Is it strep?

A parent’s initial fear when a child complains about a sore throat is usually, could it be strep? Here is some helpful information when you hear “Mommy, daddy — my throat hurts.”

Rachel Orscheln, MD, Washington University specialist in pediatric infectious diseases at St. Louis Children’s Hospital explains, “A sore throat can be a symptom of a variety of illnesses including upper respiratory tract infections (colds), bacterial infections, or allergies. Viruses cause most sore throats and will resolve with symptomatic care.

Group A streptococcus is responsible for causing up to 25% of cases of pharyngitis in children ages 5 to 15 years during the late winter and early spring.
Although most cases of streptococcal pharyngitis will go away spontaneously (without medication), antibiotics are necessary to prevent complications of this infection such as acute rheumatic fever. Additionally, antibiotics help to shorten the duration of illness and reduce the spread of strep to other individuals.”

Strep throat facts:

  • Strep throat can happen any time of the year, but occurs most commonly in the late winter and early spring.
  • Symptoms include sore throat, fever, headache, abdominal pain, nausea and vomiting.
  • Scarlet fever rash (fine, red, sandpaper-like rash) is highly suggestive of strep throat.
  • Cough, hoarseness, red eyes, and runny nose are usually not seen with strep throat and are more suggestive of a viral cause.
  • Five to 15 years old is the peak age. It is usually not seen in children under 2 years old unless sibling has strep.
  • Diagnosis should be confirmed by rapid streptococcal testing or throat culture prior to starting treatment (there is little 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.
  • Children less than two 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.

Call your pediatrician immediately (night or day) if your child:

  • Looks or acts very sick
  • Has difficulty breathing (Call 911 if it is severe breathing difficulty and unable to speak or cry)
  • Has great difficulty swallowing fluids or saliva
  • Shows signs of dehydration (dry mouth, no tears with crying and no urine for more than eight hours)
  • Has purple or blood-colored spots or dots on skin
  • Has a weak immune system
  • Has a fever over 104º F

Call your doctor during normal office hours if your child:

  • Has severe sore throat pain that does not improve two hours after taking ibuprofen
  • Has a persistent sore throat as the main symptom lasting more than 48 hours
  • Has cold/cough symptoms that are present more than five days without any improvement
  • Has a widespread pink rash
  • Has a fever for more than three days
  • Has been exposed to strep within the last seven days

Visit the St. Louis Children’s Hospital website for more information about strep and sore throats. Dr. Orscheln sees physician-referred patients at:

St. Louis Children’s Hospital
One Children’s Place, Suite 1102, 2nd floor