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Kids sore throat

Sore throat also called pharyngitis, is common at any age and can be caused by many things, from viral infections (most often, the common cold or flu), or mononucleosis (mono) to seasonal allergies and gastroesophageal reflux (GER). Sore throats can also be caused by a strep throat infection (bacterial infection), although this is rare in children younger than 2 years old.

Sore throat signs and symptoms:

  • painful throat
  • fever
  • swollen glands in the neck
  • bad breath
  • scratchiness in the throat
  • redness in the back of the mouth

As with most common illnesses, preventing a sore throat or tonsillitis starts with regular hand washing. Kids also can avoid sore throats by:

  • not sharing food utensils and glasses with others and wash them in hot, soapy water or a dishwasher after each use.
  • don’t share food, drinks, napkins, or towels
  • avoiding contact with people who have sore throats or cold symptoms
  • sneeze or cough into a shirtsleeve, not your hands.

Here are some ways kids can relieve sore throat pain:

  • sip warm liquids
  • drink plenty of water
  • eat cool or soft foods
  • eat cold or frozen liquids (such as ice pops) – but do not give young children anything small and hard to suck because of the risk of choking
  • gargle with saltwater
  • suck on hard candy or throat lozenges (for kids age 4 or older)
  • take ibuprofen or acetaminophen (paracetamol) as needed
  • rest
When to see a doctor

Get immediate medical care if your child:

  • has trouble swallowing or breathing
  • making a high-pitched sound as you breathe (called stridor)
  • isn’t drinking liquids
  • is drooling (in a young child)
  • feels very tired
  • has pus in the back of the throat
  • has a sore throat that lasts longer than a few days

These symptoms can make breathing more difficult.

Sore throat causes

Viruses are the most common cause of sore throat in all age groups. Experts estimate that group A strep, the most common bacterial cause, causes 20% to 30% of sore throat episodes in children. In comparison, experts estimate it causes approximately 5% to 15% of sore throat infections in adults.

Many sore throats are due to:

  • Strep throat, which is a contagious bacterial infection of the throat and tonsils (the fleshy clusters of tissue on both sides of the back of the throat). It also can cause headache and fever.
  • Tonsillitis, which is usually not serious but can lead to complications, like breathing or swallowing trouble. Most cases are caused by either a virus (such as a common cold virus or Epstein Barr virus, the virus that causes mono) or strep bacteria.

Conditions that can cause a sore throat:

  • Laryngitis
  • Tonsillitis
  • Strep throat (a bacterial throat infection)
  • Glandular fever

What is Strep throat?

Strep throat is an infection caused by a type of bacteria (Streptococcus pyogenes also called group A Streptococcus or group A strep). Strep bacteria cause almost a third of all sore throats. However, not all sore throats are strep throats. Often, kids have a sore throat because of a virus , which will usually clear up without medical treatment.

Strep throat usually needs treatment with antibiotics. With the proper medical care — and plenty of rest and fluids — most kids get back to school and play within a few days.

Strep throat signs and symptoms

Symptoms of strep throat include:

  • sore throat
  • fever
  • red and swollen tonsils
  • painful or swollen neck glands

Kids who do have strep throat might get other symptoms within about 3 days, such as:

  • red and white patches in the throat
  • trouble swallowing
  • a headache
  • lower stomach pain
  • general discomfort, uneasiness, or ill feeling
  • loss of appetite
  • nausea
  • rash

Is strep throat contagious?

Strep throat is very contagious. Anybody can get it, but most cases are in school-age kids and teens. Infections are common during the school year when big groups of kids and teens are in close quarters.

To prevent spreading strep throat to others in your home:

  • Keep your child’s eating utensils, dishes, and drinking glasses separate and wash them in hot, soapy water after each use.
  • Make sure your child doesn’t share food, drinks, napkins, handkerchiefs, or towels with other family members.
  • Teach your child to cover all sneezes or coughs. If a tissue isn’t handy, kids should sneeze or cough into a shirtsleeve, not their hands.
  • Remind everyone to wash their hands well and often.
  • Give your child a new toothbrush after the antibiotic treatment starts and he or she is no longer contagious.

