Sore Throat

Older children can tell us directly if their throat is painful. Younger children may let us know by refusing food, crying when eating or drinking or showing more drooling.

Typical strep throat

What infections causes sore throats?

Usually sore throats are part of a cold and are caused by viruses. It is very common to have a sore throat with cough and congestion of a cold (upper respiratory infection). The strep bacteria (Strep Pyogenes or Group A Strep) cause about 10% of sore throats and about one third of throats with “white spots” in the back. Strep throat is more likely in the abscence of cold symptoms, especially if the sore throat is accompanied by headache, fever, or stomach ache. Strep throat can have rare (but serious) complications when it is not treated within ten days of the beginning of symptoms. Throat culture (or a rapid strep test) is needed to diagnose strep since it can be difficult to diagnose based on exam alone. See below for a scoring system based on symptoms to better predict chance that throat infection is caused by strep bacteria. Persistent sore throat (no relief after one week) without nasal congestion or other explanation can sometimes be a sign of infectious mononucleosis (another viral cause or throat infection).

What is the course?

Usually sore throats that occur with viral illnesses resolve in about 3 or 4 days. Children with strep throat respond well to penicillin. The child is contagious with strep throat for 24 hours after the medication is begun. Strep throat will resolve without treatment but can take longer and there is a small risk of complications if not treated within 10 days of start of symptoms.

Parents often ask if their child has tonsillitis. Most throat infections do involve the tonsils. Only tonsil infections caused by the strep bacteria are helped by antibiotics. All other causes (most of them viral) resolve without antibiotics. One cause is the virus that causes mono (Epstein-Barr virus) which also causes tonsillitis and will run its course without antibiotics but can be a more prolonged course than other throat infections.

Home Care for Sore Throats

Pain relief

Have children over 8 years old gargle with warm salt water. If child is over 4 years old, sucking on hard candy can be soothing. 1 teaspoon of corn syrup now and then can be soothing for very young children. Acetaminophen (Tylenol)may be used for significant pain.

DO NOT USE leftover antibiotics (these should be discarded). Antibiotics do not help with viral infections. If taken inappropriately, antibiotics can cause harm and will disrupt any testing making it difficult to tell the difference between Strep throat and viral throat infection.

Call Right Away If

  • Child’s pain is severe
  • Child is drooling or having significant problems in swallowing
  • Child cannot open mouth up fully
  • Child’s breathing is difficult, and not because of a stuffy nose

Call the office if

  • Sunburned-looking rash
  • Breathing/swallowing becomes difficult
  • Fever lasts more than 3 days
  • Known exposure to Strep throat (bacteria)

Strep Score

Score one point for each of the following that is true:

  1. Temperature greater than 100.4 degrees F
  2. No cough
  3. Tender glands in front of neck
  4. Tonsil swelling or white spots on tonsils
  5. Age <15 years old

Score Chance of Strep Throat
2-3%
1 4-6%
2 10-12%
3 27-28%
4-5 38-63%