet of Secretary of Defense Robert Gates on his college campus (way cooler than any movie star as far as Zack is concerned). We send pictures or videos of what we are doing back and forth. We wish each other good luck. We are always within reach of each other—and as a parent, I love that.

So as Natasha’s 11^th birthday approached, I talked to my husband. Turns out he’d been thinking the same thing. Here’s the video (the hugs caused some technical difficulties):

For more information about kids and cell phones, visit the website of the Center on Media and Child Health

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Confession: this pediatrician is a sleep softie

by Claire McCarthy on January 31, 2012

This may not be a great confession to make as a pediatrician, but when it comes to sleep and kids, I am a total softie.

Our kids slept in our bed. We slept in theirs (which was very cramped in the toddler bed, and didn’t do great things to the frame)—or lay next to them as they drifted off to sleep. We sat on the floor, telling stories and singing lullabies and slowly edging out of the bedroom as their breathing got deep and regular. We went in again and again to retrieve the stuffed animal from under the bed or to investigate the scary noise or possible spider. When they woke in the middle of the night, we held them until they went back to sleep—sometimes night after night. Full story »

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