How do people get strep throat?

The group A strep bacteria (Streptococcus pyogenes) that cause strep throat tend to hang out in the nose and throat and spread through direct person-to-person transmission. So normal activities like sneezing, coughing, or shaking hands can easily spread an infection from one person to another. Typically transmission occurs through saliva or nasal secretions from an infected person.

Kids with untreated strep throat are more likely to spread the infection when their symptoms are most severe, but can still infect others for up to 3 weeks. People with group A strep pharyngitis are much more likely to transmit the bacteria to others than asymptomatic pharyngeal carriers. Crowded conditions — such as those in schools, daycare centers, or military training facilities — facilitate transmission. Although rare, spread of group A strep infections may also occur via food. Foodborne outbreaks of pharyngitis have occurred due to improper food handling. Fomites, such as household items like plates or toys, are very unlikely to spread these bacteria.

Humans are the primary reservoir for group A strep. There is no evidence to indicate that pets can transmit the bacteria to humans.

That’s why it’s so important to teach kids the importance of hand washing. Good hygiene can lessen their chances of getting contagious diseases like strep throat.

Risk factors for strep throat

Group A strep pharyngitis can occur in people of all ages. It is most common among children 5 through 15 years of age. It is rare in children younger than 3 years of age.

The most common risk factor is close contact with another person with group A strep pharyngitis. Adults at increased risk for group A strep pharyngitis include:

  • Parents of school-aged children
  • Adults who are often in contact with children

Crowding, such as found in schools, military barracks, and daycare centers, increases the risk of disease spread.

Strep throat complications

Rarely, suppurative and nonsuppurative complications can occur after group A strep sore throat. Suppurative complications result from the spread of group A strep from the pharynx to adjacent structures. They can include:

  • Peritonsillar abscess
  • Retropharyngeal abscess
  • Cervical lymphadenitis
  • Mastoiditis

Other focal infections or sepsis are even less common.

Acute rheumatic fever is a nonsuppurative sequelae of group A strep sore throat. Post-streptococcal glomerulonephritis is a nonsuppurative complication of group A strep sore throat or skin infections. These complications occur after the original infection resolves and involve sites distant to the initial group A strep infection site. They are thought to be the result of the immune response and not of direct group A strep infection.

How is Strep throat diagnosed?

If your child has a sore throat and other strep throat symptoms, see your doctor. Your doctor will use either a rapid antigen detection test (RADT) or throat culture to confirm group A strep pharyngitis. Throat culture is the gold standard diagnostic test. Your doctor will likely do a rapid strep test in the office, using a cotton swab to take a sample of the fluids at the back of the throat. The test only takes about 5 minutes.

If it’s positive, your child has strep throat. If it’s negative, the doctor will send a sample to a lab for a throat culture. The results are usually available within a few days.

Your doctor should confirm group A strep pharyngitis in children older than 3 years of age to appropriately guide treatment decisions. Giving antibiotics to children with confirmed group A strep pharyngitis can reduce their risk of developing complication such as acute rheumatic fever. Testing for group A strep pharyngitis is not routinely indicated for:

  • Children younger than 3 years of age
  • Adults

Acute rheumatic fever is very rare in those age groups.

Your doctor can use a positive rapid strep test as confirmation of group A strep pharyngitis in children. However, clinicians should follow up a negative RADT in a child with symptoms of sore throat with a throat culture. Clinicians should have a mechanism to contact the family and initiate antibiotics if the back-up throat culture is positive.

How is Strep throat treated?

Doctors usually prescribe about 10 days of antibiotic medicine to treat strep throat. Within about 24 hours after starting on antibiotics, your child probably won’t have a fever and won’t be contagious. By the second or third day, other symptoms should start to go away.

Penicillin or amoxicillin is the antibiotic of choice to treat group A strep sore throat. There has never been a report of a clinical isolate of group A strep that is resistant to penicillin. However, resistance to azithromycin and clarithromycin is common in some communities. For patients with a penicillin allergy, recommended regimens include narrow-spectrum cephalosporins (cephalexin, cefadroxil), clindamycin, azithromycin, and clarithromycin.

