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SORE THROAT
Virtually every child and adult gets a sore throat once or twice a year.
What should you do when this happens? Could it be strep throat? How can you
tell? Should you go to the doctor? Should you just call your doctor and ask
for medicine over the phone?
Here is the Dr. Sears guide to diagnosing and treating sore throats in
children.
CAUSES OF SORE THROAT
Viruses. By far, the most common cause of sore throat is any one of
a large number of viruses, none of which are treatable with antibiotics. These
viruses can cause high fever and very painful sore throat. They can feel just
as bad or worse as strep throat.
Colds and coughs. The common cold virus can cause a sore throat in
addition to its many other symptoms. Coughing can also irritate the throat, and
so can post-nasal drip from a cold.
Strep throat. This is caused by the strep bacteria, and is treated
with antibiotics.
Coxsackie virus (hand, foot, and mouth disease). This is a virus
that causes high fever and painful canker sores on the throat, cheeks, gums, or
lips. Click on mouth sores for more info on this.
Allergies. Allergies do not cause sudden sore, painful throats.
They can, however, cause chronic mild throat irritation.
DOES MY CHILD HAVE STREP THROAT?
The main question parents should ask when their child has a sore throat is
"does my child have strep that needs antibiotics or is this just a virus?" The
answer to this is not always obvious. Here are some clues to help you
decide:Signs of strep throat:
Fever is very common to strep throat; although viruses can also give you
fever. Fever over 101 for more than three days is more likely to be strep
throat.
Very red throat with bright red spots on the back of the palate and white
pus on the tonsils. One note, however, is that some viruses can also look this
way, and sometimes strep may not look this bad.
Known exposure to someone with strep throat.
It's uncommon for a child less than age 3 to get strep throat.
Swollen neck glands.
Strep throat is most common during late fall and winter.
Pain during swallowing or pressing on the neck glands or having pain during
coughing usually is not strep throat.
No other symptoms besides sore throat and fever – strep throat usually does
not cause multiple symptoms such as runny nose, cough, and congestion. If you
have multiple symptoms, it is less likely to be strep.
Headache, stomachache and vomiting can, however, occur with strep.
There is a characteristic rash that sometimes accompanies strep throat.
This appears as fine, red pimples all over the trunk (chest, abdomen and back)
that feel rough, almost like sandpaper and may look like a sunburn. This rash,
with strep throat, is called Scarlet Fever. Do not worry; this is not serious
like it used to be. It is simply the body reacting to a toxin produced by the
strep. It does not mean the infection is more serious than strep throat without
a rash, and it goes away with treatment.
Signs that your child is more likely to have an untreatable virus, and not
strep:
Age 3 or younger
Multiple cold or flu symptoms
Throat not very red
Child not acting very sick overall
Throat pain only when coughing, but not when swallowing or pressing on
throat
HOW DID MY CHILD CATCH THE SORE THROAT?
All throat infections are transmitted via the saliva, either from coughing or
contact with the bacteria or virus on an infected person's hands or personal
items. The incubation period (the time from when you contact the illness to the
time when you feel sick) is 2 to 5 days. The incubation period for viral causes
of sore throat varies from 3 days to 2 weeks.
WHEN SHOULD I GO TO THE DOCTOR?
Do not run your child to the doctor at the first sign of a sore throat. Wait
a day or two, or more if your child is not acting ill. See which direction the
illness is going. If your child begins to fit the picture of strep throat
above, then see your doctor.
TREATING SORE THROAT
At-home treatments:
Pain reliever.Acetaminophen or
Ibuprofen can help significantly. Click on them for dosing.
Use both together for extreme pain.
Throat lozenges.
Gargle warm salt water. Mix 1/4 to 1 Tsp salt with 8 ounces warm water.
If you can get your child to do this, it works
great!
Anesthetic throat gargle. Chloraseptic can work well, but only if your
child is old enough to not swallow it.
Tea. Some herbal teas with honey or lemon may help.
Dr. Sears Clue: Citrus juices, such as orange juice, often "burn" the
sore throat caused by a virus but are usually not painful to strep throat.
Antibiotics:
Penicillin. This is the usual treatment for strep throat. It has several
drawbacks however: it must be taken three times a day, and the liquid for
children tastes terrible.
Amoxicillin. This is the "pink stuff", and is probably the most commonly
used antibiotic for strep throat. The liquid tastes much better for children,
and is only given twice a day. Even if this antibiotic has not worked well for
your child for past ear and sinus infections, it is still effective for strep
throat. It is important you take the antibiotics for a whole 10 days, or else
the strep might come back. Some research has shown a shorter course of
antibiotics may work, but this has not yet become standard.
Penicillin shot. If the thought of trying to
get your child to take an antibiotic twice daily for 10 days sounds
like too much of a chore, this option might me for you. A one-time
shot in the muscle of Long Acting Bicillin, although initially painful,
is a convenient way to make sure your child gets treated for the
strep throat.
