Hilliard Pediatrics, Inc. - Dr. Tim Teller, MD
Sore throats commonly occur for children. They can be caused by many things, including viral illnesses, Strep throat, nasal and sinus drainage, coughing, and allergies. Viruses that cause sore throats include many upper respiratory (“cold and cough”) viruses, influenza viruses, the croup (parainfluenza) virus, the bronchiolitis (RSV) virus, the hand-foot-and-mouth (coxsackie) virus, the “mono” or mononucleosis (Epstein-Barr) virus, adenovirus, enterovirus, and many others.
Most sore throats will last a few days to a week (depending on their cause, perhaps longer) without any specific treatment. The sore throat from Strep throat, even if not diagnosed and treated, will generally run its course and resolve within 5 to 7 days. A sore throat caused by a viral infection generally gets better when the viral infection runs its course (in as little as a few days to as long as 10-14 days depending on the virus). A mild, intermittent sore throat due to coughing or allergies could linger for some time.
Distinguishing Different Causes of Sore Throat
There are no “absolutes” with sore throats, unfortunately. In other words, we cannot always tell by someone’s symptoms what is causing the sore throat without examining them and possibly doing a test to determine whether they have Strep throat. But some signs and symptoms help us determine what may be causing the sore throat.
- Strep throat often has a sudden onset of a sore throat, pain with swallowing, a muffled (or “marbles in the back of the throat”) voice, fever, swollen “glands” (lymph nodes) in the neck, an upset stomach, and headache. Children with Strep throat often do not have “cold” symptoms (a runny nose). Occasionally, children with Strep have a fine, rough “sand-paper” rash that often looks worse in the “creases” of the skin (at the elbow, waist, etc.). It is unusual but not impossible for children less than 2 years of age to get Strep throat. Of all the possible changes to the appearance of someone’s throat and tonsils when they have Strep throat, the only change that points to the cause being Strep more than half of the time is tiny red dots on the area of the mouth called the soft palate (these are called palatal petechiae and are just above the uvula that hangs down between the tonsils). Although you can have swollen red tonsils with Strep, sometimes with a whitish patches or coating to the tonsils, these signs also often occur with the viral sore throats and do not help distinguish Strep throat from other causes of sore throat.
- Cold (upper respiratory) viruses cause the majority of sore throats. Because cold viruses can cause similar signs and symptoms as Strep throat, it may be difficult to determine which sore throats are caused by colds and which are caused by Strep without seeing the child for an appointment. Because cold viruses so often have a runny nose and a cough as symptoms, this can help distinguish a sore throat due to a cold versus Strep throat. Many cold viruses are accompanied by a fever. See Colds protocol.
- Sinus drainage can cause a very sore throat. The sore throat of sinus drainage would generally occur with obvious thick, discolored sinus (nasal) drainage, sometimes not out the front of the nose but be just “post-nasal drip” down the throat from the nasal and sinus passages. This would likely occur without a fever, although a sinus infection can cause a fever.
- Allergies can cause a sore throat. Nasal allergies often have sneezing, itchy nose or eyes, and clear, watery nasal drainage. Depending on the cause, allergies can be year-round or seasonal. Allergies do not cause a fever. See Allergies protocol.
- Croup can cause a sore throat. Croup is a respiratory virus that causes a variety of symptoms, including a hoarse voice (laryngitis), a barky (like a seal barking) cough, runny or congested nose, and fever. See Croup protocol.
- Hand-foot-and mouth disease is a common childhood illness caused by a family of viruses called enteroviruses. Children with hand-foot-and-mouth disease often have canker-sore-like ulcers in their mouth, small blisters on their hands and feet, fever, achiness and headache, a decreased appetite, and grouchiness. See Hand, Foot, and Mouth protocol.
- Herpangina causes ulcers in the back of the throat and the back of the roof of the mouth, along with fever. The illness is caused by enteroviruses, the same family of viruses that cause hand-foot-and-mouth disease. It generally lasts 5-7 days and is treated the same way as hand-foot-and-mouth disease.
- Influenza (the “flu”) causes a high fever, headache, sore throat, dry cough, runny or stuffy nose, muscle achiness, extreme tiredness, and occasional diarrhea, vomiting, and nausea. If this combination of symptoms occur during the “flu” season, the sore throat is much more likely to be due to the influenza virus rather than Strep throat.
- Mono (mononucleosis) is a viral illness that can cause sore throat in children. Children and teens with “mono” typically are very tired, have dramatically swollen “glands” in the neck, and have a persistent fever. The tonsils typically look large and inflamed with a white coating during a mononucleosis infection. “Mono” can last for weeks.
- Tonsillar abscesses are rare causes of sore throat, but occur when a pus-pocket forms at or near one tonsil, causing extreme difficulty swallowing (often with drooling of the saliva), high fever, and swollen “glands” (lymph nodes) in the neck. With a Tonsillar abscess, one side of the throat will be very inflamed and swollen. This is a medical emergency and children should be seen at Nationwide Children's Hospital Emergency Department right away.
Treatment for Sore Throats
If your child has a sore throat => call during regular office hours to discuss with the nurse whether an office visit is needed or come in at 8 a.m. for walk-ins. Note that if it is after-hours or over the weekend, many of our families will utilize Nationwide Children’s Hospital Urgent Care centers to determine if their child has Strep throat. Although it is safe to wait until the next business day to see a child, it is fine to use the Urgent Care.
If your child has Strep throat and does not improve within 2-3 days (48-72 hours) on the antibiotic => call during regular office hours. Although most cases of Strep respond quickly to the antibiotic, occasionally a different antibiotic is needed.
If your child is being treated for Strep throat and they are getting much worse, with difficulty swallowing their own saliva (spit) => call us immediately, even after hours. We may need to have your child seen right away to determine if they have developed an abscess (or pus pocket) at their tonsils. This is a medical emergency.
If your child was diagnosed with Strep and had a fine, sandpaper rash with it, but now after completing the antibiotic treatment, areas of the skin are peeling => this is common in “Scarlet Fever” and the skin will simply flake off on its own. A moisturizer can be applied if the peeling skin is bothersome.
If your child has had repeated separate Strep infections => we will discuss a referral to an ear, nose, and throat (“ENT”) specialist to have the tonsils removed. We also currently recommend a referral to the “ENT” if a child shows signs of large tonsils with difficulty swallowing or sleep apnea (long pauses in the breathing during sleep of 15-20 or more seconds).
If your child was seen in the office and was found to have a negative Strep test and is not feeling better in a couple days but is not worse => most of these children just need to keep doing things to keep their throat more comfortable and treat any fever. Remember that depending on the cause, a sore throat might linger for a few days.
If your child was tested for Strep and was negative but is having lingering fever, sore throat, swollen glands, and tiredness for days afterwards => we want to see you child back to evaluate for the possibility of “Mono” (mononucleosis), a viral illness that can linger for weeks. Although antibiotics cannot help with Mono, we will discuss with you having your child have a blood test for Mono.
Last Updated: 06/2019