Strep Throat in Children: Symptoms, Treatment & When to See a Doctor

What Is Strep Throat and How Is It Different from Regular Sore Throat?

Strep throat (streptococcal pharyngitis) is a bacterial throat infection caused by Group A Streptococcus (GAS) bacteria. Unlike viral sore throats which account for most throat infections, strep throat requires antibiotic treatment and can cause serious complications if untreated. The hallmark difference is that strep throat causes sudden, severe throat pain with high fever but typically NO cold symptoms like cough or runny nose.

Understanding the difference between strep throat and a common viral sore throat is crucial for parents. While both conditions cause throat pain, they have fundamentally different causes, treatments, and potential consequences. Strep throat is caused by a bacterium called Group A Streptococcus (also known as Streptococcus pyogenes), whereas most sore throats in children are caused by viruses that require no antibiotic treatment.

Strep throat accounts for approximately 15-30% of all sore throat cases in children aged 5 to 15 years. This makes it one of the most common bacterial infections in this age group. The infection spreads through respiratory droplets when an infected person coughs, sneezes, or talks. Children can also become infected by touching contaminated surfaces and then touching their mouth, nose, or eyes.

The reason proper diagnosis matters so much is that untreated strep throat can lead to serious complications including rheumatic fever - an inflammatory disease that can permanently damage the heart valves. While rheumatic fever has become rare in developed countries due to widespread antibiotic treatment, it remains a significant concern globally and a key reason why strep throat should always be properly diagnosed and treated.

Why Strep Throat Is More Common in Children

Children between ages 5 and 15 are most susceptible to strep throat for several reasons. Their immune systems are still developing and learning to fight off various pathogens. School environments bring children into close contact with many other children, facilitating the spread of respiratory infections. Additionally, children are less consistent with hygiene practices like handwashing and covering coughs, which allows bacteria to spread more easily.

Interestingly, strep throat is relatively uncommon in children under 3 years of age. When very young children do get strep infections, they often present differently, with symptoms like runny nose and irritability rather than the classic severe sore throat seen in older children. This age-related pattern helps doctors determine how likely a strep infection is based on the child's age.

Seasonal Patterns of Strep Throat

Strep throat shows a clear seasonal pattern, with peak incidence occurring in late winter and early spring (typically February through April in the Northern Hemisphere). This coincides with the time when children spend more time indoors in close contact with others. However, strep throat can occur at any time of year, so parents should remain vigilant regardless of season when their child develops characteristic symptoms.

What Are the Symptoms of Strep Throat in Children?

Classic strep throat symptoms include sudden onset of severe sore throat, fever above 38.3C (101F), painful swallowing, swollen red tonsils often with white patches or streaks, swollen tender lymph nodes in the front of the neck, headache, and stomach pain. Importantly, strep throat typically does NOT cause cough, runny nose, hoarseness, or conjunctivitis - the presence of these symptoms suggests a viral cause instead.

Recognizing the symptoms of strep throat can help parents decide when to seek medical care. The onset of strep throat is typically sudden and dramatic - a child who seemed fine in the morning may develop severe throat pain and high fever by afternoon. This abrupt onset differs from viral sore throats, which usually develop more gradually over several days.

The sore throat caused by strep is often described as one of the most painful sore throats a child will experience. Children may refuse to eat or drink because swallowing is so uncomfortable. Some children describe it as feeling like they're swallowing razor blades or glass. The severity of the throat pain, combined with high fever, often prompts parents to seek medical attention.

Characteristic Signs Parents Should Look For

When examining your child's throat (which can be done at home with a flashlight), several visual signs may suggest strep throat. The tonsils typically appear bright red and swollen, often significantly larger than normal. You may see white or yellow patches, streaks, or coating on the tonsils - this is pus caused by the bacterial infection. The back of the throat may also appear very red with possible tiny red spots (petechiae) on the soft palate.

