Managing Sore Throat in Children – Clinical Advice by Dr. Pothireddy Surendranath Reddy 

Managing Sore Throat in Children – Clinical Advice by Dr. Pothireddy Surendranath Reddy 

by Dr. Pothireddy Surendranath Reddy

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A sore throat is one of the most common complaints in childhood. Most sore throats are harmless and pass in a few days with simple home care, but they can sometimes signal a bacterial infection that needs antibiotics or a complication that needs prompt medical attention. This guide explains why children get sore throats, how to tell viral from bacterial causes (especially group A streptococcal — “strep throat”), what tests and treatments are used, home-care tips, when to see a doctor, and how to prevent spread. Key evidence-based sources are linked in the references at the end. CDC+1

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1. Causes — viruses are most common

In children, the most frequent causes of sore throat are viral infections — the same viruses that cause the common cold, influenza, adenovirus, Epstein–Barr virus (mononucleosis), and others. Viral sore throats usually come with cough, runny nose, hoarseness, and conjunctivitis. Bacterial causes—most importantly group A Streptococcus (Streptococcus pyogenes), which causes strep throat—are less common but important to recognise because appropriate antibiotic treatment shortens illness, reduces transmission, and prevents rare complications. CDC+1

2. Typical symptoms: what to look for

Children with a sore throat may have any combination of:

§   Pain or discomfort when swallowing (odynophagia).

§   Red, swollen throat and tonsils; sometimes white patches/exudates on the tonsils.

§   Fever (more common with bacterial causes).

§   Swollen, tender neck glands (cervical lymphadenopathy).

§   Difficulty swallowing or drooling (in infants/young toddlers).

§   Accompanying symptoms: cough and runny nose (more suggestive of viral causes), rash (scarlet fever may follow strep), extreme lethargy or high fever (worry signs). nhs.uk+1

3. When to suspect strep throat

No single sign perfectly identifies strep. However, strep is more likely when a child has sudden onset sore throat, fever, painful/tender anterior cervical lymph nodes, tonsillar exudates (white patches), and little or no cough. Clinical scoring systems (Centor or modified Centor / McIsaac and FeverPAIN) help gauge probability and decide on testing or empiric treatment — but they are tools, not absolute rules. For children, many clinicians confirm with a rapid antigen detection test (RADT) and/or throat culture before prescribing antibiotics. PMC+1

4. How doctors test for strep

§   Rapid antigen detection test (RADT) — done in clinic with a throat swab; gives quick results (minutes). A positive RADT is highly specific for group A strep. Some guidelines recommend confirming a negative RADT with a throat culture in certain age groups or settings.

§   Throat culture — sent to the lab; slower (24–48 hours) but more sensitive.
Clinical practice varies by country and age: some doctors use RADT first and only culture negatives when clinical suspicion is high. Your pediatrician will follow local guidelines. CDC+1

5. Treatment — supportive care for most; antibiotics when strep

Supportive care (for most viral sore throats):

§   Rest and good fluid intake. Offer cool, soft foods and soothing drinks (warm broths, warm water with honey for children older than 1 year — honey is not safe under 1 year).

§   Analgesics: paracetamol (acetaminophen) or ibuprofen for pain and fever (follow dosing by weight/age). Do NOT give aspirin to children or teenagers because of Reye’s syndrome risk.

§   Comfort measures: throat lozenges for older children, cold treats (popsicles), and humidified air. Gargling warm salt water can help older children. nhs.uk

When antibiotics are needed (strep throat):
Group A strep infections are treated with antibiotics — penicillin or amoxicillin is the first-line choice in most guidelines. A full course (commonly 10 days for oral penicillin/amoxicillin) helps eliminate the bacteria, shortens the duration of symptoms slightly if started early, prevents transmission, and reduces the risk of rare complications such as rheumatic fever (especially in areas where rheumatic fever is more common). Always follow the pediatrician’s prescription and finish the entire course. CDC

6. Which antibiotics and duration

§   Penicillin V or amoxicillin are widely recommended as first-line oral treatments for children with confirmed group A strep.

§   For penicillin-allergic patients, alternative regimens (macrolides or certain cephalosporins) may be used depending on the allergy type and local resistance patterns.

