An older child complaining of a sore throat, pain with swallowing.

A younger child may have a sore throat if they refuse to eat or cry with feedings.

When examined with a light, the throat may be red.

• Most sore throats are caused by a virus and may be part of a cold.
• Tonsillitis means any swelling or redness of the tonsils and may be caused by a virus or a bacteria. Viruses are more common in children under a year.
• About 10% of sore throats are caused by the strep (streptococcus Group A) bacteria. This does need treatment with antibiotics because of rare complications of an untreated strep bacteria such as rheumatic fever (which can lead to heart damage) or post-streptococcal glomerulonephritis ( a kidney complication where blood and protein are detected in the urine and causes a "coca-cola" colored urine). Strep throat may occur at any age, but is most common in children over 4 or 5 years of age. It is contracted by person-to-person contact and the incubation is 2 to 5 days. Strep rarely causes nasal congestion and cough. Symptoms of strep throat may include the following:

• fever
• sore throat with red spots or white spots on the tonsils
• swollen tender neck glands
• headaches
• stomachaches, nausea or vomiting
• fine, sandpaper-like rash may occur with strep called a scarletina rash or scarlet fever

• Children with congestion due to a cold or allergies may have a sore throat in the morning, that resolves later in the day and is secondary to mouth breathing and post-nasal drip.
• Infectious mononucleosis, commonly called mono is caused by the Epstein-Barr virus. See below under viral pharyngitis.

• Child is drooling, spitting or having great difficulty swallowing
• Child with difficulty breathing, not due to a stuffy nose
• Child acting sick despite acetaminophen
• "Coca-Cola" colored urine or blood in the urine

• Sore throat more than 3 days
• Accompanied by high fever
• Known recent contacts with strep throat
• Fine, red sandpapery rash usually starting in lower abdomen

Home Care. Acetaminophen or ibuprofen are recommended for pain relief. Older children may gargle with warm salt water. Make sure the child is drinking fluids to stay hydrated and do not worry as much about food. Soft foods are usually better tolerated. A humidifier may help is sore throat is due to a dry throat from mouth breathing.

Viral pharyngitis. Many viruses may cause a sore throat. Most of the time if your child has an accompanying cold with congestion and cough, they will be more likely have a virus rather than strep throat. One virus that may cause a severe sore throat is mono (infectious mononucleosis caused by the Epstein-Barr virus). Recognized frequently in adolescents ( the "kissing" disease), it may occur in young children. Mono usually is accompanied by fatigue, fever, very swollen tonsils with a white coating and possibly an enlarged spleen. A blood test is needed to diagnose mononucleosis and there is no real treatment. Steroids are occasionally used if tonsils are so large that the child has difficulty breathing.

Strep pharyngitis. Strep does need treatment with antibiotics. The diagnosis is made with a throat swab and performing a rapid strep test (usually takes a few minutes to do in the office) or a throat culture (results after 24 to 48 hours from a lab). The scarlet fever rash that may occur with strep feels like a fine, sandpapery rash usually starting in the groin area, neck and then spreads. The child is contagious until they have been treated with antibiotics for at least 24 hours. They are usually feeling better after being on the antibiotics for at least 48 hours. Not everyone is prone to strep throat, so even though someone is exposed, they may not necessarily get the disease.

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