Child stands with mouth open wide covering his eyes.

Sore throat in Kids. Is it Strep?

Sore throats are a common symptom in kids and can be a real pain. However, did you know not every sore throat is strep, and not every sore throat needs antibiotics? Fortunately, most sore throats will go away on their own. However, if your child has a sore throat, there are some things you can do in the meantime to help your little one feel better. Read on for more info about what strep throat is, how it is diagnosed and how to treat strep and other causes of sore throat!

What is a sore throat?

A sore throat refers to pain and inflammation of the throat (pharyngitis) or tonsils (tonsillitis.) Most of the time, sore throats in kids are caused by common viruses. 

What is strep throat, and is it contagious?

Strep throat pharyngitis or tonsillitis is caused by a bacteria called streptococcus. Strep throat is not common in kids under the age of two years. Strep throat is contagious and easily transmitted from bacteria present in the droplets of an infected person, so it is best to keep your child with strep away from others. As with any infection, practice good hand washing and clean shared surfaces.

What are the symptoms of strep throat?

The main symptoms of trep throat are due to inflammation in and around the tonsils. The main symptom is a sore throat, but this may not be the primary complaint in young kids. Other common symptoms of strep throat include:

  • Fever
  • Headache
  • Stomachache
  • Swollen lymph nodes (‘glands)
  • Fatigue
  • Rash

What symptoms do not usually occur with strep throat?

Strep bacteria doesn’t usually cause other upper respiratory symptoms. Therefore if your child has the following symptoms, strep throat is less likely:

  • Cough
  • Runny nose
  • Ear ache
  • Vomiting and diarrhea

How is strep throat diagnosed?

When a healthcare provider is evaluating your child for a sore throat, they will likely do the following things to determine the cause:

  • Physical exam
  • Vital signs, including temperature
  • Rapid strep test
  • Throat culture

How does a rapid strep test work?

  • With a rapid strep test, a healthcare provider swabs the back of the throat with a long cotton swab and the test gives a positive or negative result in 5 minutes or less.
  • If the test is positive, it is very reliable, and your child will likely receive antibiotics to treat strep throat. The only caveat is that some people are “carriers” of strep, meaning they have some streptococcal bacteria in their throat all the time, and it is not causing their current symptoms. Therefore, if your child continually tests positive for strep, it is worth discussing with your healthcare provider whether they could be a carrier, which may alter the treatment plan.
  • When a rapid test is negative, this either means they don’t have strep and the pain is due to a virus or that not enough bacteria were picked up by the rapid test. Often the next step would be a throat culture.

What is a throat culture?

A throat culture involves sending a swab sample from the back of the throat to the lab. In the lab, they watch the culture to see if bacteria grow. They check for growth at 24- 48 hours and can determine whether or not it is strep throat. 

How is strep throat treated?

  • Antibiotics
    • The mainstay of treatment for strep throat is an antibiotic to treat the bacteria.
    • In most cases, the infection would likely resolve eventually without antibiotics. However, if untreated, there is an increased risk for prolonged illness or other complications from strep throat, such as rheumatic fever.
    • Remember, antibiotics only treat bacterial infections, so if your child’s strep test is negative, antibiotics will not help. 
  • Pain relievers
    • Treating the inflammation and discomfort of a sore throat can help your child feel better quickly. 
    • Acetaminophen(Tylenol) and Ibuprofen (Motrin) are over-the-counter pain relievers that can help. 
  • Fluids
    • Hydration is essential during any infection. 
    • Your child may need extra encouragement to drink if swallowing is painful. One benefit of ensuring their pain is well controlled is that they will be better able to stay hydrated. 
    • Warm tea, broth, ice-cold liquids, or even popsicles are sometimes tolerated better than room-temperature fluids.
  • Other helpful tricks
    • Lozenges for older children may help keep the throat moist and provide some relief.
    • Saltwater gargles for older children who can gargle and spit may also be helpful for temporary relief.

How can I treat other sore throats that are caused by a virus? 

  • All of the above, except for the antibiotics! 
  • Remember, antibiotics only work on infections caused by bacteria. They do not affect viruses. 

What are other causes of a sore throat?

Other viral infections are the most common causes of sore throat. Less commonly, other types of bacterial infections can lead to sore throat as well.

  • Common cold viruses can often cause pharyngitis.
  • Coxsackie virus causes hand-foot-and-mouth disease and can lead to sores in the mouth and throat that cause pain.
  • Infectious Mononucleosis, also called “mono,” can cause various symptoms, including severe pharyngitis and tonsillitis.
  • Croup is a viral infection that causes inflammation in the upper airway leading to a barky cough, sore throat, fever, and congestion.
  • Abscesses or severe swelling are a less common result of strep throat or other bacterial throat infections that can lead to swelling in the back of the throat. These can be dangerous due to the potential to block the airway. 
    • If your child has a severe sore throat, fever, difficulty swallowing, or noisy breathing, they should be urgently evaluated by a healthcare provider. 

My child gets strep throat a lot. Do they need their tonsils out?

Tonsillectomy, or the removal of tonsils, was historically common practice for children with multiple episodes of strep throat. However, it is only recommended now in extreme cases because the procedure’s risks often outweigh the benefits. Talk with your doctor if you are concerned your child may need a tonsillectomy. 


More resources:

CDC – strep throat – Strep throat or Sore throat