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Sore throat


Disclaimer: This fact sheet is for educational use only. Please consult your doctor or other health professional to make sure this information is right for your child.

Key points to remember about sore throats

  • most sore throats are caused by viruses and need no treatment other than pain relief
  • sometimes children can get strep throat (Group A streptococcus bacteria)
  • a rare complication of strep throat is rheumatic fever (see the rheumatic fever fact sheet)
  • Maori and Pacific Island children are most at risk of rheumatic fever, and should see a doctor with any sore throat
  • seek medical attention if the symptoms are not improving after 48 hours or your child develops other symptoms that concern you

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What is a sore throat?

A sore throat is pain or discomfort in the throat. Often the pain is worse when your child swallows.
 
Tonsillitis or pharyngitis is the term used when there is swelling and redness (inflammation) of the tonsils and pharynx which lie at the back of the throat.
 

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What causes a sore throat?

Sore throats are common in children. Causes can include:

  • infection by viruses - the most common cause
  • infection by Group A streptococcus bacteria (strep throat) - a less frequent cause
Viral sore throats
 
Colds and flu viruses commonly cause sore throats / tonsillitis in children. Children often complain of a sore throat at the beginning of a cold. This happens because either:
  • the infection in the nose and sinuses causes drainage down the back of the throat, causing irritation, or
  • there may be direct infection of the throat / tonsils by the virus
Less frequently, glandular fever (Epstein Barr virus) can cause sore throats, particularly in teenagers and young adults.
 
Strep throat
 
Group A streptococcus is a bacteria that can cause throat infection / tonsillitis (strep throat) in children and young people (see How is it diagnosed? and What are the complications of strep throat?).
 

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What are the signs and symptoms of a sore throat?

Viral sore throats
 
If your child has a sore throat caused by a cold or flu virus, they will usually have other symptoms such as a runny nose and cough.
 
If your teenager’s sore throat is caused by glandular fever (Epstein Barr virus), they will usually also have enlarged tonsils and enlarged glands in their neck and often fever and tiredness.
 
Strep throat
 
Children with strep throat will often also have:
  • a fever (greater than 38.5 degrees Celsius)
  • swollen tonsils, sometimes with white patches
  • swollen or tender glands in their neck

and may:

  • complain of headache and stomach pain
Strep throat can not be diagnosed on symptoms and signs alone; a swab of the throat is needed if strep throat is suspected. Glandular fever also can not be diagnosed without a blood test.
 

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How is a sore throat diagnosed?

In many cases of sore throat, no tests are needed.
 
Depending on the symptoms and signs some of the following may be performed:
  • throat swab (to test for strep throat)
  • blood test ( to test for glandular fever)

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What puts my child at risk of getting a sore throat?

Sore throats caused by viruses are common in all children.
 
Strep throat is more common in school-age children. Sore throats in children under three are seldom due to strep throat.
 
In New Zealand, Maori and Pacific Island children are at greatest risk of developing complications from strep throat (see What are the complications of strep throat?).
 

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How long do sore throats usually last?

Viral sore throat
  • infections caused by viruses usually just run their course
  • most symptoms caused by a cold-type virus start improving after several days and are gone in a week to 10 days
Strep throat
  • symptoms caused by strep throat also usually go away in five to 10 days with or without antibiotic treatment
  • antibiotics can have a small effect on the pain and discomfort associated with strep throat
  • antibiotics are recommended for children with strep throat who are at risk of developing rheumatic fever. This is because unless the strep bacteria are killed with antibiotics, these children are still at risk of getting rheumatic fever (see What are the complications of strep throat?)
Glandular fever (Epstein Barr virus) symptoms can last several weeks.
 

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What are the complications of strep throat?

