Just another sore throat, or could it be strep?

sick boy

It’s hard to get through the winter without having at least one sore throat.  Most sore throats are minor, more of an annoyance than anything else, and they tend to be the first sign of a viral cold.

But what if it’s strep?

Strep is a bacteria that commonly invades the throat and tonsils causing pain, fever, and swollen lymph nodes.  We care because strep bacteria can be pesky.  Left untreated, the bacteria can wreak havoc in more than just your throat by invading other parts of the body.  Some complications of strep are minor, such as an ear or a sinus infection.  Some, however, are more serious involving a collection of pus in the back of your throat called an abscess, a blood infection, heart disease, kidney inflammation, or a neurologic disorder known as PANDAS.  If you do not treat strep throat with an antibiotic, there is also a greater chance that you will spread the infection to someone else.

How do I know if my kid has strep? 

Well, that’s the problem.  It’s hard to know.

In general, if you child is congested, has a runny nose, or has pink eye with their sore throat, it’s probably due to a cold virus and not strep.  Also, strep is more prevalent in the late fall, winter, and early spring – it is rare for someone to catch strep in the summer.  School-aged children are more commonly affected; however, it is possible for toddlers and babies to get strep too.

Certainly strep and colds are not the only infections that can cause a sore throat; individuals can also get sore throats from the virus that causes herpes, mononucleosis, and other bacteria and viruses.

How do I know if my child’s sore throat warrants a trip to my health care provider to rule out strep or other conditions?

In general, you should see your healthcare provider ASAP if any of the following are true:

  • Your child has a sore throat and he or she has been around someone who has been diagnosed with strep or mononucleosis
  • Your child is in extreme pain and/or says this is the worst sore throat he or she has ever had
  • Your child has a sore throat and no other symptoms of a cold, especially with sore glands in the neck
  • A sore throat that is accompanied by nausea or vomiting
  • Fever greater than 101
  • Rash all over the body

Warning! A sore throat that is so severe your child is drooling, refusing to eat or drink, or having trouble opening their mouth could indicate a medical emergency.  In this case, seek healthcare immediately.

If I take my child in to see his or her healthcare provider, what will happen at the visit? 

Your healthcare provider will do a thorough examination to determine what type of testing is necessary.  Strep testing involves two swabs of the throat.  One swab is used for a “rapid” strep test.  This test is performed quickly in the medical office and can give a results within minutes.  Unfortunately, it doesn’t catch every case of strep.  If the rapid test is negative, the second swab will be sent to a laboratory for a longer and more accurate test known as a culture.  The culture can take up to two days.  Occasionally a child will have a negative rapid test but a positive throat culture.  Any positive testing means your child will be prescribed an antibiotic.

If the strep test is positive, what’s next? 

Take the entire course of antibiotics that your healthcare provider prescribes.  Even if your child feels better before the antibiotic is complete, he or she must finish the full length of treatment.  Stopping treatment early leads to antibiotic resistance and could cause your child’s infection to return.

Keep the germs contained.  Have your child stay home from school or daycare until her or she has had at least 24 hours of antibiotics. Some newer studies on strep suggest kids are no longer contagious 12 hours after the first antibiotic dose; however, national recommendations continue to suggest waiting at least 24 hours before returning to school.  Avoid sharing food or drink with your child and encourage them to cover their mouth if they cough.  As always, wash hands when they are visibly dirty and use a gel based sanitizer as needed, but especially before eating.

If your child does not seem to be responding to treatment, or if their sickness is getting worse, return to your healthcare provider for another visit.

Aside from taking any prescribed antibiotics, is there anything else you can do to soothe a sore throat?

Absolutely. Consider anti-inflammatory medications such as ibuprofen or acetaminophen for comfort; though, be sure to talk with your healthcare provider about the correct dosing.  Also, for non-pharmacologic ways decrease throat pain, check out my graphic:

Sarah’s Top 8 Ways to Sooth a Sore Throat


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Just another sore throat or could it be strep? by Sarah Kiser, CPNP-PC is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

About sarahkiser

Pediatric nurse practitioner, writer, mother of two.

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