Key points to remember

This fact sheet is designed for parents / caregivers of children with rheumatic fever and rheumatic heart disease. For information about preventing rheumatic fever, see Sore throat on this website (especially Key points to remember about sore throats and When should I seek help for my child with a sore throat?).

• rheumatic fever is an illness which starts with a streptococcal infection.
• a few weeks after infection with the "strep bug ‘your child may develop other symptoms such as sore or swollen joints
• each attack of rheumatic fever may cause permanent damage to their heart valves. This is called rheumatic heart disease
• it is very important that your child does not get rheumatic fever again
• the best way to stop your child having another attack of rheumatic fever is to make sure they have regular penicillin injections - on time

What is it?

Rheumatic fever is an illness which starts with a streptococcal infection.

A few weeks after the "strep" throat or “ school sores” your child may develop:

• sore or swollen joints (knees, elbows, ankles and wrists)
• a skin rash
• a fever
• stomach pain
• jerky movements

See the following fact sheet on this website:

• Sore throat

How can rheumatic fever affect the heart?

If your child has a bad attack of rheumatic fever, it may cause permanent damage to their heart valves. This is called rheumatic heart disease.

A heart valve acts like a one-way door. It makes sure that blood pumped by the heart flows in one direction only. When the heart valve is damaged it can leak and may cause:

• breathlessness
• tiredness

Will these symptoms of rheumatic fever go away?

Most of these acute symptoms, such as sore or swollen joints (knees, elbows, ankles and wrists), a skin rash, a fever, stomach pain and jerky movements, will go away in time.

However, damage to the heart valves - rheumatic heart disease - may be permanent.

What happens when my child is in hospital?

Your child will usually need to stay in hospital for one to two weeks, but it is sometimes longer if their heart is affected. They will have regular examinations and blood tests to check their condition. Sore joints can be treated with rest and aspirin.

What if my child also has rheumatic heart disease?

If your child has damage to their heart valve they:

• may need to stay in hospital for longer
• may have penicillin injections for much longer
• will need special care when visiting the dentist or dental therapist (nurse)
• may eventually need surgery to repair the damaged valve.

Your doctor or nurse will speak to you about the care and treatment your child needs while they are in hospital.

What care will my child need at home?

Your child will still need to take it easy when they go home. They will also need to have ongoing penicillin injections to prevent another attack. Another antibiotic, (for example, Erythromycin) will be given to people who are allergic to penicillin.

It is very important that your child does not get rheumatic fever again. Another attack could cause long term damage to the heart and heart valves.

How can I stop my child having another attack of rheumatic fever?

The best way to stop your child having another attack of rheumatic fever is to make sure they have regular penicillin injections - on time.

Penicillin injections:

• must be given every 28 days
• are given in your child's thigh or bottom
• can be painful at first but children quickly get used to them
• are given by your community nurse, district nurse or public health nurse. They will come to your home or your child's school and give the injection

How long will my child need to have penicillin injections?

Your child will need to have injections for 10 years, or until they are 21 years old, whichever is longer. If your child has damage to their heart valve they may need injections  until they are 30 years old..

This may seem like a long time but if your child doesn't have these injections they could have another rheumatc fever attack which increases the risk of heart valve damage..

Your doctor will tell you when it  is safe for your child to stop having the penicillin injections.

What if my child misses or forgets an injection?

It is very important that your child does not miss an injection. If they do, then you must arrange for them to get the next injection as soon as possible.

Remember to tell your doctor or nurse if your child is going overseas, on holiday, away for a while, or you are moving house.

They can then arrange ongoing treatment for your child.

Your child should never stop penicillin treatment without discussing this first with your doctor.

Will my child be able to lead a normal life?

With proper care and regular penicillin injections, most children with rheumatic fever lead a normal life.

The important thing is to make sure your child never has another attack of rheumatic fever. The only way you can do this is to make sure they have their regular penicillin injections.

What else do I need to do if my child has rheumatic heart disease?

Looking after their teeth
You need to tell your child's dentist or dental therapist (nurse) that your child has rheumatic heart disease because your child will need extra antibiotics by mouth before some types of dental treatment.

When the dentist is working on your child's teeth, tiny bugs in the mouth (we all have them) can get into the blood stream. The blood will carry these bugs to the heart and may cause further damage to the heart valves. This is called infective endocarditis.

You need to help your child to look after their teeth and avoid any infection.

Make sure that they:

• brush their teeth twice a day with fluoride toothpaste
• don't have sweet food and drinks too often
• have dental checks every six months

Looking after their health
You need to tell your child's doctor if they are having a medical procedure. There is an increased risk to them if they get an infection.

Your daughter should continue having penicillin injections during pregnancy until her doctor says they are no longer needed.

Other common questions and answers about rheumatic fever

What happens when my child finishes having injections?
Your doctor will tell you when it is safe for your child to stop having the penicillin injections.

When your child gets a sore throat, they will need to have a check-up to see if they have a "strep" throat. If they do, it will have to be properly treated.

What about diet and rheumatic fever?
Because rheumatic fever can affect the heart, it is important not to add further stress on the heart either by smoking or being overweight.

To help your child, make sure they eat a healthy diet.

Is rheumatic fever catching?
You cannot "catch" rheumatic fever from another person, but "strep" throats can be passed on to others by breathing or coughing over them.

Does rheumatic fever run in the family?
There is no real evidence that rheumatic fever runs in the family. However some families get rheumatic fever more than others.

Members of those families should make sure that when they get a sore throat they go to the doctor for a check-up. If it is a "strep" throat they can get it properly treated.

How to treat sore throats to prevent rheumatic fever

If your child or anyone in your family gets a sore throat:

• go to their doctor and ask for a throat swab
• have a throat swab done and check if it is a "strep" throat
• the doctor will either give: 
  - a course of penicillin tablets. These tablets must be started straight away and taken for ten days (even if the sore throat feels better after two to three days). Erythromycin will be given to people who are allergic to penicillin.
  - or one injection of penicillin

Your doctor will tell you if it is not a "strep" throat.

Where to go for more information

On this website
Sore throat

@Heart www.heartnz.org.nz
Postal address: PO Box 108 034, Symonds Street, Auckland
Physical address: @Heart, Level 1, 60 Grafton Road, Auckland 1010
Phone: 0800 KIDZ HEARTS (543 943) or 64 9 377 9950
Fax: 64 9 377 9954
Email: info@heartnz.org.nz

The National Heart Foundation www.heartfoundation.org.nz
The Heart Foundation is a not-for-profit, non-government organisation that funds research and promotes heart health. Their website provides access to Heart Health Resources:

• the Heart Foundation rheumatic fever booklet for parents in English
• the Heart Foundation rheumatic fever booklet for parents in Samoan
• the Heart Foundation rheumatic fever booklet for parents in Tongan

This booklet is designed for parents / caregivers of children with rheumatic fever and rheumatic heart disease. It answers commonly asked questions about the illness, the care and treatment your child will need and how to prevent future attacks.

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