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Should Your Child See a Doctor?

Sore Throat

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Definition

  • Pain, discomfort or raw feeling of the throat, especially when swallowing.

Symptoms in Infants and Toddlers 

  • Children less than 2 years of age usually don't know how to complain about a sore throat. A young child who refuses previously enjoyed foods or begins to cry during feedings may have a sore throat.

Causes 

  • Colds (Upper Respiratory Infections or URIs): Most sore throats are part of a cold. In fact, a sore throat may be the only symptom for the first 24 hours.
  • Viral pharyngitis: Some viruses cause a sore throat without nasal symptoms.
  • Strep pharyngitis: Group A Strep is the most common bacterial cause. It accounts for 20% of persistent sore throats. Only these need an antibiotic.

Return to School 

  • Your child can return to child care or school after the fever is gone and your child feels well enough to participate in normal activities. Children with Strep throat also need to be taking an oral antibiotic for 24 hours before they can return.

Strep Throat 

  • Symptoms include sore throat, fever, headache, abdominal pain, nausea and vomiting
  • Cough, hoarseness, red eyes, and runny nose are usually not seen with Strep throat and are more suggestive of a viral cause.
  • Scarlet fever rash (fine, red, sandpaper-like rash) is highly suggestive of Strep throat
  • Peak age: 5 to 15 years old. Uncommon under 2 years old unless sibling has strep.
  • Diagnosis should be confirmed by throat culture prior to starting treatment (there is no risk to your child to delaying treatment until a throat culture can be performed).
  • Acute Rheumatic Fever may occur in children not treated within ten days of symptom onset.
  • Standard treatment is with penicillin or amoxicillin, other antibiotics may sometimes be used.

When to Call Your Doctor for Sore Throat

Call 911 If…

 
  • Your child has severe difficulty breathing (struggling for each breath, making grunting noises with each breath, unable to speak or cry because of difficulty breathing)
 

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Difficulty breathing, but not severe
  • Great difficulty swallowing fluids or saliva
  • Stiff neck
  • Signs of dehydration (very dry mouth, no tears with crying and no urine for more than 8 hours)
  • Purple or blood-colored spots or dots on skin
  • Weak immune system (sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids, etc.)
  • Fever over 104° F (40° C) and not improved 2 hours after fever medicine 

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs an office visit or throat culture
  • Sore throat pain is severe and not improved 2 hours after taking ibuprofen
  • Pink rash that's widespread
  • Earache or sinus pain/pressure
  • Fever present for more than 3 days
  • Fever returns after gone for over 24 hours
  • Age under 2 years old
  • Exposure to Strep within last 7 days
  • Sores present on the skin
 

Call Your Doctor During Weekday Office Hours If

  • Sore throat is the main symptom and persists more than 48 hours
  • Sore throat with cold/cough symptoms is present more than 5 days
  • You have other questions or concerns
 

Parent Care at Home If

  • Probable viral throat infection and you don't think your child needs to be seen
 

Home Care Advice for Sore Throats

  1. Reassurance: Most sore throats are just part of a cold. The presence of a cough, hoarseness or nasal discharge points to a cold as the cause of your child's sore throat.
  2. Local Pain Relief:
    • Children over age 1 can sip warm chicken broth, apple juice or other warm fluid.
    • Children over age 6 can suck on hard candy (e.g., butterscotch) or lollipops.
    • Children over age 8 can also gargle warm water with a little table salt or liquid antacid added.
    • Medicated throat sprays or lozenges are generally not helpful.
     
  3. Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen for severe throat discomfort or fever greater than 102° F (39° C).
  4. Soft Diet: Cold drinks and milk shakes are especially helpful. (Reason: Swollen tonsils can make some solid foods hard to swallow.)
  5. Contagiousness:
    • Your child can return to child care or school after the fever is gone and your child feels well enough to participate in normal activities.
    • Children with Strep throat also need to be taking an oral antibiotic for 24 hours before they can return.
     
  6. Expected Course: Sore throats with viral illnesses usually last 4 or 5 days.
  7. Call Your Doctor If:
    • Sore throat is the main symptom and lasts over 48 hours
    • Sore throat with a cold lasts over 5 days
    • Fever lasts over 3 days
    • Your child becomes worse
     

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.


References

  1. Bisno AL. Acute pharyngitis: Etiology and diagnosis. Pediatrics. 1996;97(6 Pt 2):949-954.
  2. Ebell MH, Smith MA, Barry HC, Ives K, Carey M. Does this patient have strep throat? JAMA. 2000;284:2912-2918.
  3. Gerber MA. Diagnosis of Group A Streptococcal pharyngitis. Pediatr Ann. 1998;27:269-273.
  4. Hofer C, et al. Strategies for managing group A streptococcal pharyngitis. Arch Pediatr Adolesc Med. 1997;151:824-829.
  5. Jaggi P, Shulman ST. Group A streptococcal infections. Pediatr Rev. 2006;27(3):99-105.
  6. McIsaac WJ, Kellner JD, Aufricht P, et al. Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA. 2004;291:1587-1595.
  7. Park S, Gerber M, Tanz R, et. al. Clinicians’ management of children and adolescents with acute pharyngitis. Pediatrics. 2006;117(6):1871-1878.
  8. Putto A. Febrile exudative tonsillitis: Viral or streptococcal. Pediatrics. 1987;80:6.
  9. Tsevat J and Kotagal UR. Management of sore throats in children. Arch Pediatr Adolesc Med. 1999;153:681-688.
  10. vanDriel ML, Sutter AD, Deveugele M, et al. Are sore throat patients who hope for antibotics actually asking for pain relief? Ann Fam Med. 2006;4(6):494-499.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 10/1/2010

Copyright 1994-2011 Barton D. Schmitt, M.D.

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