Sore throats in children are usually viral and settle on their own. Strep throat is the one worth identifying, because it is bacterial, it responds to antibiotics, and treating it prevents the rare but serious complications that can follow an untreated infection.
Strep throat or just a sore throat?
You cannot reliably tell by looking, and neither can we — which is why we swab. But the pattern differs.
More suggestive of strep:
- Sore throat that comes on suddenly
- Pain on swallowing, fever, headache, sometimes stomach ache or vomiting
- Swollen, tender glands in the neck
- Red or white-spotted tonsils, sometimes tiny red spots on the roof of the mouth
- A fine, sandpapery rash (scarlet fever — the same bacterium, not a different or more alarming illness)
- No cough and no runny nose
More suggestive of a virus: cough, runny nose, hoarseness, red eyes, mouth ulcers. These point away from strep, and a child with a streaming cold almost certainly does not have it.
Strep is uncommon in children under three, and most common between about five and fifteen.
Testing
We take a quick throat swab. A rapid test gives an answer within minutes; if it is negative but strep still looks likely, we may send a culture, which takes a day or two. Please do not ask for antibiotics without a test — most sore throats are viral, and antibiotics will not help them while still carrying side effects and contributing to resistance.
Treatment
Confirmed strep is treated with antibiotics. Children usually feel markedly better within a day or two, and are generally no longer contagious after about 24 hours of treatment — most schools use that as the return threshold, though check your school’s policy.
Finish the entire course, even once your child seems well. This is the one infection where stopping early genuinely matters: completing treatment is what protects against rheumatic fever, which can affect the heart.
For comfort meanwhile: acetaminophen or ibuprofen (see dosing guidance), cold drinks and ice lollies, and for older children, warm salt-water gargles. Avoid throat lozenges in young children because of the choking risk.
At home
Replace your child’s toothbrush once they have been on antibiotics for a day, and do not share cups or cutlery while they are unwell. There is no need to test other family members unless they develop symptoms.
When to call us
- Sore throat with fever, especially with no cough or runny nose
- Difficulty swallowing, or refusing to drink
- Not improving after 48 hours on antibiotics
- A rash appearing with the sore throat
Go to the emergency room for difficulty breathing, drooling with an inability to swallow, inability to open the mouth fully, or a severely swollen neck.
Strep testing in MetroWest, Orlando
We offer same-day sick visits for sore throats. Call (407) 445-9224. Primary Care Pediatrics, 1507 S Hiawassee Rd, Suite 105, Orlando, FL 32835, Monday to Friday, 9:00 AM – 5:00 PM.
