Rheumatic Fever

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. 

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Key points about rheumatic fever

  • 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

The content on this page is for parents and caregivers of children with rheumatic fever and rheumatic heart disease.

For information about preventing rheumatic fever, check the information about sore throats

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, and 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.

Diagram showing how rheumatic fever starts

How can rheumatic fever affect my child's 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. Murmurs are often normal in unwell children but sometimes they can be a sign that blood is flowing the wrong way through a leaky valve.

What if rheumatic heart disease causes leaky heart valves?

Watch a series of animated videos about rheumatic fever and the heart

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 are the steps to getting well after rheumatic fever?

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 my 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 my child stay well after recovering from rheumatic fever?

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

Image of calendar

Find out about an app to help get your bicillin on time every time

Penicillin injections can be painful. Nurses can use numbing medicine (local anaesthetic), distraction techniques and other ways to minimise the pain.

See tips for making penicillin injections more comfortable

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

'Fight the Fever' app logo

If you forget an injection, ring your nurse to arrange to get the next injection as soon as possible.

An illustration showing that a penicillin injection is needed every 28 days

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

COVID-19 vaccine

It's important for your child 5 year and over to have the COVID vaccine. It's especially important for those with underlying health conditions such as rheumatic heart disease. Matt Johnson had rheumatic fever when he was younger. Despite his underlying health conditions, he's had no issues with the COVID vaccine, besides having a sore arm for a day or two.

Watch the video


The Paediatric Society of New Zealand is grateful to the Heart Foundation for providing the content for this page. The booklet Rheumatic fever and rheumatic heart disease (PDF, 1.7MB) was revised in November 2019.

The video is copyright Kylie Sullivan 2017. Licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License. Acknowledgements: Starship Child Health, Starship Foundation, Auckland District Health Board (Alison Leversha, Faith Mahony).

This page last reviewed 29 September 2020.

Call Healthline on 0800 611 116 any time of the day or night for free health advice when you need it