DIAGNOSING STREP THROAT
When you take your child to the doctor, he or she will examine your child's
throat and neck glands. If the child fits all the signs of strep, and the
throat looks exactly like strep, then your doctor may elect to assume it really
is strep and treat with an antibiotic without doing a throat swab test to check
for strep. If it looks nothing like strep, and your child is acting fine, your
doctor may choose not even to do a test and consider the infection viral. This
is a common approach.
Another common approach is to rely on a throat swab test to help decide
whether or not strep is present. A cotton swab is rubbed against the back of
the throat and the tonsils. It can make most children gag. There are two types
of throat swab tests:
Rapid strep test. This test can be run in your doctor's office, and
takes just five minutes. It is about 95% accurate, which means that it will
miss about 5% of strep throats. It is therefore very useful if it shows
positive – you know for sure your child has strep throat. However, if it shows
negative (not strep), then you can only be 95% sure that your child really
doesn't have strep throat.
Throat culture. This test usually would be run in a lab, using a
throat swab collected in the doctor's office. Very few doctor's offices run
this test themselves. The lab will place the throat swab in an incubator to see
if the strep bacteria grow. This test is about 99% accurate, and therefore
less likely to miss strep throat. One drawback is that it takes 24 to 48 hours
for the lab to grow strep.
Some doctors will rely on only one of these tests. Other doctors will first
run a rapid test, and if it does not show strep, send a throat culture to be
sure your child does not have strep. The decision of which test to do, and when
to do it, is based on what the throat looks like and how sick the child is.
There is a trend toward increased use of throat swabs to confirm strep before
treating. This is to decrease the unnecessary use of antibiotics and avoid
antibiotic resistance.
If a throat culture is sent, what do you do for the next 48 hours while
waiting for the results? If your child is fairly sick, with fevers and very
sore throat, the doctor may elect to start an antibiotic right away. If the
culture comes back negative (not strep), then your doctor may advise you to stop
the antibiotics. If your child is not very sick, then your doctor may choose to
wait the 1 or 2 days without antibiotics pending the results of the strep
culture.
I am worried that if my child has strep throat he should start antibiotics
right away. I don't want him to get sicker while waiting to go in to see the
doctor or waiting for a culture result.
This is an obvious concern for parents,
and is a big reason many parents want to start an antibiotic over the phone on
the weekend for a bad sore throat.
The truth about strep is that it is safe to wait a couple of days before
treatment is started. Studies have shown that delaying treatment does not
increase the risk of complications from strep. One study has even shown a
beneficial effect if treatment is delayed because the body has a few days to
mount an immune response to the infection. The only drawback from delayed
treatment is more days of sore throat. If possible we recommend treating strep
throat early rather than later.
How long is my child contagious from a sore throat?
For strep throat treated with antibiotics, your child is no longer contagious
after 24 hours of antibiotics (it used to be 48 hours, but was recently changed
to 24 hours). For viral sore throat, your child is no longer contagious once he
has been fever free for 24 to 48 hours (without any medication to hide the
fever).
If my child has strep throat, what can I do to prevent it from spreading to
family and friends and from re-occurring?Here are some basic instructions to
keep the infection contained:
Throw away your child's toothbrush. Use a new toothbrush for two days once
antibiotics are started, then throw that one away. You can then stick with a
new one after that.
Clean any dental appliances (retainers, etc.) well every day for the first
few days on antibiotics.
Any family members or friends who have come in contact with a person with
strep throat do not have to be automatically tested for the illness unless they
themselves become ill. If a family member becomes ill with obvious symptoms of
strep throat, then your doctor may elect to treat that person without testing.
COMPLICATIONS OF STREP THROAT
Rheumatic fever. Occurs when the body's immune system interacts in
an abnormal way with the strep bacteria. This interaction is not well
understood, but is thought that the bacteria combine with antibodies. These
combined clusters attack the heart valves, joints, skin, and other organs.
While this is an extremely rare complication, you should see your doctor right
away or go to an ER if your child gets severe chest pain, shortness of breath,
joint aches and inflammation and red, blood colored spots on the skin. This
usually does not occur until several weeks after a strep infection.
Glomerulonephritis. This complicated word simply means inflammation
of the kidneys. Through a similar mechanism as rheumatic fever, the
bacteria/antibody clusters lodge in the kidneys, causing bleeding into the urine
and decreased kidney function. This also does not usually occur for several
weeks after a strep infection. You should call your doctor if you see any blood
in the urine, dark cola-colored urine, a sharp decrease in urine volume, and
swelling of the face, ankles, and feet.
These two complications are very, very rare. Treating strep throat with an
antibiotic will virtually eliminate the risk of rheumatic fever.
Glomerulonephritis, on the other hand, is not prevented by antibiotics. It just
occurs randomly, but again, very, very rarely.
AskDrSears.com is intended to help parents become better informed consumers
of health care. The information presented in this site gives general advice
on parenting and health care. Always consult your doctor for your individual
needs.