The lymph nodes in the neck often become noticeably swollen and tender to touch. These can be felt as firm, tender bumps just below the jaw and along the front of the neck. The lymph node swelling occurs because these are part of the immune system fighting the infection.

Symptoms in Younger Children

Children under 3 years of age may present with different symptoms than older children. Instead of complaining about sore throat, younger children may simply become irritable, refuse to eat, have a runny nose, or develop a low-grade fever. They may drool more than usual because swallowing is uncomfortable. Some may develop a rash similar to scarlet fever. Because symptoms can be atypical in this age group, diagnosis can be more challenging.

Associated Symptoms

Beyond the throat symptoms, children with strep throat often experience other symptoms that can help with diagnosis. Headache is common and can be quite severe. Many children complain of stomach pain, which may be accompanied by nausea or vomiting - this is particularly common in younger children and can sometimes be mistaken for a stomach illness. Some children develop a general feeling of illness and fatigue that keeps them in bed.

When Should You Take Your Child to the Doctor?

See a doctor if your child has severe sore throat with fever above 38.3C (101F), difficulty swallowing, swollen lymph nodes, white patches on tonsils, or sore throat lasting more than 48 hours. Seek immediate emergency care if your child has difficulty breathing, severe neck stiffness, cannot open their mouth, or cannot swallow their own saliva.

Knowing when to seek medical care for your child's sore throat can be challenging. Not every sore throat needs a doctor visit - most are viral and will resolve on their own. However, certain signs and symptoms warrant medical evaluation to rule out strep throat and ensure appropriate treatment if needed.

The combination of symptoms is often more telling than any single symptom. A child with sudden severe sore throat, high fever, and swollen tonsils with white patches should be evaluated for strep throat. Similarly, if your child's sore throat is severe enough that they refuse to eat or drink, medical evaluation is warranted to ensure they don't become dehydrated and to check for strep.

Specific Situations Requiring Medical Attention

Beyond the classic symptom combination, several specific situations should prompt a visit to your child's healthcare provider. If your child has been exposed to someone with confirmed strep throat and develops any throat symptoms, testing is advisable. Children who have had rheumatic fever in the past need prompt evaluation and treatment of any suspected strep infection to prevent recurrence.

Duration of symptoms also matters. While viral sore throats typically improve within 3-5 days, sore throat lasting beyond 48 hours with no improvement may indicate strep throat or another bacterial infection requiring treatment. Similarly, if your child was diagnosed with a viral illness but symptoms worsen rather than improve, re-evaluation is appropriate.

How Is Strep Throat Diagnosed?

Strep throat is diagnosed through a rapid strep test (results in 5-10 minutes) and/or throat culture (results in 24-48 hours). The rapid test detects strep antigens from a throat swab with about 95% accuracy in positive results. If the rapid test is negative but strep is still suspected, a throat culture may be performed for confirmation. Clinical symptoms alone cannot reliably diagnose strep throat.

Accurate diagnosis of strep throat is essential because the symptoms can overlap significantly with viral pharyngitis, yet the treatment is completely different. While doctors use clinical criteria to assess the likelihood of strep throat, laboratory testing is necessary for definitive diagnosis. The Centor criteria (modified McIsaac criteria for children) help doctors assess probability: fever, tonsillar exudates (white patches), tender anterior cervical lymph nodes, and absence of cough.

However, even children meeting all clinical criteria may not have strep throat, and some with fewer criteria may still have strep. This is why testing is so important - treating viral infections with antibiotics is harmful (contributing to antibiotic resistance and side effects) while not treating true strep infections risks serious complications.

Rapid Antigen Detection Test (Rapid Strep Test)

The rapid strep test is the most commonly used diagnostic tool in office settings. A healthcare provider uses a special swab to collect a sample from the back of the throat and tonsils. The test works by detecting specific proteins (antigens) from Group A Streptococcus bacteria. Results are available within 5-10 minutes.

