•  How to Stop a Cold •  Sore Throat (Children)

Strep throat is a bacterial throat infection marked by swelling and extreme soreness of the back of the throat, or pharynx. It can hurt so much your child doesn't want to swallow. (The name "strep throat" is a shorthand term for the throat infection, which is caused by Group A streptococcus bacteria.) Other symptoms of strep are fever (often above 101 degrees), chills, decreased appetite, and swollen lymph glands in the neck. Children can also develop symptoms of stomach distress such as nausea and vomiting.

Only a small number of sore throats are strep infections in children: Viruses, not bacteria, cause most sore throats. A sore throat that comes with other cold symptoms like a runny nose, or which causes hoarseness or laryngitis, is probably not a streptococcal infection.

Your child's symptoms are important clues. If your pediatrician sees a very red throat with streaks of pus when the child "opens wide," the diagnosis is likely to be strep. To make certain, the doctor may use a cotton swab to collect a sample of cells from the back of the throat. The swab can be tested for bacteria right away with a tool known as the rapid antigen detection test (RADT). With a culture, it takes at least 24 hours for the bacteria to multiply enough to be seen.

If the RADT test indicates that it's strep, there's no need for a culture, because the test is extremely accurate when it reads positive. If the RADT is negative, the doctor should send for a culture -- the faster tests can miss the infection if there are only a few bacteria on the swab.

Your doctor may also order a rapid DNA test, which can detect strep in less than a day and is as accurate as a throat swab.

The main reason your doctor will want to diagnose whenever strep is suspected is that your child could develop rare but serious complications if it's not treated. Left alone, the streptococcal infection in the throat can grow into a pocket of pus called an abscess, which usually requires surgery. The streptococcal bacteria can also sensitize the body's immune system in such a way that it starts to attack its own organs. About 3 percent of people with untreated strep throat develop rheumatic fever, which affects the heart and joints, lasts for months, and can cause permanent damage to the heart valves. Rheumatic fever is still a common cause of heart trouble in young adults worldwide.

If your child has strep, antibiotics will help the sore throat go away quickly and will prevent complications like rheumatic fever from developing. (Without antibiotics, the throat pain would eventually go away, but the child would risk serious complications.) That's why pediatricians recommend a full 10-day course of oral antibiotics even if your child is feeling better. Echinacea, vitamin C, throat lozenges, and acetaminophen for fever will ease symptoms, but they don't provide the protection the antibiotics give.

Old-fashioned penicillin is still the first choice for strep, either taken orally or as an injection (shot). Some doctors prefer amoxicillin, a form of penicillin, since the liquid form tastes better than penicillin; amoxicillin is also available as a chewable, which some children find easier to take. If your child is allergic to penicillin, your doctor will probably recommend erythromycin as an alternative, or choose another antibiotic based on your child's individual case.

If antibiotics were prescribed for everyone with a sore throat, as much as two-thirds of patients would be spending money and risking side effects for a medicine that wouldn't help them. Scientists also think that overuse of antibiotics encourages the growth of bacteria that can resist them.

Yes. Your child should stay home from school for 24 hours after starting antibiotics. Family members or classmates who develop a sore throat should tell their doctor they were exposed to strep; they'll probably start feeling sick two to seven days after exposure. Except during an epidemic, people without symptoms do not require treatment.

-- Toni Martin, MD, is a board-certified internist and geriatrician who has practiced in Oakland, California, for 20 years. She has served as Chief of Patient Education at Kaiser Oakland and is a member of the clinical faculty at UCSF Medical School. She is also the author of How To Survive Medical School (Holt, Rinehart, and Winston, 1983).

Further Resources

National Institute of Child Health &Human Development

http://www.nichd.nih.gov/default.htm

Robert H. Pantell M.D., James F. Fries M.D., Donald M. Vickery M.D., Taking Care of Your Child: A Parent's Illustrated Guide to Complete Medical Care. Perseus Books Publishing, L.L.C.: 1999.

References

First published August 18, 1999
Last updated October 27, 2008
Copyright © 1999 Consumer Health Interactive

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