“Mom, my throat hurts!”
Your child came home from school and said “Mom, my throat hurts!” What do you do next?
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Parents often think about strep when their child complains of a sore throat, but most of the time, the cause is something else. Viruses, allergies, reflux and even mouth breathing or dryness can also cause a sore throat.
So how do I know if it is strep?
With strep throat, or strep pharyngitis, the symptoms often begin very abruptly. There is usually a fever, and there are no upper respiratory symptoms (cough, congestion, runny nose). If you see any of those respiratory symptoms, strep is not a likely cause. Starting antibiotics will not help if the cause is a virus.
The only way to definitively diagnose strep throat is to swab the back of the throat and send the sample for a culture.
It can be helpful to look in your child’s throat if they will allow it. Is it red? Do you see white patches? Do you see lots of individual sores?
Some common infectious causes of sore throat in children include COVID-19, Ebstein-Barr virus (“mono”),
Timeline
Sometimes a sore throat precedes upper respiratory infection symptoms by about 24h. If your child is complaining, but overall still relatively comfortable - able to drink, talk, and not overly sick-appearing, observation for a day or two is very reasonable. However if thy have underlying health issues or are worsening, or you are concerned, reach out to your pediatrician.
Things to try:
Treating a sore throat is primarily about managing symptoms. This can be done with a combination of over-the-counter medications and with natural remedies.
Pain management: Technically, there is some data that suggests that Ibuprofen may work slightly better for pain than Tylenol (PMID: 33125495), but the difference is not huge - so use whichever you prefer. Check out the guides section of this website to download a dosing cheat sheet to keep in your medication cabinet.
Hydration: Some kids prefer lukewarm liquids, and others prefer cold (think smoothies or popsicles). Check out my posts on assessing for dehydration, and how to treat it for some guidelines.
Jello, especially warmed up, can be a fantastic way to maintain hydration. It is easy to swallow and tastes good!
Avoid salty, acidic or spicy food or drinks.
Saline and steam/humidified air: If the sore throat is associated post-nasal drip or upper respiratory symptoms, nasal irrigation and steam inhalation (or using humidified air) can be very helpful.
Allergy medication: if you suspect your child has allergies, you may need to consider allergy medications.
Honey: this should only be used in children over the age of 1. Some data suggests honey can provide some symptom relief for upper respiratory infection symptoms (PMID: 32817011) and for sore throat although if I’m being honest, these studies are far from robust. With that said, it won’t hurt!
Mix 1 tbsp with 1-3 oz warm water.
Salt water gargles: Believe it or not, some evidence does support using these for upper respiratory infections (including COVID).
For children over 6 years: mix 0.25 tsp salt in 8oz warm water, gargle/spit. Repeat 3-4 times per day.
PMID: 16242593, 30705369
Maaaaybe:
Lozenges: These have not been shown to be helpful in the data, and can be choking hazards in children under 5 years. For a dry throat, a lollipop or lozenge may help generate saliva, but this should only be tried in children >6 years.
Magic mouthwash: This is a remedy sometimes recommended for mouth sores, but there is a lot of variability in terms of recipe and specifics. Talk to your pediatrician about whether it is appropriate for your child before trying it.
When to call the pediatrician
This is not a comprehensive list. In general, always err on the side of calling your pediatrician if you have any concerns about your child. There is a lot to be said for a parent’s gut instinct, and I promise: your pediatrician would rather you called!
If a sore throat is not improving within a few days, or if it is getting worse, call your pediatrician. Other concerning symptoms include:
Dehydration (see my post on this)
Drooling or inability to swallow
Stiff neck
Worsening pain
Persistent high fevers
A change in the sound of the voice (muffled)
Inability or discomfort with opening the mouth
Difficulty breathing
Lethargy or excess fatigue
Anything else tickling your spidey sense!!
Other things to know
Unfortunately, many causes of sore throats are infectious, and can be shared throughout a household. Here are some ways to help minimize spread!
Wash hands with soap and water
Avoid sharing utensils, cups, etc
Used tissues, etc should go straight into the trash
Stay home!
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