sore throat

As we move into fall, viruses and bacteria begin to circulate. Kids often complain of a sore throat this time of year, which is usually caused by a virus. Viral sore throat occurs with typical cold symptoms including runny nose, congestion, cough, low grade fever, and hoarseness. Because this is due to a virus, antibiotics do not help, but the illness typically resolves on its own in about a week. Home care includes encouraging adequate fluids and Tylenol or Advil if needed for pain and discomfort; dosing depends on your child’s age and weight.

In children the most common bacterial throat infection is due to Group A streptococcus, known simply as “Strep throat”.  This illness comes on quickly and is not accompanied by cold symptoms. Strep throat causes pain with swallowing, redness of the throat, and swollen neck glands. The tonsils, which are located on both sides of the back of the throat, become red and swollen with white pus on them. There may be bright red spots on the back of the roof of the mouth. Headache, nausea and vomiting, abdominal pain, and a sandpaper-like red body rash may also occur.

Strep causes 20-30% of pediatric sore throats. It is most common in kids aged 5-15 years and is very unlikely in those under age 3. Testing is done with a rapid test on a swab from the back of the throat with results are ready in minutes. Sometimes a throat culture is done to confirm a negative result though this takes 1-2 days. If there are ulcerations in the mouth or cold symptoms with a sore throat, strep testing is not usually done since the cause is almost certainly a virus.

Some kids and adults are ‘strep carriers’ meaning they carry a light amount of strep but do not typically get sick with it or spread it to others. Up to 1 out of 5 children are strep carriers. They will have a positive strep test, but do not need treatment. If kids do not have strep signs and symptoms, it is best to not test since you may pick up a carrier state which does not need antibiotics.

Strep throat is treated with antibiotics, usually a 10-day course. It is paramount to finish the antibiotics, even though kids usually feel better within 2 days. The full course of antibiotics shortens the illness and decreases the risk of spreading strep to others. Antibiotics also cut the risk of inflammatory complications after strep throat such as kidney disease and rheumatic heart disease. Kids may return to school and activities after 12-24 hours on antibiotics if they are improving and without fever. Your child should also switch to a new toothbrush after antibiotics are completed.

Home care for strep includes ensuring your child is drinking adequately and getting some nutrition, which may be challenging in view of the throat pain. Cool soft foods like smoothies or popsicles are usually easiest to swallow. Avoid acidic foods like orange juice. Tylenol or Advil are fine for fevers and discomfort but follow age and weight guidelines. Aspirin is not safe for children.

Strep spreads quickly and easily by respiratory droplets when an infected person sneezes or talks and by sharing personal items like cups or water bottles. Since strep can be transmitted for 3 days before someone develops symptoms, it is best to routinely avoid sharing silverware, glasses, etc. Frequent handwashing and avoiding touching one’s eyes, nose and mouth help limit spread of strep and other illnesses- especially important this time of year.