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following this time period, the immunization schedule and dental visits need to
be resumed.
▪ The child should have a dental visit every 6 months after age 3 years and inform
the dentist of the cardiac problem so that antibiotics can be prescribed if
necessary.
▪ Call the pediatrician if coughing, tachypnea, cyanosis, vomiting, diarrhea,
anorexia, pain, or fever occur, or any swelling, redness, or drainage occurs at
the site of the incision.

Box 36-6

Jones Criteria for Diagnosis of Rheumatic Fever

Major Criteria

▪ Carditis
▪ Arthralgia

▪ Chorea
▪ Erythema marginatum
▪ Subcutaneous nodules

Minor Criteria

▪ Fever
▪ Arthralgia
▪ Elevated erythrocyte sedimentation rate or positive C-reactive protein level
▪ Prolonged PR interval on electrocardiogram

Note: For making a diagnosis, 2 major or 1 major and 2 minor manifestations must
be accompanied by supporting evidence of a preceding streptococcal infection
(positive throat culture for group A Streptococcus and an elevated or increasing anti–
streptolysin O titer).

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