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Child having fever, red throat and strained breathing. Strep test and culture negative. What to do?

Answered by
Dr. Sujeet N Charugulla

General & Family Physician

Practicing since :2004

Answered : 540 Questions

Posted on Wed, 2 Jan 2013 in Infections
Question: My son is 4 year 8 months old. He has fever for the last 4 days. Strep test and culture were negative. He has red throat and does not eat much. Fever comes and goes with ibuprufen. He sleeps with strained breathing. Right now he is getting foam on his lips while sleeping. Breathing is same, strained as before. What should I do?
Answered by Dr. Sujeet N Charugulla 2 hours later
Hello and thanks for your query.

I shall make an effort to provide you with good professional recommendations specific to your questions.

Your son's present status has obviously got you concerned. With this medical history, his ongoing fever indicates active infection. And I do not think administering Ibuprofen is a good idea for the same. His wheezing would need the appropriate bronchodilator drug therapy, which has already been used for his bronchiolitis episode earlier. Foaming in the mouth is a symptom that requires ruling out lung causes most commonly like pneumonia, considering your son's history. Hence, the wheezing and strained breathing.

I understand that Streptococcus had been ruled out with sputum examination. Of course this is the most common cause of pneumonia, but the possibility of other bacteria involved has to be looked into. Again, with history of bronchiolitis - a viral cause also may be one of the reasons - in which case symptomatic therapy is anyway recommended. Moreover, there are other investigations like blood tests, bronchoscopy, chest radiography that aid in the diagnosis to a clinican and may be ordered as per need.

The ideal treatment, in the case that a bacteria is identified eventually - would be appropriate antibiotics selected on the basis of susceptibility reports for a set duration.

His age is over the vaccine age group, but you could discuss the same only after complete treatment of the present condition.

Hence, keeping in purview all the above - I would suggest you to get immediate medical attention with a chest medicine specialist as it is already 4 days of fever.

Let me know if I have missed out any other concern in your question.

Yet again, I duly appreciate your query to me, I do hope that you have found something useful to help you and I shall be glad to answer any further apprehensions.


Dr Sujeet N Charugulla,
Consultant Physician.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Sujeet N Charugulla 11 minutes later
My son does not have wheezing any more for two weeks now. He has been advised to continue steroid inhalers for the next few months as a preventive step.
His fever started with vomiting on Friday, December 07, which went away after a few hours. But the fever continued. On Saturday he developed sore throat and this has worsened. We took him to his pediatrician. She examined him thoroughly. His chest is clean, both on exam and X-ray. His strep test was negative. His fever responds to ibuprufen but returns after a few hours, especially at night. He has difficulty breathing when asleep as if there is congestion behind the nose; the nose is not watery otherwise. Today we gave him saline drops before putting him to bed. I don't know if the foam on his lips is because of this. In any case, what should we do and if it's a viral sore throat, what should be done? He had bronchiolitis in Nov and now sore throat and fever? What could be the cause of getting infections?
Answered by Dr. Sujeet N Charugulla 20 hours later
Thanks for the follow up reply, and adding further details about your son's condition.

Yes, those steroid inhalers do wonders as bronchodilators and are necessary to keep his breathing difficulty on the low.

Now, I realize that sore throat as examined by your pediatrician as inconclusive otherwise as evident by those negative tests. Saline drops are usually prescribed in children and give a reasonable symptom relief - hence needs compliance.

In this present obvious strong possibility of viral sore throat - the line of treatment as given by your doctors look good, as antibiotics are unnecessary, and only symptomatic therapy is indicated for fever, breathing difficulty.

Foaming in lips is an offshoot of certain breathing difficulty when asleep, and should subside as steroid inhalers take some time to attain peak clinical effect and lung airways get fully cleared.

Bronchiolitis does have a propensity to recur sometimes, and especially so during seasonal changes in the year. To be precise, the cause depends on age of child - 4 different viruses have been documented to cause this condition which is usually seen in infants and those less than 2 years. But, the treatment remains same.

I would suggest you to calm down and follow treatment for now, as I believe the course of your son's therapy looks good and rational. Later, when the steroid inhalers are gradually weaned away and your child is entirely well, you can think of ways to increase his overall immunity - as this is one area that protects from future viral infections.

Let me know if you need further clarifications.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

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