The rapid strep test has excellent specificity (around 95%), meaning a positive result is highly reliable. However, its sensitivity is somewhat lower (around 70-90%), meaning some true strep cases may be missed. For this reason, when a rapid test is negative but clinical suspicion remains high, especially in children, a throat culture may be performed for confirmation.

Throat Culture

Throat culture is considered the gold standard for diagnosing strep throat. Like the rapid test, it requires a throat swab. The sample is then placed in a special growth medium and incubated in a laboratory. Group A Streptococcus bacteria, if present, will grow and can be identified. Results typically take 24-48 hours.

The main advantage of throat culture is its high sensitivity - it can detect strep even when bacterial numbers are low. Many pediatric guidelines recommend confirming negative rapid tests with throat culture in children, as missing a strep diagnosis can have consequences. Adults, who are at lower risk for complications, may not need culture confirmation of negative rapid tests.

How Is Strep Throat Treated?

Strep throat is treated with antibiotics, most commonly penicillin V or amoxicillin for 10 days. Treatment relieves symptoms within 24-48 hours, makes children non-contagious after 24 hours of antibiotics, and most importantly prevents complications like rheumatic fever. The complete antibiotic course must be finished even if symptoms improve quickly. Pain and fever can be managed with acetaminophen or ibuprofen.

Antibiotic treatment is the cornerstone of strep throat management. Unlike many childhood infections that are viral and don't require antibiotics, strep throat is a bacterial infection that benefits significantly from antimicrobial therapy. The goals of antibiotic treatment are multiple: relieve symptoms faster, prevent complications (especially rheumatic fever), reduce contagiousness, and prevent suppurative complications like peritonsillar abscess.

The most important reason for antibiotic treatment is preventing rheumatic fever, a serious inflammatory condition that can damage heart valves permanently. Research has shown that starting antibiotics within 9 days of symptom onset effectively prevents this complication. This gives parents some reassurance - waiting a day or two for test results or doctor appointment won't compromise your child's health.

Antibiotic Choices

Penicillin V (phenoxymethylpenicillin) has been the first-line treatment for strep throat for decades. It remains highly effective because Group A Streptococcus has never developed resistance to penicillin - a remarkable fact in an era of increasing antibiotic resistance. The standard regimen is twice or three times daily for 10 days.

Amoxicillin is often preferred for children because it tastes better than penicillin suspension and can be given once daily (with the extended-release formulation) or twice daily. Studies show it is equally effective as penicillin. Many children prefer the taste, improving compliance with completing the full course.

For children allergic to penicillin, alternatives include cephalexin (for non-severe penicillin allergy), azithromycin, or clindamycin. Azithromycin has the advantage of a shorter course (typically 5 days), but there is emerging resistance of Group A Strep to this antibiotic in some regions.

Home Care and Symptom Relief

While antibiotics treat the infection, several measures can help your child feel more comfortable during recovery. Pain and fever management with acetaminophen (paracetamol) or ibuprofen is important for comfort. These medications can be given according to age-appropriate dosing. Never give aspirin to children due to the risk of Reye's syndrome.

Hydration is crucial. Encourage your child to drink plenty of fluids even if swallowing is painful. Cold drinks, ice pops, and warm broths can all be soothing. Some children find that cold items numb the throat pain, while others prefer warm liquids. Avoid acidic drinks like orange juice that may irritate the throat.

Offer soft, easy-to-swallow foods such as soup, yogurt, mashed potatoes, scrambled eggs, smoothies, and ice cream. These provide nutrition without requiring much chewing or painful swallowing. As your child improves, gradually reintroduce normal foods.

For older children (typically 8 years and above), gargling with warm salt water can provide temporary pain relief. Mix about half a teaspoon of salt in 8 ounces of warm water. Younger children who cannot gargle safely should not attempt this.

How Long Is Strep Throat Contagious?