  • without treatment, strep throat can lead to rheumatic fever in at-risk people (see the rheumatic fever fact sheet)
  • rheumatic fever can cause permanent damage to the heart
  • in New Zealand, Maori and Pacific Island children are most at risk of developing rheumatic fever and should see a doctor with any sore throat
  • in rare cases an abscess (collection of pus) can develop in the tonsil - symptoms of this are one sided swelling, worsening pain and difficulty swallowing

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What treatment is needed for a sore throat?

Viral sore throat
 
Pain relief is important; easing the discomfort will help your child eat and drink. You can relieve pain in the following ways:
  • give paracetamol (you must follow the dosage instructions on the bottle; it is dangerous to give more than the recommended dose)
  • gargle with warm salt water (one teaspoon of salt per glass of water)
  • throat sprays can help but stop using them if your child doesn’t like them
  • sucking on lozenges can help by increasing saliva production but they are not recommended in young children because of the risk of choking
  • drink warm liquids - honey or lemon is a common way of providing relief
  • cool liquids and ice blocks can help some sore throats
Infections caused by viruses can not be treated with antibiotics. The body will clear out the virus on its own without treatment (see How long could it last?).
 
If your child has glandular fever (Epstein Barr virus), they should not take antibiotics because antibiotics don't work gainst viral infections. In fact, some types of antibiotics, especially amoxycillin, can cause a rash in children with glandular fever.
 
Strep throat
  • antibiotics are recommended for strep throat to prevent rheumatic fever in at-risk children (see What are the complications of strep throat?)
  • make sure your child takes all the doses even if their symptoms have improved
  • pain relief is also important (see What treatment is needed?)
  • children can return to school or day care 24 hours after they start antibiotics as the risk of spreading the strep is reduced

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When should I seek help for my child with a sore throat?

Maori or Pacific children and teenagers are in a high risk group for developing rheumatic fever from sore throats caused by strep (see What are the complications of strep throat?). For this reason, all Maori and Pacific children should see their doctor for any sore throat. If the symptoms listed below don't improve, you should take your child back to your doctor.
 
You should see your GP (general practitioner) if your child:
  • has symptoms that are not improving after 48 hours
  • has been drinking poorly for longer than 24 hours, or you are worried about dehydration
  • has other symptoms which develop to complicate your child's illness and you are concerned about them
  • has great difficulty swallowing
  • has increased snoring when asleep, or periods of stopping breathing when asleep
  • your child has tender lumps in the neck that are getting bigger (enlarging)
You should see a doctor urgently if your child has:
  • drooling (dribbling)
  • difficulty breathing
  • a new skin rash or bruising
  • extreme tiredness or drowsiness
  • possibly choked on a foreign object or swallowed a toxic substance

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What about recurrent sore throats / tonsillitis?

Tonsillectomy is the surgical procedure used to remove tonsils. Most children who have several bouts of sore throat / tonsillitis don't need a tonsillectomy. Your child might need a tonsillectomy if, for example, your child’s tonsils are too large and they are causing problems with their breathing (see the obstructive sleep apnoea fact sheet). Your doctor can tell you if your child needs a tonsillectomy (see the tonsillectomy / adenotonsillectomy fact sheet).
 
Breathing dry winter air during the winter months can lead to children waking up with a sore throat most mornings - this usually disappears after they have something to drink.
 
Recurrent or persistent sore throats without infection may be due to allergies (see the allergy fact sheet) and require anti-allergy treatment.
 

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Acknowledgements

This fact sheet has been produced by the Paediatric Society of New Zealand in collaboration with the co-chair of the Rheumatic Fever Guidelines Writing Group. This fact sheet conforms with the Rheumatic Fever Guideline 2: Group A Streptococcal Sore Throat Management.
 

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Endorsement

This fact sheet was endorsed by PSNZ - 25/06/2010

Copyright

Fact sheets are subject to copyright. In the interests of information sharing they may be copied but acknowledgement must be given to PSNZ and Starship Foundation.
© The Paediatric Society of New Zealand and Starship Foundation 2005 - 2010


The Paediatric Society of New Zealand
http://www.paediatrics.org.nz 		Starship Foundation
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