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Pain, discomfort or raw feeling of the throat, especially when swallowing.
Colds (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.
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.
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. Their symptoms are usually better covered using the DRINKING FLUIDS -DECREASED guideline.
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.
The main symptom is croup, hoarseness or a cough, see CROUP or COUGH (Note: these symptoms are rarely seen with Strep.)
Severe difficulty breathing (struggling for each breath, making grunting noises with each breath, unable to speak or cry because of difficulty breathing)
Your child looks or acts very sick
Difficulty breathing, but not severe
Great difficulty swallowing fluids or saliva
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
You think your child needs to be seen urgently (Note: a throat culture or rapid strep test alone is not urgent)
You think your child needs to be seen, but not urgently (OR needs a 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
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
Probable viral throat infection and you don't think your child needs to be seen
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.
Sore Throat 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.
Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen for severe throat discomfort or fever greater than 102° F (39° C).
Soft Diet: Cold drinks and milk shakes are especially helpful. (Reason: Swollen tonsils can make some solid foods hard to swallow.)
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.
Expected Course: Sore throats with viral illnesses usually last 4 or 5 days.
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
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