Sore Throat

Sore throat is a very common problem in children. Most sore throats are caused by an infection. Infections are caused either by viruses or bacteria. Viral infections are more common, and 7 out of 10 children with a sore throat have a viral infection. Bacterial infections cause 3 out of 10 cases of sore throat in children. Most bacterial infections in the throat are caused by Group A streptococcus, also known as “strep throat.”

How can I tell if my child has Strep Throat or a Viral Infection?

Unfortunately, there is no single sign to look for that can identify Strep Throat. However, there can be some hints in the symptoms your child has in addition to their sore throat. Children who might have Strep Throat should be seen by their doctors for further testing. However, children with likely viral illness do not need to be seen by their doctor.

Less likely to be Strep

  • cough
  • runny nose
  • red, watery eyes
  • no fever or low grade fever
  • sore throat for more than 6 days

More likely to be Strep

  • headache
  • vomiting
  • high fever

 

How can we treat sore throat?

Viral infections and Strep Throat infections can both make a child very uncomfortable and unhappy. However, there is no medication that your doctor can prescribe that can treat viral infections. They must be managed with what we call “supportive care”.

Supportive care for Viral Sore Throat:

  • Acetaminophen (Tylenol) or Ibuprofen (Motrin) for fevers and pain
  • Sucking on candy, lollypops, or freezer treats
  • In children >6 years old, gargling with salt water

Because sore throats caused by Strep are due to a bacteria, they can be treated with an antibiotic prescribed by your doctor. Most children with Strep Throat will get better without antibiotics, but your doctors prescribe medication anyway to prevent complications of Strep throat, to help your child feel better faster, and to reduce the likelihood that your child will pass on the bacteria to others. Children with Strep Throat ALSO benefit from the supportive care techniques used with viral infections.

How does the doctor test for Strep Throat?

If your doctor suspects your child may have Strep Throat, they will swab the back of your child’ throat with a long Q-tip. They then perform a rapid test that takes about 5-8 minutes. You generally find out the result of that test before you leave the office. If the test is positive your child will be treated for Strep Throat.

If the rapid test is negative you doctor will perform a culture on the swab. This is because sometimes the rapid test is negative even when a child does have Strep Throat. Throat cultures are much more accurate, but take 24 hours to give results. If the result of the culture is positive your doctor will contact you by phone and make sure your child receives the medication that they need.

References:

Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis 2012; 55:1279.

Lin MH, Fong WK, Chang PF, et al. Predictive value of clinical features in differentiating group A beta-hemolytic streptococcal pharyngitis in children. J Microbiol Immunol Infect 2003; 36:21.

Gerber MA, Baltimore RS, Eaton CB, et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation 2009; 119:1541.