Even when kids feel better, they should take the antibiotics as prescribed. This is the best way to kill the harmful bacteria. Otherwise, bacteria can remain in the throat and symptoms can return. Completing all the antibiotics also prevents other health problems that a strep infection can cause, such as rheumatic fever (which can cause heart damage), scarlet fever, blood infections, or kidney disease.

When left untreated, the symptoms of group A strep sore throat are usually self-limited. However, acute rheumatic fever and suppurative complications (e.g., peritonsillar abscess, mastoiditis) are more likely to occur after an untreated infection. Patients, regardless of age, who have a positive rapid strep test or throat culture need antibiotics. Clinicians should not treat viral sore throat with antibiotics.

Table 1. Antibiotic regimens recommended for Group A Streptococcal pharyngitis

Drug, RouteDose or DosageDuration or Quantity
For individuals without penicillin allergy
Penicillin V, oralChildren: 250 mg twice daily or 3 times daily; adolescents and adults: 250 mg 4 times daily or 500 mg twice daily10 days
Amoxicillin, oral50 mg/kg once daily (max = 1000 mg); alternate:
25 mg/kg (max = 500 mg) twice daily
10 days
Benzathine penicillin G, intramuscular<27 kg: 600 000 U; ≥27 kg: 1 200 000 U1 dose
For individuals with penicillin allergy
Cephalexin,a oral20 mg/kg/dose twice daily (max = 500 mg/dose)10 days
Cefadroxil,a oral30 mg/kg once daily (max = 1 g)10 days
Clindamycin, oral7 mg/kg/dose 3 times daily (max = 300 mg/dose)10 days
Azithromycin,b oral12 mg/kg once (max = 500 mg), then 6 mg/kg (max=250 mg) once daily for the next 4 days5 days
Clarithromycinb, oral7.5 mg/kg/dose twice daily (max = 250 mg/dose)10 days

Footnotes:

a Avoid in individuals with immediate type hypersensitivity to penicillin.
b Resistance of group A strep to these agents is well-known and varies geographically and temporally.

Abbreviation: Max, maximum.

[Source 1 ]

How can I help my child feel better?

Home care can help your child feel better while battling strep throat. Give plenty of liquids to prevent dehydration, such as water or ginger ale, especially if he or she has had a fever. Avoid orange juice, grapefruit juice, lemonade, or other acidic beverages, which can irritate a sore throat. Warm liquids like soups, sweetened tea, or hot chocolate can be soothing.

Talk to your doctor about when your child can return to normal activities. Most kids can go back to school when they’ve taken antibiotics for at least 24 hours and no longer have a fever.

Sore throat remedies for kids

Treatment for a sore throat will depend on what’s causing it. Treating an underlying condition (like gastroesophageal reflux or allergies) can bring relief, as can home care (like gargling with saltwater, running a cool mist humidifier at night, and avoiding irritants like smoke).

Strep throat requires medical treatment with antibiotics, which will improve symptoms quickly. Untreated strep throat can lead to complications like rheumatic fever (which can cause permanent heart damage), a peritonsillar abscess, scarlet fever, or kidney disease.

Treatment for tonsillitis depends on whether it is caused by a virus or by bacteria. Doctors usually will test for strep bacteria with a rapid strep test or a throat culture. Tonsillitis caused by a virus will go away on its own. If it’s caused by strep bacteria, the doctor probably will prescribe an antibiotic. If so, it’s important to take all of the antibiotic for as long as prescribed to help prevent complications.

People with tonsillitis or strep throat can return to activities 24 hours after beginning antibiotic treatment if there’s no fever and they’re feeling better. If someone is still feeling weak, tired, or achy, staying home for another day or two is recommended.

  1. Stanford T. Shulman, Alan L. Bisno, Herbert W. Clegg, Michael A. Gerber, Edward L. Kaplan, Grace Lee, Judith M. Martin, Chris Van Beneden, Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 55, Issue 10, 15 November 2012, Pages e86–e102, https://doi.org/10.1093/cid/cis629[]
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