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Kids and Strep Throat

Posted on Nov 29, 2021

Sore throats in children are very common, and parents are almost always worried about strep throat. But more sore throats are caused by viruses or even post-nasal drip from allergies. On this week’s On Call for All Kids, Rachel Dawkins, M.D., medical director of the Pediatric and Adolescent Medicine Clinics at Johns Hopkins All Children’s Hospital, helps parents tell the difference between a sore throat and strep.

What exactly is strep throat?

It is an infection in the throat and of the tonsils caused by bacteria called group A streptococcus. Group A strep lives in the nose and throat and can be spread by respiratory droplets (coughing and sneezing). Kids can get sick with the bacteria if they breathe in those droplets, touch something that is contaminated then touch their mouth or nose, or drink from the same glass as a sick person.

Strep can also cause skin infection. This is known as impetigo.

Interestingly, some kids can be asymptomatic carriers of strep bacteria. They may test positive for strep but if they don’t have symptoms of severe illness, they should not be treated.

What are the symptoms of strep throat?

Strep throat is usually mild. Throat pain and fever WITHOUT cough are the most common signs. Red, swollen tonsils with white patches might be present and there might be red dots on the roof of the mouth. Kids may also present with headache or belly pain. Scarlet fever has a particular rash on the body that is common.

What symptoms would make a parent think their child has a virus rather than strep throat?

Cough, runny nose, pink eye, or hoarseness/laryngitis are not common with strep throat. So when a child comes in with a runny nose, cough and sore throat this is almost always due to a viral cause and should not be treated with antibiotics.

What is the treatment for a sore throat and, more specifically, strep throat?

First of all, your doctor should test for strep throat. You cannot look in a throat and determine if a child has strep. A good history and a quick swab will give your doctor good information. A throat culture might be done to pick up bacteria a rapid test might have missed.

For those kids with a positive test, antibiotics will help treat the infection.

For kids with a negative test, supportive care is all that is needed. Acetaminophen or ibuprofen can help with pain. Eating cold foods such as popsicles or gargling with salt water may help symptoms. In kids older than a year, they can use honey to relieve cough. Make sure to avoid any other cough or cold medicine in children less than 4 and talk to your pediatrician about any over-the-counter medication.

On Call for All Kids is a weekly series featuring Johns Hopkins All Children's Hospital experts. Visit each Monday for the latest report. You also can explore more advice from Rachel Dawkins, M.D., or download our free Pocket Doc app, which features a symptom checker, parenting advice and other tools for staying in touch with us.

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