Some answers to questions your child might have about their penicillin injections after they have had rheumatic fever.
Rheumatic fever is a serious illness. It often starts with a sore throat. Without treatment, some sore throats can cause rheumatic fever which can lead to heart damage. If your child has had rheumatic fever, the best way to stop them having another attack is to make sure they have regular penicillin injections - on time.
Key points to remember
The content on this page is for parents/caregivers of children with rheumatic fever and rheumatic heart disease. For information about preventing rheumatic fever, see Sore throat on this website.
- rheumatic fever is a serious illness
- it often starts with a sore throat caused by strep bacteria
- without treatment, the strep throat can cause rheumatic fever
- rheumatic fever can damage your heart - 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 rheumatic fever?
Rheumatic fever is a serious illness that can cause damage in your child's heart as well as swelling and pain in their hips, knees, ankles, elbows, wrists. You may also notice a skin rash, fever or jerky movements. Over time, most of these symptoms will go away but any damage to your child's heart may be permanent.
How did my child get rheumatic fever?
Rheumatic fever often starts with a sore throat caused by strep bacteria.
Without treatment, the strep throat can cause rheumatic fever.
Rheumatic fever can damage your heart. This is called rheumatic heart disease.
How can rheumatic fever affect the heart?
The heart is a pump with 4 chambers (rooms) and 4 valves. A heart valve acts like a one-way door. It makes sure that blood pumped by the heart flows in one direction only. If rheumatic fever damages the heart valves, this is called rheumatic heart disease. When your doctor listens to your child's heart, they may hear extra sounds called murmurs. A murmur is the sound of some blood flowing the wrong way through a leaky valve.
Leaky heart valves - rheumatic heart disease
Not everyone with rheumatic fever will have heart valve damage, but people with badly damaged heart valves may need heart surgery.
When rheumatic fever damages your child's heart valve, their heart cannot pump properly and they may feel:
- short of breath when lying down flat
- the need to sleep with more pillows
- more short of breath than others when doing the same exercise
- short of breath when doing nothing
- a lack of energy
What happens in hospital?
During your child's stay in hospital, they will have many tests. These include blood tests and an echo scan (echocardiogram) to check on your child's heart. The treatment for sore joints
is rest and pain relief. Your child will have penicillin to get rid of the strep bacteria. They will have their first penicillin injection before leaving hospital. Depending on your child's symptoms and test results, they may need to stay resting in hospital for some weeks or months. Children with badly damaged heart valves may need heart surgery.
What happens when your child goes home?
It is very important that your child doesn't get rheumatic fever again. This can cause more damage to their heart.
Your doctors will let you know how long your child will need to rest when they go home. As soon as your doctor says it is safe for your child to be active again, it is important that they start exercising regularly and lead a healthy lifestyle.
With proper care and regular penicillin injections, most people who have had rheumatic fever lead a normal life. Penicillin is the best antibiotic to prevent rheumatic fever. If your child is unable to have penicillin, your doctor will discuss another treatment with you.
It is very important that your child doesn't get rheumatic fever again. Every strep throat can lead to rheumatic fever, which can cause more damage to their heart.
To stop your child from getting strep throat, which can cause rheumatic fever again, make sure they have regular penicillin injections. Talk with the nurse about arranging your child's penicillin injections, to see what may work best for you.
How can your child avoid getting rheumatic fever again?
Your child will need a penicillin injection every 28 days.
The best way to prevent rheumatic fever is to make sure your child has regular penicillin injections on time. Penicillin kills the strep bacteria that trigger rheumatic fever, stopping any further damage to your child's heart valves.
Your child will have penicillin injections:
- every 28 days
- in a muscle near their bottom or hip
- from your community nurse, district nurse or public health nurse
Penicillin injections can be painful. Nurses can use numbing medicine (local anaesthetic), distraction techniques and other ways to minimise the pain.
The nurse may come to your home or your school clinic to give the injection. There are also community nurse clinics available.
How long will penicillin injections be necessary?
Your child will need to have injections every 28 days for at least 10 years, or until they are 21 years old, whichever is longer. In some cases, particularly if your child has heart valve damage, they may need to continue penicillin injections for longer.
Never stop penicillin treatment without discussing it first with your child's doctor, as your child could get rheumatic fever again. This can cause more damage to their heart valves. Remember to tell your child's nurse if you are moving house, going overseas, on holiday, or going away. Your child may need to get their injection early, or their nurse may be able to arrange for them to receive their injections elsewhere.
Tips for remembering penicillin injections
- write it on your calendar
- ask your nurse to text you a reminder
- ask your family/whānau to help you remember
- write a reminder on your fridge
If you forget an injection, ring your nurse to arrange to get the next injection as soon as possible.
Why do you need to tell people that your child has had rheumatic fever?
Tell every doctor, dentist or dental therapist that your child has had rheumatic fever.
Heart valves damaged by rheumatic heart disease can occasionally get infected during certain types of operations and dental work. Your child may need extra antibiotics to help protect their heart. This is why it is important to remember to tell every doctor, dentist or dental therapist that your child has had rheumatic fever before they have any medical procedures or operations.
Ask your doctor for a copy of a rheumatic fever wallet card. It has important information about your child's rheumatic fever. You should show it to any dentist, dental therapist or doctor before they treat your child.
At the dentist
Everyone has tiny bugs in their mouths. These bugs are usually harmless, but sometimes when the dentist is working on your child's teeth, the bugs can get into their bloodstream. If they reach your child's heart, the bugs can cause more damage to the heart valves. This is called endocarditis.
Your child can look after their teeth and help to avoid any infection by:
- having their own toothbrush - don't let them share with anyone
- brushing their teeth twice a day with fluoride toothpaste
- not having sweet food and drinks too often
- having dental checks every 6 months
If your child is younger than 18 years old, they can get free dental care. Call 0800 825 583 to find out more.
What else can my child do to stay healthy?
Avoid smoking and being around people who smoke.
Even after your doctor tells you that it is safe for your child to stop having their regular penicillin injections, it is important to get every sore throat checked.
Because rheumatic fever can cause rheumatic heart disease, it is important that your child doesn't add further stress to their heart.
They can do this by:
- avoiding smoking
- avoiding any exposure to smoke
- managing their weight
- eating healthy foods
- exercising regularly (as soon as the doctor says it is safe for your child to be active again)
Does rheumatic fever run in the family?
There is no good evidence that the risk of rheumatic fever is passed down to children. However, some families get rheumatic fever more than others.
If anyone in your household gets a sore throat, they need to go to the doctor and ask for a throat swab. If it is a strep throat, the doctor will give antibiotics. It is important your child starts these antibiotics straight away and takes them for 10 days to fully kill all the strep bugs (even if the sore throat feels better).
Can you catch rheumatic fever?
You cannot 'catch' rheumatic fever from another person, but you can easily catch the strep bug that triggers rheumatic fever through:
- sharing cups
- sharing toothbrushes
Bugs are often shared while you are sleeping close to other people. To help to stop the spread of strep bugs and keep your child and your family/whānau healthy, try creating a 'sleep space' for your child by getting them to sleep in their own bed or 'top and tailing'. Try to keep your house warm and dry. Ask to speak to a social worker to find out if you qualify for help with this.
As a parent, what else do I need to know?
Sometimes parents will feel guilty and responsible for their child having rheumatic fever. You may experience:
- feeling overprotective of your child
- sleep disturbances
- being inconsistent with discipline or parenting style
Remember, it is not your fault. If your feelings of guilt are strong or you feel overwhelmed, please talk to your child's nurse about what support may be available.