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Sore Throat

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Definition

  • Pain or discomfort of the throat
  • Made worse when swallows
  • Rare symptom before 2 years old
  • Not caused by an injury to the throat

Causes of Sore Throat

  • Colds. Most sore throats are part of a cold. In fact, a sore throat may be the only symptom for the first 24 hours. Then a cough and runny nose occur.
  • Viral Pharyngitis. Some viruses cause a sore throat without other symptoms. A cough and runny nose don't become part of the illness. An antibiotic won't help.
  • Strep Pharyngitis. Group A Strep is the most common bacterial cause. It accounts for 20% of sore throats without any cold symptoms. Pus is seen on the tonsils. Peak age is 5 to 15 years. An antibiotic is helpful.
  • Mono. Infectious Mono mainly occurs in teens and young adults. The main symptoms are sore throat, fever and widespread swollen lymph nodes. Like Strep, Mono also has pus on the tonsils. Patients with Mono also may have a large spleen. It's located in the upper left side of the stomach. Mono is diagnosed with special blood tests.
  • Post-nasal Drip. Drainage from a sinus infection can cause a sore throat. The throat clearing that goes with the drainage may cause most of the irritation. The sinus infection is more likely to be viral than bacterial.
  • Mouth Breathing. Breathing with the mouth open during sleep can cause a sore throat. After eating breakfast, it often goes away.
  • Abscess of Tonsil (Serious). A bacterial infection of the tonsil can spread to the surrounding tissues. The main symptoms are severe trouble swallowing, fever and one-sided throat pain. It's also hard to fully open the mouth. The peak age is teens.
  • Epiglottitis (Very Serious). A bacterial infection of the flap of tissue above the vocal cords. It normally covers the windpipe during swallowing. The main symptoms are severe sore throat, drooling, spitting and fever. It can shut off the airway. Needs a 911 response.

Strep Throat: When to Suspect

  • Symptoms include sore throat, fever, headache, stomach pain, nausea and vomiting.
  • Cough, hoarseness, red eyes, and runny nose are usually not seen with Strep throat. These symptoms point more to a viral cause.
  • Scarlet fever rash (fine, red, sandpaper-like rash) is highly suggestive of Strep throat.
  • Peak age: 5 to 15 years old. Not common under 2 years old unless sibling has Strep.
  • If you think your child has Strep, call your doctor.
  • Your doctor will do a Strep test. If the test is positive, they will start treatment. There is no risk from waiting until a Strep test can be done.
  • Standard treatment is with antibiotics by mouth.

Symptoms in Infants and Toddlers

  • Children less than 2 years of age usually don't complain about a sore throat. A young child who does not want favorite foods may have a sore throat. They may also start to cry during feedings. Their symptoms are usually better covered using Drinking Fluids - Decreased care guide.
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When To Call

Call 911 Now

  • Severe trouble breathing (struggling for each breath, can barely speak or cry)
  • Purple or blood-colored spots or dots on skin with fever
  • You think your child has a life-threatening emergency

Go to ER Now

  • Can't swallow any fluids and new onset drooling
  • Purple or blood-colored spots or dots on skin without fever

Call Doctor or Seek Care Now

  • Trouble breathing, but not severe
  • Great trouble swallowing fluids or spit
  • Can't open mouth all the way
  • Stiff neck or can't move neck like normal
  • Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
  • Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
  • Fever higher than 104° F (40° C)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent. Note: a Strep test alone is not urgent.

Contact Doctor Within 24 Hours

  • Sore throat pain is severe and not better 2 hours after taking ibuprofen
  • Large lymph nodes in the neck
  • Pink rash that's widespread
  • Earache or ear drainage
  • Sinus pain (not just congestion) around cheekbone or eyes
  • Fever lasts more than 3 days
  • Fever returns after being gone more than 24 hours
  • Age less than 2 years old
  • Close contact to a person with Strep within last 7 days
  • Sores on the skin
  • You think your child needs to be seen, but the problem is not urgent (or needs a Strep test)

Contact Doctor During Office Hours

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

Self Care at Home

  • Viral throat infection suspected
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Care Advice

What You Should Know About Sore Throats:

  • Most sore throats are just part of a cold and caused by a virus.
  • A cough, hoarse voice or nasal discharge points to a cold as the cause.
  • Most children with a sore throat don't need to see their doctor.
  • Here is some care advice that should help.

Sore Throat Pain Relief:

  • Age over 1 year. Can sip warm fluids such as chicken broth or apple juice. Some children prefer cold foods such as popsicles or ice cream.
  • Age over 6 years. Can also suck on hard candy or lollipops. Butterscotch seems to help.
  • Age over 8 years. Can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed.
  • Medicated throat sprays or lozenges are generally not helpful.

Pain Medicine:

  • To help with the pain, give an acetaminophen product (such as Tylenol).
  • Another choice is an ibuprofen product (such as Advil).
  • Use as needed.

Fever Medicine:

  • For fevers higher than 102° F (39° C), give an acetaminophen product (such as Tylenol).
  • Another choice is an ibuprofen product (such as Advil).
  • Note: fevers less than 102° F (39° C) are important for fighting infections.
  • For all fevers: keep your child well hydrated. Give lots of cold fluids.

Fluids and Soft Diet:

  • Try to get your child to drink adequate fluids.
  • Goal: keep your child well hydrated.
  • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
  • Solid Foods: offer a soft diet. Also avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: fluid intake is much more important than eating any solid foods.
  • Swollen tonsils can make some solid foods hard to swallow. Cut food into smaller pieces.

Return to School:

  • Your child can return to school after the fever is gone. Your child should feel well enough to join in normal activities.
  • Most often, having just a sore throat is not a reason to miss school.
  • Children with Strep throat need to be taking an antibiotic for at least 12 hours.

What to Expect:

  • Most often, sore throats with a viral illness last 4 or 5 days.

Call Your Doctor If:

  • Sore throat is the main symptom and lasts more than 48 hours
  • Sore throat with a cold lasts more than 5 days
  • Fever lasts more than 3 days or goes higher than 104° F (40° C)
  • You think your child needs to be seen
  • Your child becomes worse

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Photos

Scarlet Fever Rash

The photo shows a scarlet fever rash on the forearm.

The rash first appears as tiny red bumps on the chest and abdomen that may spread all over the body. It looks like a sunburn and feels like a rough piece of sandpaper. It lasts about 2-5 days.

Scarlet fever is a disease caused by the same bacteria that causes strep throat. A person with scarlet fever has a throat that is red and sore, often a fever and swollen glands in the neck, and a scarlet fever rash.

Source: CDC PHIL
From the CDC's Public Health Image Library (http://phil.cdc.gov), ID#5163, in the public domain.

Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2024. Schmitt Pediatric Guidelines LLC.
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