§   Typical oral course: 10 days for penicillin/amoxicillin (some regimens vary with single-dose intramuscular benzathine-penicillin as an alternative in special situations). Your child’s doctor will pick the right drug and duration. CDC

7. Home care checklist (practical, day-by-day)

§   Encourage fluids; prevent dehydration.

§   Use weight-based paracetamol/ibuprofen for pain and fever; keep dosing intervals and maximum daily dose in mind.

§   Offer soft, soothing foods; avoid very acidic drinks if the throat is raw.

§   Use a cool-mist humidifier in the child’s room if air is dry. Clean humidifiers regularly.

§   Keep the child home from school/daycare until fever-free for 24 hours without antipyretics and/or until 24 hours after starting antibiotics if strep has been diagnosed (local policies vary).

§   Practice good hand hygiene and avoid sharing utensils to limit spread. nhs.uk

8. Red flags — when to seek urgent care

Seek immediate medical attention or emergency care if your child has any of:

§   Severe difficulty breathing, noisy breathing, or stridor.

§   Drooling or refusal to swallow (risk of airway compromise or dehydration).

§   Severe neck stiffness, high fever with extreme lethargy, or a toxic appearance.

§   Rapidly progressive swelling of neck or face (possible deep neck space infection).

§   Signs of dehydration: very little urine, dry mucous membranes, lightheadedness.
These signs can indicate complications (e.g., peritonsillar or retropharyngeal abscess) that may require urgent ENT (ear–nose–throat) evaluation. stgeorges.nhs.uk

9. Complications (rare but important)

Most sore throats resolve without problems. However, untreated group A strep can rarely lead to complications:

§   Suppurative complications: peritonsillar abscess (quinsy), otitis media, sinusitis.

§   Non-suppurative complications: acute rheumatic fever (rare in many countries but still a concern in some regions) and post-streptococcal glomerulonephritis. Appropriate diagnosis and antibiotic treatment reduce these risks. NCBI+1

10. Prevention — practical steps

§   Encourage regular handwashing, respiratory hygiene (cover coughs/sneezes), and avoiding close contact with sick individuals.

§   Children with strep should stay home until they have had at least 24 hours of effective antibiotic therapy and are clinically improving.

§   There is no vaccine for group A strep yet; prevention relies on hygiene and early diagnosis/treatment of cases. CDC

11. Common parental questions (quick answers)

Q: Should my child get antibiotics for every sore throat?
A: No. Most sore throats are viral and do not benefit from antibiotics. Antibiotics are used when group A strep is confirmed by testing or strongly suspected based on clinical assessment and local guidance. CDC

Q: Can my baby have honey for a sore throat?
A: No — do not give honey to children under 1 year because of the risk of botulism. For older children, honey can soothe the throat. nhs.uk

Q: How long does strep throat last after starting antibiotics?
A: Symptoms often improve within 24–48 hours of starting appropriate antibiotics, though a child may still feel tired for several days. Antibiotics help reduce contagiousness and complications. CDC

12. Practical notes about testing and school policies

Testing practices and school exclusion policies vary. Many schools and daycares require a child with strep to complete at least 24 hours of antibiotics before returning; others require fever resolution. If in doubt, follow your pediatrician’s advice and local public-health or school policies.

Bottom line (brief)

Most sore throats in children are viral and need only supportive care. Testing (rapid test and/or culture) is important when strep is suspected, because antibiotics are effective for group A strep and prevent rare complications. Seek care promptly for difficulty breathing, drooling, severe pain, dehydration, or a very sick-appearing child. Good hygiene reduces spread.

Selected references & useful links

(These are the authoritative resources used while preparing this article — click to read more.)

HealthyChildren.org (American Academy of Pediatrics family resource) — Group A streptococcal infections: advice for parents. Healthy Children

CDC — About Strep Throat (Group A Strep). Centers for Disease Control and Prevention. CDC

CDC — Clinical Guidance for Group A Streptococcal Pharyngitis (treatment recommendations). CDC

NHS — Tonsillitis / Sore throat (self-care and when to seek help). National Health Service (UK). nhs.uk

StatPearls / NCBI — Streptococcal Pharyngitis review (pathophysiology, differential diagnosis). NCBI

PubMed Central — Centor criteria and diagnostic utility in children (clinical scoring). PMC

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