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

What is a sore throat?

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

• 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

What are the signs and symptoms of a sore throat?

• 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

How is a sore throat diagnosed?

• throat swab (to test for strep throat)
• blood test ( to test for glandular fever)

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

How long do sore throats usually last?

• 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

• symptoms caused by strep throat usually go away with or without antibiotic treatment
• antibiotics can have a small effect on the pain and discomfort associated with strep throat
• antibiotics are especially recommended for children with strep throat who are at risk of developing rheumatic fever (Maori and Pacific Island children). 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?)

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

What treatment is needed for a sore throat?

• 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

• antibiotics are especially recommended for strep throat to prevent rheumatic fever in at-risk children - Maori and Pacific Island children
• 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

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

Maori and Pacific Island children and teenagers
If your Maori or Pacific Island child or teen has any sore throat, you need to take them to your GP (general practitioner). Other school-age children in your family / whanau may also have symptoms and should be checked. You can expect your child or teen to have a throat swab. In some situations, your doctor may immediately prescribe 10 days of antibiotics for a suspected strep throat to prevent rheumatic fever.

Non Maori, non Pacific Island children and teenagers
Your non Maori, non Pacific Island child or teen with a sore throat has a low risk of developing rheumatic fever. Sore throats are usually viral, especially if your child or teen also has a cough. A throat swab taken by your doctor will rule out a strep throat. If your child or teen does have a strep throat, they will need 10 days of antibiotics.

All children

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
• 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

See Is my child sick? for an additional list of worrying symptoms to watch for.

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.

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.