Strep Throat: What Parents Need to Know

Sore throats are one of the most common reasons kids end up at the pediatrician’s office. Sometimes it’s just part of a cold, but other times it can be strep throat — a bacterial infection that does need antibiotics. The tricky part? You typically can’t tell the difference just by looking at the throat.

What Is Strep Throat?

Strep throat is an infection of the throat caused by a bacteria called Group A Streptococcus or strep pyogenes. It accounts for 15-30% sore throat infections in children ages 5-15 years old, making it the most common bacterial cause of sore throat in children. Strep throat can occur any time of year, but we tend to see peaks in late fall, winter, and early spring

What Are the Symptoms?

Classic strep throat usually comes on suddenly with fever, sore throat, swollen lymph nodes, headache, decreased energy and decreased appetite.

Some children also have abdominal pain, nausea, or vomiting, which are more common in younger kids than in older children or adolescents.

The back of the throat appears red and inflamed with enlarged tonsils. You may also see exudates “white spots” on the tonsils or palatal petechiae “tiny red spots” on the roof of the mouth.

If strep throat is the source of the infection, children are less likely to have congestion, runny nose, conjunctivitis or a hoarse voice. These symptoms are more commonly associated with viral illnesses. 

Scarlet Fever and Strep Throat

Up to 10% of children with strep pharyngitis may also have the “scarlet fever” rash. The rash feels fine and “sandpapery” starting on the trunk of the body and spreading outwards -though not usually including the palms or soles. The rash appears within 12-48 hours of symptom onset. 

No specific treatment for the rash is needed aside from treating the underlying strep infection. Most children are not very bothered by it, and the rash usually fades away over several days. 

Testing: Why It Matters and When to Consider It

Viruses can cause identical symptoms and exam findings as strep throat, which is why testing to confirm infection is so important. 

Group A strep bacterial infection is treated with antibiotics while viral sore throats will not respond to them. In fact, viral infections cause 60–70% of sore throats in children. Common viral causes include EBV (mono), influenza, COVID-19, adenovirus, and enteroviruses. 

If you believe your child may have strep throat, it is important to discuss their symptoms with their pediatrician. If your doctor feels that testing for strep is appropriate, this can typically be done in the office during the visit. 

Most offices perform a rapid strep test as a screen in the office.

-If the test is positive and the exam and history are consistent with strep, antibiotics are usually prescribed

-If the test is negative, a confirmatory throat culture or PCR test is often sent to the lab. In this case, antibiotics should be held until the confirmatory result is positive.

Why Do We Treat Strep Throat?

Treatment of a confirmed case of strep throat is usually penicillin or amoxicillin. Treatment will help your child recover faster and help prevent the spread of the illness to others. Treatment also helps prevent some of the complications that can occur with strep throat such as ear infection, peritonsillar abscess, sinusitis, bacteremia and rheumatic fever. 

In addition to antibiotics, you can provide supportive care for sore throat symptoms with warm fluids like tea with honey or chicken broth, cold water or ice pops, salt water gargles (if old enough to gargle safely) and pain/fever reducers such as acetaminophen and ibuprofen.

Most children will be able to return to school after 24hr of beginning the antibiotics as long as they are fever free and feeling better. 

It is important to complete the entire course of antibiotics even though your child feels better sooner. In most cases, a repeat test to confirm clearance isn’t necessary — but if symptoms persist or worsen, follow up with your pediatrician.

What If My Child is Exposed to Strep Throat?

Siblings and other close contacts of someone with strep do not routinely need preventive antibiotics. Instead, it’s best to observe for symptoms and test if they develop.

There are a few situations where preventive treatment may be considered after exposure, but this should always be discussed directly with your primary care doctor.

Conclusion

Most sore throats in children are caused by viruses, but symptoms can overlap significantly with strep throat. Discuss your concerns with your child’s doctor to determine whether testing is appropriate — it may not be needed in every situation.

Antibiotics should only be given if testing confirms strep and the symptoms and exam support the diagnosis. Using antibiotics appropriately helps your child recover safely while reducing the risk of resistance and unnecessary side effects.

-Dr. Christina Piron

Board Certified Pediatrician

MamaDoc NJ