Sore Throat

Hilliard Pediatrics, Inc. - Dr. Beth Schloss, MD

Introduction

Sore throat is a common complaint in children. It can be caused by multiple illnesses, but most commonly a sore throat is due to a viral infection. Older kids will be able to tell you that their throat hurts and/or it hurts when they swallow or they refuse to eat, even their favorite foods. Most sore throats will resolve in 3-7 days. It cannot be determined if your child has Strep throat based on what the throat looks like, as some viral infections can cause a similar appearance of the throat and tonsils.

Symptoms

  • Painful or scratchy throat
  • Pain with swallowing or talking
  • Muffled or hoarse voice
  • Refusing to eat in younger kids
  • May be associated with sore, swollen lymph nodes in the neck

Common Causes of Sore Throat

Since there are many causes of a sore throat, we often need an exam and possibly a Strep test to determine the cause. Certain signs and symptoms are helpful to determine the cause of the sore throat. Here are common causes of sore throat and their associated symptoms:

  • Upper Respiratory Viruses - These sore throats usually have some runny nose, nasal congestion, and cough associated with the sore throat. The sore throat is typically not severe. Antibiotics are not helpful to treat these infections.
  • Other Viral Infections - Lots of other viruses can cause sore throats as well. Sometimes these viruses can present with just a sore throat and/or fever without any cold-like symptoms. Other viruses can have associated sore throats as well, including:
    • The Hand Foot Mouth virus causes ulcers on the throat and often the virus that causes hand foot and mouth disease (HFM), causes ulcers on the throat and often a rash on the hands and feet as well. Please see our HFM protocol for additional guidance.
    • The mono virus can also cause a sore throat and is often associated with enlarged lymph nodes in the neck, extreme fatigue, and a prolonged fever. 
  • Strep Throat - This is caused by a type of strep bacteria. About 15 - 30 percent of sore throats in kids ages 5 - 15 are caused by Strep. Typical symptoms can include: sore throat, fever, enlarged lymph nodes in the neck, headaches, belly aches, and sometimes vomiting. There is not usually much coughing with Strep throat. Sometimes there is a rash associated with Strep throat that is fine, small pink bumps on the trunk that sort of feel like sandpaper. Strep is uncommon in children under the age of 2. Antibiotics are needed to treat Strep throat. If untreated, Strep throat can rarely cause complications like Rheumatic fever.
  • Post-Nasal Drip/Allergies - Drainage from the sinuses into the throat due to allergies or a sinus infection can cause a sore throat as well.  For more information about allergies and sinus infections, see our protocol.
  • Tonsillar Abscess - This is a serious complication from a sore throat infection where an abscess (collection of pus) develops within or around a tonsil. This most commonly occurs in teenagers and symptoms include very painful swallowing, one-sided throat pain, and fever. This needs prompt medical attention. 

Testing

If there is concern for Strep throat as the cause of the sore throat, this will always require a Strep test to determine if it is Strep bacteria causing the infection. We can perform the test in office and get results in a few minutes. The rapid test catches 90% of Strep infections, but not 100%, so we will send a backup test (molecular) to Nationwide Children's Hospital lab if the rapid test is negative. We will get those results back the next day. If the gene-probe test is positive, we will contact you in the morning and send antibiotics to your pharmacy. We will not contact you if the results are negative.  You can also find your results on both NCH's MyChart and our patient portal.

Treatment

  • The pain and discomfort of a sore throat can be helped by giving your child ibuprofen (Motrin or Advil, give if over 6 months of age) or acetaminophen (Tylenol).
  • Cool liquids or popsicles can be soothing as well.
  • As swallowing may be difficult, offer softer foods to eat.
  • Your child may not eat much if they have a sore throat. That is okay as long as they are drinking fluids to stay hydrated.
  • If your child has a postiive test for Strep throat, then antibiotics will be used as well. Kids may return to school the next day if the antibiotics are started before 5pm and any fever has resolved.

What to Do When

When to go the Emergency Department (ED)

  • Severe worsening throat pain, especially if it is mostly on one side.
  • Concern for dehydration (less than 3 wet diapers in 24 hour period, no tears when crying, lethargic, etc.).
  • New onset drooling or unable to swallow their own saliva.

When to Call the Doctor On Call

  • If you are trying to decide if you should take your child to the Emergency Department or Urgent Care, give us a call. We can review the symptoms your child is having and help you decide if you need to take them in or if it can wait. 

When to Call the Office

  • If your child is experiencing any of the following, please call the office to discuss further options or the need to schedule an appointment. When you call, please press option 1 and leave a message with the child's name, DOB, a brief description of the situation and one of our triage nurses will call you back to discuss further.
    • Severe or persistent sore throat
    • Recent exposure to strep throat and new sore throat or fever
    • Sore throat with a rash of fine, small pink bumps on the trunk that feels like sandpaper
    • Recently treated for Strep throat and the symptoms have returned
    • On antibiotic for Strep throat, but not improving or worsening
    • Enlarged lymph nodes in the neck
    • Painful or stiff neck
    • Fever for more than 3 days with a sore throat or headache