Without treatment, strep throat remains contagious for 2-3 weeks. With antibiotic treatment, children are no longer contagious after 24 hours of medication AND when fever has resolved. Children can return to school or daycare after being on antibiotics for at least 24 hours and feeling well enough to participate in normal activities.

Understanding the contagious period is important for preventing spread to siblings, classmates, and other family members. Strep throat spreads through respiratory droplets produced when an infected person coughs, sneezes, laughs, or talks. It can also spread through sharing food, drinks, or utensils with an infected person, or by touching contaminated surfaces and then touching the face.

The good news is that antibiotics dramatically shorten the contagious period. Once your child has taken antibiotics for at least 24 hours and their fever has resolved, they are generally no longer contagious and can return to school or daycare if feeling well enough. This typically means missing only one or two days of school rather than an extended period.

Preventing Spread Within the Family

Several measures can help prevent strep throat from spreading to other family members. The infected child should cover coughs and sneezes with a tissue or their elbow. Frequent handwashing by all family members is important. Avoid sharing utensils, cups, water bottles, and towels with the infected child.

Replace your child's toothbrush after they have been on antibiotics for 24 hours - bacteria can survive on the toothbrush and potentially cause reinfection. Clean commonly touched surfaces like doorknobs, light switches, and bathroom fixtures. Ensure good ventilation in the home.

What Are the Potential Complications of Strep Throat?

Untreated strep throat can cause serious complications including rheumatic fever (which can permanently damage heart valves), post-streptococcal glomerulonephritis (kidney inflammation), peritonsillar abscess, scarlet fever, and toxic shock syndrome. Prompt antibiotic treatment prevents most complications. Rheumatic fever, the most concerning complication, typically develops 2-4 weeks after untreated strep infection.

While most strep throat cases resolve without problems, especially with proper treatment, understanding potential complications helps parents appreciate why testing and treatment are important. Complications fall into two categories: suppurative (due to spread of the bacterial infection) and non-suppurative (inflammatory reactions triggered by the immune response to the bacteria).

Rheumatic Fever

Rheumatic fever is the most serious potential complication of strep throat. It is an inflammatory disease that can affect the heart, joints, brain, and skin. The most concerning manifestation is rheumatic heart disease, where inflammation damages the heart valves, potentially requiring lifelong medical management or even valve replacement surgery.

Rheumatic fever typically develops 2-4 weeks after an untreated or inadequately treated strep throat. Symptoms include fever, painful swollen joints (that may move from joint to joint), chest pain, shortness of breath, involuntary movements, and skin rash. Thanks to widespread antibiotic treatment, rheumatic fever has become rare in developed countries, but it remains a significant problem in developing nations and underserved populations.

Post-Streptococcal Glomerulonephritis

Post-streptococcal glomerulonephritis (PSGN) is a kidney disease that can follow strep throat (or strep skin infections). It occurs when the immune system's response to strep bacteria causes inflammation in the kidney's filtering units. Symptoms include dark or bloody urine, decreased urine output, swelling (especially around the eyes and in the legs), high blood pressure, and fatigue.

PSGN typically develops 1-2 weeks after strep throat. Unlike rheumatic fever, antibiotic treatment of strep throat does not reliably prevent PSGN. However, most cases of PSGN in children resolve completely with supportive care. Severe cases may require hospitalization for management of fluid balance and blood pressure.

Peritonsillar Abscess

A peritonsillar abscess (also called quinsy) is a collection of pus that forms beside the tonsil. It is one of the most common complications of strep throat and other throat infections. Symptoms include severe throat pain (often worse on one side), difficulty opening the mouth, muffled voice, fever, drooling, and visible swelling on one side of the throat.

Peritonsillar abscess requires prompt medical treatment, usually drainage of the abscess and intravenous antibiotics. If you notice that your child's throat symptoms seem much worse on one side, their voice becomes muffled, or they cannot open their mouth properly, seek medical care promptly.

