Sore Throat  

This Care Guide Covers:

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

If not, see these topics
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Scarlet Fever Rash
Scarlet Fever Rash

When to Call Your Doctor

Call 911 Now (your child may need an ambulance) If
  • Severe trouble breathing (struggling for each breath, can barely speak or cry)
  • You think your child has a life-threatening emergency
Call Your Doctor Now (night or day) If
  • Your child looks or acts very sick
  • Trouble breathing, but not severe
  • Great trouble swallowing fluids or spit
  • New drooling
  • Stiff neck
  • Dehydration suspected. (No urine in over 8 hours, dark urine, very dry mouth and no tears)
  • Purple or blood-colored spots or dots on skin
  • Weak immune system. (Such as sickle cell disease, HIV, cancer, organ transplant, taking oral steroids)
  • Fever over 104° F (40° C)
  • You think your child needs to be seen urgently. (Note: A Strep test is not urgent)
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think your child needs to be seen, but not urgently. (OR needs a Strep test)
  • Sore throat pain is severe and not improved 2 hours after taking ibuprofen
  • Large lymph nodes in the neck
  • Pink rash that's widespread
  • Earache or sinus pain (not just congestion)
  • Fever lasts more than 3 days
  • Fever returns after gone for more than 24 hours
  • Age under 2 years
  • Close contact to a person with Strep within last 7 days
  • Sores on the skin
Call Your Doctor During Weekday Office Hours If
  • 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
Parent Care at Home If
  • Viral throat infection suspected
Causes & Health Information

Causes·    

  • 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.

Strep Throat

  • 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.
  • Diagnosis should be confirmed by a Strep test before starting treatment. There is no risk to your child to delay treatment 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 guide.

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.
  • Also, children with Strep throat need to be taking an antibiotic for 24 hours.
CARE ADVICE FOR SORE THROATS

  1. What You Should Know:
    • 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.
    • Here is some care advice that should help.
  2. Sore Throat Pain Relief:
    • Age over 1 year. Can sip warm fluids such as chicken broth or apple juice.
    • 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.
  3. Pain Medicine:
    • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed. See Dose Table.
  4. Fever:
    • For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. See Dose Table. Note: Lower fevers are important for fighting infections.
    • For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.
  5. 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.
    • Solids. 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 solids.
    • Swollen tonsils can make some solid foods hard to swallow.
  6. 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.
    • Also, children with Strep throat need to be taking an antibiotic for 24 hours.
  7. What to Expect:
    • Most often, sore throats with a viral illness last 4 or 5 days.
  8. 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
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.
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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 9/1/2012

Last Revised: 1/13/2013

Content Set: Child Symptom Checker

Copyright 1994-2012 Barton D. Schmitt, M.D.