Check out the PedsDocTalk YouTube Video: Strep Throat in Kids for more details and guidance on navigating strep throat in children, including symptoms, toddler strep symptoms, how it’s transmitted, when to visit the clinician, treatment, and common strep throat questions.
Your child tells you they have a sore throat…yikes! Do you need to go to their pediatrician? How do you know if it’s strep throat? Is everyone in the class or family going to get it? When is treatment needed? It’s key to understand what strep throat is, the symptoms, how it’s spread, and how it’s treated to avoid panic.
What is strep throat?
Strep throat is an infection of the throat and tonsils by a bacteria called Group A streptococcus. This particular bacteria can cause many different infections in kids such as a skin condition called impetigo and cellulitis.
It is common between the ages of 5-15 years of age and accounts for about 15-30% of cases of pharyngitis (which is pain or inflammation of the throat). It can also affect infants and toddlers but is less common in the age group.
What are the symptoms of strep throat?
Children over 3 years will typically have a quick onset of symptoms, including fever, headache, sore throat, abdominal pain, nausea, vomiting, and decreased appetite. If you look in a child’s mouth, you’ll often see a red throat with white pus-like patches on their tonsils, although the white patches aren’t always present. Also, note that not all white patches on the tonsils mean strep throat. Children’s lymph nodes on their necks may be enlarged and tender. Kids may also have a pink, fine, sand-papery rash that often starts in the groin or armpits and spreads onto their chest, back, and extremities. Strep throat that presents with this rash is also called Scarlet Fever.
It’s important to note that not all sore throats are caused by strep bacteria. Sore throats are more often viral and resolve on their own without treatment. One way to differentiate a viral illness from strep is to look for classic viral symptoms: such as cough, runny nose, diarrhea, or a hoarse voice. These symptoms are typically absent in strep, and their presence makes strep much less likely.
Seasonal allergies can also cause a sore throat, but typically allergies will also present with sneezing, runny nose, and itchy or red eyes.
Watch this PedsDocTalk YouTube video for more details and guidance on seasonal allergies.
Interestingly, kids younger than 3 are very unlikely to get strep. It’s thought that they are unlikely to get infected due to antibodies they receive before birth and also because they have small or underdeveloped tonsils. Although unlikely, I have seen some cases of strep in toddlers. Typically the symptoms are milder with a slower onset of congestion, low-grade fever, enlarged neck lymph nodes, decreased appetite, and irritability. These children usually have a sibling with a positive strep case in the home.
Is strep throat contagious? How is strep throat spread?
Strep throat is spread through droplets in the air from someone coughing or sneezing or direct contact with secretions or a wound. It typically peaks during the winter and spring months.
In older children, one of the major reasons that treatment is necessary is to reduce transmission. It is a contagious illness that can spread quickly among household members or classrooms. Treating an infected individual with an appropriate antibiotic, such as amoxicillin or cephalexin, typically eliminates their ability to spread the illness within 12 hours of initiating treatment.
That means as long as your child is fever free for at least 24 hours and is at least 12 hours out from taking their first dose of antibiotics, they are no longer considered contagious and can return to school or a childcare setting.
When to visit the pediatrician with a sore throat?
It’s best to take your kiddo to their clinician for evaluation if they are over 3 years, have a quick onset of multiple symptoms, including fever, sore throat, and/or lymph node swelling, abdominal pain, nausea, vomiting, headache or decreased appetite. It’s also worthwhile to see your clinician if symptoms aren’t improving within 24-48 hours of starting antibiotics or if symptoms are significantly worsening. A muffled voice, inability to swallow, or trouble turning the neck are symptoms that need to be evaluated in person.
Your clinician will swab the back of your child’s throat (the tonsil area) with swabs. One swab is a rapid test that is done in the office and takes less than 10 minutes. If the rapid test is negative, but there is still suspicion of strep, a throat culture is sent off, which takes at most 48 hours to return. Throat cultures are more sensitive, so in some cases, a rapid strep test is negative or normal, but the cultures come back positive. It is recommended to start antibiotics only if there is a positive test.
Is treatment for strep throat needed?
Treatment is recommended for all symptomatic children over the age of 3, but it may not be for the reason you think! Many parents think strep needs to be treated with antibiotics so kids can feel better since it is a bacterial illness. Interestingly, even without antibiotic treatment, most children will feel better after 3-5 days. The most important reason to treat with antibiotics is to prevent the risk of future complications.
Antibiotics are typically amoxicillin or an alternative if allergic. Remember, if your child has strep, it’s necessary to complete the full course, which is 10 days – don’t stop the antibiotics if they start feeling better.
Complications of strep throat
Untreated strep can result in the spread of infection to other parts of the body. Sometimes it can lead to common infections, such as ear or sinus infections. Less commonly, it can result in an abscess or pocket of infected fluid around the tonsil or an infection of the bone behind the ear.
It can also very rarely cause severe infections if it spreads to other parts of the body, including a life-threatening soft tissue infection called necrotizing fasciitis or streptococcal toxic shock syndrome which is an infection in the bloodstream that leads to organ shutdown. Those both sound so scary, but they are both extremely rare. Other potential complications include post-streptococcal glomerulonephritis, rheumatic fever, and PANAS or Pediatric Autoimmune Neuropsychiatric Disorders Associated Strep.
These conditions sound scary and can be, but it’s important to remember these illnesses are extremely rare in developed countries where antibiotics are much easier to access. If strep is treated appropriately, children are at very low risk for these complications.
Do you still have questions about strep throat?
For example, do you need to throw out your child’s toothbrush if they have strep throat? Or, does your child need to get their tonsils out because they seem to get strep throat often? What does it mean to be a carrier of strep?