Sore Throat In Detail

Sore Throat In Detail

Sore throats are common in children. Sometimes children can get 'strep throat'. A rare complication of strep throat is rheumatic fever.

Checking sore throats to prevent rheumatic fever

A guide to checking sore throats to prevent rheumatic fever.

Copyright Kylie Sullivan 2017. Licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License. 


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 page)
  • 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 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 common cause

Less frequently, glandular fever (Epstein Barr virus) can cause a sore throat, enlarged glands in the neck, fever and tiredness, particularly in teenagers and young adults. Glandular fever is diagnosed with a blood test.

What are the complications of strep throat?

In at-risk people, untreated strep throat can lead to rheumatic fever. See the rheumatic fever page

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. Strep throats are rare in children under 3.

In New Zealand, Māori and Pacific children are at greatest risk of developing complications from 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.

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

It's very difficult to tell the difference between a viral sore throat and strep throat. 

Māori and Pacific children and teenagers

If your Māori or Pacific child or teen has any sore throat, please take them to your family doctor or school clinic for a throat swab. Your child may need 10 days of antibiotics for a suspected strep throat to prevent rheumatic fever. 

Other children and teenagers

If your child with a sore throat is not Māori or Pacific, they have a low risk of developing rheumatic fever. Sore throats are usually viral. Most children with a sore throat do not need any tests but your child may have a throat swab to rule out a strep throat. 

All children

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

You should see your family doctor 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 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)

What is the treatment for a sore throat?

Infections caused by viruses can not be treated with antibiotics. The body will clear out the virus on its own without treatment.

If your child needs take antibiotics for a strep throat, make sure they take all the doses for 10 days even if their symptoms have improved. Your child can return to school or daycare 24 hours after they start antibiotics.

Pain relief can help any sore throat. It will help your child eat and drink. You can relieve pain in the following ways:

  • paracetamol (you must follow the dosage instructions on the bottle; it is dangerous to give more than the recommended dose)
  • gargling 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 don't give them to young children because of the risk of choking
  • drinking warm liquids - honey or lemon is a common way of providing relief
  • cool liquids and ice blocks 

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.


The content on this page has been produced by the Paediatric Society of New Zealand in collaboration with the co-chair of the Rheumatic Fever Guidelines Writing Group. The content conforms with:

The video is copyright Kylie Sullivan 2017. Licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License. Acknowledgements: Starship Child Health, Starship Foundation, Auckland District Health Board (Alison Leversha, Faith Mahony).

This page last reviewed 05 September 2017.
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