Rheumatic fever is a serious but preventable complication of strep throat. Untreated or inadequately treated strep throat may result in bacteria remaining in the tonsils where they can trigger a person’s immune system to mistakenly attack other parts of the body.
Over the last week we have had reports of Strep Throat....any sore throat should be treated seriously and checked out. Te Puna Pharmacy is offering free throat swabs.
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.
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
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
- 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
- download and use the 'Fight the Fever' mobile app
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
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.
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).
An App To Help Get Your Bicillin On Time Every Time
'Fight the Fever' is a mobile app to help people with rheumatic fever get their bicillin injections on time, every time.
Common questions about penicillin injections
Some answers to questions your child might have about their penicillin injections after they have had rheumatic fever.
Helping to make the penicillin injections more comfortable
As a caregiver or parent it is important you take a few deep breaths and relax yourself, because if you are feeling very afraid and upset then your child will find the experience more difficult.
Rheumatic Fever - Women & Pregnancy
If you have had rheumatic fever or rheumatic heart disease, you should have a heart check-up before you fall pregnant.
Rheumatic Fever Care Plan
A checklist to help you with your child's rheumatic fever treatment.
EXTERNAL LINKS AND DOWNLOADSRheumatic fever information (Heart Foundation)
The Heart Foundation is a non profit, non government organisation that funds research promotes heart health.
Every week, 12 babies are born with a heart defect in New Zealand. Whilst there are surgical procedures that can improve the heart's function, there is no cure for a congenital heart disease (CHD). Heart Kids NZ is a charity that supports Kiwi children and families affected by CHD, right through their life. Phone 0800 KIDZ HEARTS (543 943) or 64 9 377 9950.
Rheumatic fever and rheumatic heart disease information booklet (The Heart Foundation)
Rheumatic fever and rheumatic heart disease (PDF, 1.7MB) information booklet by The Heart Foundation covers everything from what rheumatic fever is through to getting well and staying well after rheumatic fever.
Pū Manawa | Rheumatic Fever Network Aotearoa, New Zealand
Pū Manawa has lots of resources to help parents and whānau of tamariki affected by rheumatic fever. They share information on ways whānau can live well and look after each other.