Scarlet Fever

Scarlet fever occurs when the strep bacteria produce toxins that cause a characteristic rash. The rash is red, feels like sandpaper to the touch, and typically starts on the neck and chest before spreading. Other features include a "strawberry tongue" (red bumpy tongue) and facial flushing with pale area around the mouth.

Scarlet fever is essentially strep throat with a rash and is treated the same way - with antibiotics. While the name sounds alarming (due to its historical severity before antibiotics), scarlet fever today is generally a mild illness that responds well to treatment.

How Can You Prevent Strep Throat?

Prevent strep throat through good hygiene: frequent handwashing, covering coughs and sneezes, not sharing utensils or drinks, and keeping sick children home. Replace toothbrushes after strep infection. There is no vaccine for strep throat. If your child has recurrent strep, discuss with your doctor whether tonsillectomy might be appropriate.

While no vaccine exists for Group A Streptococcus (though research is ongoing), several practical measures can reduce the risk of strep throat. Since strep spreads through respiratory droplets and contact with contaminated surfaces, good hygiene practices are the foundation of prevention.

Handwashing is one of the most effective ways to prevent strep throat and many other infections. Teach children to wash their hands thoroughly with soap and water for at least 20 seconds, especially before eating, after using the bathroom, after coughing or sneezing, and after being in public places.

Hygiene Practices for Prevention

Beyond handwashing, several other hygiene practices help prevent spread. Teach children to cover coughs and sneezes with a tissue or their elbow, not their hands. Used tissues should be discarded immediately. Children should avoid sharing cups, water bottles, utensils, and food with others.

When a family member has strep throat, disinfect commonly touched surfaces such as doorknobs, light switches, remote controls, and bathroom fixtures. Consider washing bedding and towels used by the sick person in hot water.

When to Keep Children Home

Keeping sick children home prevents spread to classmates. Children with strep throat should stay home until they have been on antibiotics for at least 24 hours AND their fever has resolved. Even if they feel better quickly, the 24-hour antibiotic rule should be followed to prevent spreading the infection to others.

Recurrent Strep Throat

Some children seem to get strep throat repeatedly. True recurrent strep throat (multiple documented episodes in a year) may be due to new infections from ongoing exposure, carriage state (carrying strep in the throat without active infection), or treatment failures. If your child has multiple documented strep infections per year, discuss with your pediatrician whether further evaluation or referral to an ENT specialist is appropriate.

Tonsillectomy (surgical removal of the tonsils) may be considered for children with very frequent strep throat episodes. The generally accepted criteria are 7 or more documented strep episodes in one year, 5 or more per year for two consecutive years, or 3 or more per year for three consecutive years. The decision should be individualized based on the impact on the child's quality of life and other factors.

What Should You Know About Recurring Strep Throat?

Some children experience recurring strep throat, defined as multiple documented episodes within a year. Possible causes include new infections, strep carriage, antibiotic treatment failures, or exposure to carriers. If your child has frequent strep episodes, consult a doctor about possible evaluation, carrier testing, or referral to an ENT specialist to discuss whether tonsillectomy might be beneficial.

Recurring strep throat can be frustrating for families. Understanding why some children get repeated infections can help guide management decisions. There are several possible explanations for recurring strep throat that your doctor may consider.

New infections are the most common cause of what appears to be recurring strep. Children in school or daycare are continuously exposed to various strains of strep bacteria. Each episode may actually be a new infection from a different source rather than a recurrence of the previous infection.

Strep carriage is a condition where strep bacteria live in the throat without causing active infection. Carriers have strep detected on throat swabs but may not actually be sick with strep throat - their symptoms may be from viral infections instead. Carriers generally don't need treatment unless there are special circumstances.

Treatment failures can occur when the full antibiotic course isn't completed, when poor absorption affects antibiotic levels, or when the bacteria are protected from antibiotics by other throat bacteria. In some cases, alternative antibiotic regimens may be tried.

Medical References and Sources