Information for parents

This article has been written to help you understand more about rheumatic fever and rheumatic heart disease.

It answers questions you may have about:

• the illnesses
• the care and treatment your child will need
• how to prevent rheumatic fever attacks in the future.

What is rheumatic fever?

Rheumatic fever is an illness. It often starts with a sore throat (a streptococcal infection).
A few weeks after the "strep" throat your child may develop:

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

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 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 1-2 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
• have penicillin injections for much longer
• will need special care when visiting the dentist
• 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 he or she goes home. They will also need to have ongoing penicillin injections to prevent another attack. Another antibiotic, eg. 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.

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. This may seem like a long time but if your child doesn't have these injections they could have another rheumatic fever attack.

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.

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

You need to tell your child's dentist. It is very important to tell your dentist or dental nurse that your child has rheumatic heart disease because your child will need extra antibiotics by mouth before any 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 bloodstream. The blood will carry these bugs to the heart and may cause further damage to the heart valves. This is called bacterial endocarditis.

An 'Infective endocarditis prophylaxis' card is available from your GP, specialist or the National Heart Foundation.

You need to help your child to look after their teeth and avoid any infection.
Make sure that they:

• brush their teeth every day 
•  have dental checks every six months.

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. It is advisable to also avoid any body piercing or tattoos.

Your daughter will need to discuss contraception with her doctor:
Your daughter may want to use contraceptives when she is older. She should not use an IUD (intra-uterine device). Oral contraceptives and condoms are recommended. Ask your doctor about this.

Your daughter should also 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. 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 straightaway and taken for 10 days (even if the sore throat feels better after 2-3 days).
     - or one injection of penicillin.

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

Original material provided by the National Heart Foundation of New Zealand, 2004. Edited by everybody, June 2005.