Children - Rheumatic Fever

What is rheumatic fever?

Rheumatic fever is a complex disease that affects the joints, skin, heart, blood vessels, and brain. It is an immune disease that may occur after an infection with streptococcus (strep) bacteria. Strep infections include strep throat (group A streptococcal tonsillopharyngitis) and scarlet fever. Rheumatic fever happens more often in the winter and spring. This is because strep throat infections occur more often in these seasons. Strep is contagious, but rheumatic fever is not.

What causes rheumatic fever?

Rheumatic fever is an autoimmune reaction to the strep bacteria. An immune reaction is when the body attacks its own tissues. It can be prevented if strep throat is diagnosed right away and treated with antibiotics. Rheumatic fever is not common in the U.S.

Who is at risk for rheumatic fever?

Children ages 5 to 15 are most at risk for developing rheumatic fever. They are most at risk if they have strep throat infections often. Children are also at risk if they have strep infections that were untreated or not treated enough. Rheumatic fever is also more common in children who have a family history of it.

What are the symptoms of rheumatic fever?

The symptoms usually start about 1 to 5 weeks after a child has been infected with strep bacteria. Symptoms can occur a bit differently in each child. Common symptoms of rheumatic fever can include:

  • Inflammation in joints such as the knees or ankles that causes swelling, tenderness, and redness
  • Small, painless, hard bumps under the skin, often over bony areas (subcutaneous nodules)
  • Unusual jerky movements (chorea), most often of the face and hands, often noted by a change in a child's handwriting
  • Red rash with odd edges on the torso, arms, or legs
  • Fever
  • Weight loss
  • Fatigue
  • Stomach pains

The symptoms of rheumatic fever can be like other health conditions. Make sure your child sees his or her health care provider for a diagnosis.

How is rheumatic fever diagnosed?

The process starts with a medical history and a physical exam. Your child may also have tests such as:

  • Blood tests. These are done to look for signs of inflammation and other problems.
  • Electrocardiogram (ECG). This is a test that records the electrical activity of the heart. It shows abnormal rhythms and detects heart muscle damage of the heart.
  • Throat culture. A swab is wiped on the throat. This is done to look for the strep bacteria.

Your child's healthcare provider will look for:

  • Inflammation of the heart (carditis)
  • Inflammation of more than one joint (polyarthritis)
  • Unusual jerky movements (chorea)
  • Subcutaneous nodules
  • Red, irregular rash
  • Fever
  • Pain in one or more joints (arthralgia)
  • Previous inflammation of the heart (rheumatic carditis)
  • Changes in the ECG pattern
  • Abnormal sedimentation rate or C-reactive protein in blood tests


Treatment will depend on your child's symptoms, age, and general health. It will also depend on how severe the condition is. Children with rheumatic fever are often treated in the hospital.

Treatment for rheumatic fever often combines the following 3 parts:

  • Treatment for strep. The first step is to treat the strep infection with antibiotics. This is done even if a throat culture is negative. Your child may need to take monthly doses of antibiotics. This is to help prevent other complications.
  • Anti-inflammatory medicines. Your child may take medicines to help decrease the swelling that occurs in the heart muscle. These medicines also help relieve joint pain.
  • Bed rest. The length of bed rest will depend on how severe your child's illness is. Bed rest may range from 2 to 12 weeks.

Talk with the healthcare providers about the risks, benefits, and possible side effects of all medicines.

What are the complications of rheumatic fever?

If the illness severely attacks a child's heart, this may damage heart valves and cause heart disease. In this case, your child may be restricted from some kinds of physical activity and sports.

If the heart was damaged by the fever, he or she will need to take special care when going to the dentist in the future. He or she may need to take antibiotics before having dental work done. This helps lower the chance of an infection traveling to the heart during a dental procedure. Talk with your child's health care provider for more information.

Can rheumatic fever be prevented?

Many cases of rheumatic fever may be prevented with the fast treatment of strep throat with antibiotics.

Helping your child live with rheumatic fever

Having rheumatic fever increases your child's chances of having the disease again. This is at highest risk during the first 3 years. The chance of having the disease again lessens with age and time.

After having rheumatic fever, your child will need to take antibiotics every month. These are to help lessen the chance of having rheumatic fever again. Often by the time a child is 18, the antibiotic therapy may be stopped. Close follow-up with your child's healthcare provider is needed.

When should I call my child's healthcare provider?

If your child's symptoms get worse or he or she has new symptoms, let the healthcare provider know.

Key points about rheumatic fever

  • Rheumatic fever is a complex disease that affects the joints, skin, heart, blood vessels, and brain.
  • It may occur after an infection with strep bacteria, such as strep throat or scarlet fever.
  • Symptoms may include joint inflammation, small hard bumps under the skin, jerky movements, a rash, and fever.
  • Treatment includes antibiotics, anti-inflammatory medication, and bed rest.
  • Your child will need to have ongoing treatment to stop the disease from coming back.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Before your visit, write down questions you want answered.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
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