Red Flags & When to Go In Person for Cat Scratch - Triage

Audience: pediatric

Cat scratch disease usually causes mild symptoms like a small bump or blister where a child was scratched or bitten by a cat. Often, the affected area may swell and the nearby lymph nodes can become tender. Many cases improve on their own or with simple care at home. Telemedicine can help assess these symptoms and guide care, especially when symptoms are mild. However, certain signs require prompt in-person evaluation to avoid complications. These include severe swelling, high fever, spreading redness, or signs of infection that worsen quickly. Knowing when to seek in-person care is important to keep your child safe and healthy.

Red flags — go in person / ER

• High fever lasting more than 2 days – seek in-person care promptly.
• Rapidly increasing redness, swelling, or pain around the scratch – get evaluated in person.
• Pus or discharge from the wound indicating possible infection – see a healthcare provider immediately.

What telemedicine can do

• Initial assessment of mild symptoms like small bumps and mild swelling.
• Guidance on home care and symptom monitoring.
• Advice on when to seek in-person evaluation.

What telemedicine cannot do

• Severe symptoms such as high fever or spreading infection signs.
• Wounds with pus, discharge, or severe pain needing physical examination.
• Complications like difficulty moving limbs or neck stiffness requiring urgent care.

What is Cat Scratch Disease?

Cat scratch disease is an infection caused by bacteria that can be passed through a scratch or bite from a cat. It often starts with a small bump or blister at the site of the scratch, followed by swelling of nearby lymph nodes. This condition is more common in children and usually causes mild symptoms that improve over time.

Common Symptoms to Watch For

Typical symptoms include a red bump or blister where the cat scratch happened, swelling and tenderness in nearby lymph nodes (such as in the neck, armpit, or groin), mild fever, and feeling tired. These symptoms often develop within one to two weeks after the scratch or bite.

When Telemedicine Can Help

Telemedicine is useful for initial assessment of mild symptoms. A healthcare provider can review your child's symptoms, look at pictures of the affected area, and recommend home care steps. They can also advise if symptoms are improving or if further care is needed.

When to Seek In-Person Care

You should take your child to see a healthcare provider in person if you notice any of the following:

Prompt evaluation can help prevent complications.

How to Care for Cat Scratch Disease at Home

For mild cases, home care includes cleaning the scratch gently with soap and water, applying a cool compress to reduce swelling, and giving age-appropriate pain relievers if needed. Keep the area clean and watch for any changes. Avoid scratching or picking at the wound.

Preventing Cat Scratch Disease

To reduce the risk, teach children to handle cats gently and avoid rough play. Wash any cat scratches or bites promptly with soap and water. Keep cats' nails trimmed and avoid stray or sick animals.

How to prepare for your tele-visit

• Have clear photos of the scratch or bite area ready to show during the visit.
• Note the date and time when symptoms started.
• List any other symptoms your child is experiencing, such as fever or fatigue.
• Prepare to describe any treatments or home care already tried.
• Have your child's medical history and any allergies available.
• Ensure a quiet place with good lighting for the telemedicine visit.

After your tele-visit

• Follow the healthcare provider's instructions for home care.
• Monitor symptoms daily and note any changes.
• Keep the affected area clean and dry as advised.
• Schedule an in-person visit if symptoms worsen or red flags appear.
• Use medications only as recommended by the provider.
• Keep follow-up appointments if suggested.

FAQs

Can cat scratch disease be serious?

Most cases of cat scratch disease are mild and get better without serious problems. However, in some cases, especially if not treated, complications can occur. It's important to watch for worsening symptoms and seek care if needed.

How long does cat scratch disease last?

Symptoms usually develop within 1 to 2 weeks after a cat scratch or bite and can last several weeks. Swollen lymph nodes may remain tender for some time but generally improve gradually.

Can antibiotics help?

Antibiotics may be recommended in some cases, especially if symptoms are severe or not improving. A healthcare provider can decide if antibiotics are needed based on your child's condition.

Is it safe to keep my child around cats if they had cat scratch disease?

Yes, once symptoms improve, children can usually be around cats safely. Teaching gentle handling and prompt wound cleaning can help prevent future infections.

When should I worry about swollen lymph nodes?

If lymph nodes become very large, hard, painful, or do not improve over time, or if you notice other signs like fever or redness spreading, seek medical evaluation.

Sources

1. Cat Scratch Disease — MedlinePlus | U.S. National Library of Medicine / National Institutes of Health.
2. Cat Scratch Disease (Bartonellosis) — Centers for Disease Control and Prevention (CDC).
3. Cat-Scratch Disease — Mayo Clinic.
4. Cat Scratch Disease — Merck Manuals: Consumer Version.

This telemedicine guidance is for educational and triage purposes only and is not a substitute for in-person medical care. If your child has severe symptoms or you are concerned about their health, please seek prompt evaluation by a healthcare professional in person.