Sore throat

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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 which can cause permanent heart damage (see the rheumatic fever fact sheet)
  • Māori and Pacific children are most at risk of rheumatic fever, and should see a doctor in the first 1-2 days of any sore throat
  • in communities where rheumatic fever is uncommon, 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?

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.

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 and 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?).

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. Glandular fever is diagnosed with a blood test.

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. 

How is a sore throat diagnosed?

In many cases of sore throat, no tests are needed.

Depending on the symptoms and signs and the risk of rheumatic fever in the community, some of the following may be performed:

  • 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?

Sore throats caused by viruses are common in all children.

Strep throat is more common in school-age children. Sore throats in children under 3 are seldom due to strep throat.

In New Zealand, Māori and Pacific children are at greatest risk of developing complications from strep throat (see What are the complications of strep throat?). Rheumatic fever occurs throughout New Zealand but is more common in Northland, the Auckland region, Waikato, Bay of Plenty, Rotorua, Tairawhiti (Gisborne and its surrounding area) and Porirua.

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 usually go away in 3-4 days 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 (Māori and Pacific children). This is because unless the strep bacteria are killed with antibiotics, these children are at risk of getting rheumatic fever (see What are the complications of strep throat?). It's very important to finish the 10-day course of antibiotics to kill the strep bacteria and prevent rheumatic fever developing

Glandular fever (Epstein Barr virus) symptoms can last several weeks.

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, Māori and Pacific 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?

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 (1 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 against viral infections. In fact, some types of antibiotics, especially amoxycillin, can cause a rash in children with glandular fever.

Strep throat

  • antibiotics are especially recommended for strep throat to prevent rheumatic fever in at-risk children - Māori and Pacific children
  • make sure your child takes all the doses for 10 days 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?

Māori and Pacific children and teenagers
If your Māori or Pacific child or teen has any sore throat, you need to take them to your GP (general practitioner). Other children in your family / whānau 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. In other situations, your doctor will prescribe 10 days of antibiotics 2 days later if the throat swab is positive for strep A.

In areas of high risk of rheumatic fever, free sore throat clinics are available. These provide free assessment and treatment if needed. See the Ministry of Health website for:

Non Māori, non Pacific children and teenagers

Your non Māori, non Pacific 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 may be taken by your doctor to 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 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.

This page last reviewed 09 April 2014
© Paediatric Society of New Zealand and Starship Foundation 2005 – 2014
Printed on 17 April 2014. Content is regularly updated so please refer to www.kidshealth.org.nz for the most up-to-date version
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