Strep throat

What is strep throat? 

It’s an all too familiar phrase: “Mommy, my throat hurts.” While most sore throats are short-lived, in addition to offering up some sympathy, it’s important to determine whether the infection is viral or bacterial. Viral infections are more common but bacterial infections, often referred to as strep throat, usually require antibiotic treatment. Strep throat is most common in children between ages 5 and 15. If left untreated, it can lead to complications such as rheumatic fever, a rare infection that can damage the heart.

How do children get strep throat? 

Strep throat is caused by a highly contagious bacterium called the streptococcus pyogenes. It can be passed from person to person through air droplets produced when an infected person coughs, sneezes, or shares food or drinks. The bacteria can also survive on inanimate objects, such as toys or doorknobs. Children touch the infected object and unknowingly transfer the bacteria to their noses or mouths.

What are the symptoms of strep throat? 

Like many childhood illnesses, symptoms of strep throat vary depending on the child’s age. Though children under 5 don’t get strep throat as often as older children, they aren’t immune to the infection. Infants with strep infection may run a low-grade fever and have thickened or bloody nasal discharge. In addition to those symptoms, toddlers may also exhibit crankiness, lack of appetite, swollen glands in the neck, and a tummy ache. Children older than age 3 will likely be ill and complain of a sore throat. They may also have a temperature greater than 102° F, swollen glands, and pus on the tonsils. Another somewhat surprising but telltale sign of strep throat? A headache!

How is strep throat diagnosed? 

Strep throat is often more painful than other throat infections but a throat culture is the best diagnostic tool. After examining your child's throat, your health care provider will then swab the back of the throat and tonsils with a cotton-tipped applicator. The sample taken from the throat is smeared onto a culture dish filled with a special material that supports the growth of bacteria if present. It takes about 24 hours for the bacteria to grow, so many health care providers will use the swab sample to perform a rapid strep test (which yields results in minutes). Even if the rapid stress test reveals that your child does not have strep, the doctor will likely confirm the result with a 24-hour culture.

How is strep throat treated? 

If your child is diagnosed with strep throat, the doctor will prescribe an antibiotic such as penicillin or amoxicillin. (If your child is allergic to penicillin, there are other antibiotics available.) Remember, when it comes to antibiotics, it’s important that your child take all the pills, as directed, even if symptoms begin to improve or go away entirely after only a few doses. Otherwise, the infection can reoccur. Before the antibiotic takes effect, your child’s health care provider may suggest an over-the-counter medication, such as Ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) to relieve your child’s sore throat pain and reduce the fever.

How can strep throat be prevented? 

Although your child should be kept away from others diagnosed with strep throat, it can often be impossible to avoid since individuals can be contagious before symptoms appear and well before they are officially diagnosed. Therefore, the best prevention method is frequent and proper handwashing. Children should also avoid sharing drinking glasses and eating utensils.

When should I call a doctor? 

Parents are advised to contact their child’s physician if their child has any of the following signs or symptoms: 

  • Sore throat without cold symptoms such as a runny nose 
  • Sore throat accompanied by tender, swollen lymph nodes
  • Sore throat that lasts longer than 48 hours 
  • Temperature above 101° F (38.3° C) in older children, or fever lasting more than 48 hours 
  • Bright, red rash, which could be indicative of scarlet fever, a complication of strep throat that is most common in children 5–15 years of age. The rash typically covers most of the body and is accompanied by a sore throat and a fever. Scarlet fever is treated with antibiotics, but if left untreated, it can damage the heart and kidneys. 
  • Problems breathing or difficulty swallowing anything, including saliva 
  • No improvement after taking antibiotics for 24 to 48 hours 
  • Persistent fever, pain or swelling in the joints, shortness of breath, or a rash as long as three weeks after a strep infection. These can be signs of rheumatic fever (a serious condition that can affect the heart, joints, nervous system, and skin). 
  • Cola-colored urine occurring more than a week after a strep infection (this may indicate kidney inflammation).

Last updated March 22, 2020

Suggested Reads