Sore Throat in Children: How to Tell if It’s Strep or Something Else

Your child came home from school and said “Mom, my throat hurts!”

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This is one of the MOST common complaints in pediatrics (and often one of the most confusing). Is it strep throat? A virus? Allergies? Do they need to be seen? Here’s how we figure it out.

Possible causes of sore throat in children

The most common cause of sore throat in kids? VIRUSES. Which is annoying, because usually there’s no quick fix. Other common causes of sore throat include:

• VIRUSES (eg a cold, influenza, HFM, EBV mono, covid)

• Postnasal drip from allergies

• Reflux (especially at night)

• Mouth breathing, dry air or dehydration

The Pediatrician Mom Tip: Antibiotics only help with bacterial infections (like Strep). They cannot help with viral sore throats.

What is strep throat?

Strep throat (strep pharyngitis) is caused by Group A Streptococcus (or Strep pyogenes). Symptoms usually begin suddenly.

Although there is some clinical judgment, most clinicians use validated criteria / scales to calculate the likelihood of strep before deciding whether or not to do a test.

Centor criteria (there are other scales too):

• Add 1 point for each of:

  • Fever over 100.4F

  • ABSENCE of cough

  • Swollen lymph nodes

  • Red, swollen tonsils / white patches on tonsils

  • Age 3-14 years

Even if your child scores high, the only way to know for sure is a throat swab and sometimes a culture.

Strep is a little unusual, though, and part of the reason I want to emphasize the clinical judgment piece. I often see it present as a stomachache, headache or vomiting in elementary-school aged kids. It can also cause a sandpapery rash, or a very specific-appearing diaper rash. Stay tuned for an instagram post detailing all the weird symptoms of Strep.

What to do when your child has a sore throat

If your child is still drinking fluids, talking, and generally acting okay, it’s reasonable to observe for 24–48 hours. However, if the pain is severe, worsening, or your instinct says something’s not right, call sooner.

Practical, safe options to try at home

• Pain and fever relief:

  • Use acetaminophen or ibuprofen as directed.
    Some studies show ibuprofen may slightly outperform acetaminophen for pain relief (PMID: 33125495), but both are effective.

  • Check out the guides section of this website to download a dosing cheat sheet to keep in your medication cabinet.

• Encourage fluids:

  • A dry throat is more likely to be painful. Hydration is (as always!) key when your child is sick.

  • Some kids prefer lukewarm liquids, and others prefer cold. You can try popsicles, smoothies, broth or even warmed up Jell-O.

  • Avoid salty, acidic or spicy foods.

  • Check out my posts on assessing for dehydration, and how to treat it for some guidelines.

• Humidified air or steam:

  • A steamy shower or a cool mist humidifier can soothe throat dryness, especially if post-nasal drip is involved.

• Address any allergies

  • If the sore throat comes with sneezing or itchy eyes, seasonal allergies may be the culprit. Always check with a pediatrician before giving your child medication. More information here.

• Honey: FOR KIDS OVER 1 YEAR

  • Honey can coat and sooth the throat and help with other respiratory symptoms like cough (PMID: 32817011).

  • Dosing and other information here.

• Salt water gargles (kids over 6 years)

  • It is old school but there’s some evidence to support this trick (PMID: 16242593, 30705369)

  • Mix ¼ teaspoon of salt in 8 oz of warm water, gargle, and spit. Repeat 3-4 times per day.

Maaaaybe:

• Lozenges:

  • There actually isn’t much evidence to support these, but they can sometimes help with throat dryness. Consider using lollipops instead.

  • Lozenges and other hard sweets be a choking hazard in young kids (=under 5 years).

• Magic mouthwash:

  • Sometimes recommended for mouth sores with Hand Foot & Mouth, but there is a lot of variability in terms of recipe and specifics. Talk to your pediatrician if you’re curious.

When to call the pediatrician

This is not a comprehensive list. I promise your pediatrician would rather you called if you had any concerns, even if you don’t see something on this list. Trust your gut!

Call your doctor for any concerns, or if your child:

• Has a sore throat that’s not improving after a few days

• Can’t swallow, is drooling, or has trouble breathing

• Has a high fever lasting more than 2–3 days

• Shows signs of dehydration (see here)

• Has a stiff neck or a change in the sound of their voice (eg: muffled)

• Is unusually tired, weak, or irritable

• Inability or discomfort with opening the mouth

• Anything else tickling your spidey sense!!

How to Prevent Sore Throat Spread

Sore throats (whether Strep or otherwise) can spread easily in families. You can minimize this by:

• Washing hands often with soap and water

• Avoiding shared cups or utensils

• Throwing away used tissues right away

• Keeping your child home while they’re symptomatic

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Sore throats in children are incredibly common, and most are viral, not strep. Talk to your pediatrician if you are concerned about strep.

And in the meantime, focus on comfort, hydration, and rest (and trust your gut if something doesn’t seem right).