Acute Pharyngitis: Presumed Strep (Child)

Pharyngitis is a sore throat. Sore throat is a common condition in children. It can be caused by an infection with the bacterium streptococcus. This is commonly known as strep throat.

Strep throat starts suddenly. Symptoms include a red, swollen throat and swollen lymph nodes, which make it painful to swallow. Red spots may appear on the roof of the mouth. Some children will be flushed and have a fever. Young children may not show that they feel pain. But they may refuse to eat or drink, or may drool a lot.

Strep throat is diagnosed with a rapid test or a throat culture. If the rapid test results are unclear, your child may need a throat culture. Results from the culture may take up to 2 days. This waiting period may be hard for you and your child. The doctor may prescribe medicines to treat fever and pain. Strep throat is very contagious. So your child must stay at home until your child's healthcare provider says they can go back to school or daycare.

If a strep infection is confirmed, your child’s healthcare provider will prescribe antibiotic medicine. This may be given by injection or pills. Children with strep throat are contagious until they have been taking antibiotic medicine for 24 hours.  

Home care

Medicines

Follow these guidelines when giving your child medicine at home:

  • If your child has pain or fever, you can give him or her medicine as advised by your child's healthcare provider.

  • Don't give your child any other medicine without first asking the provider.

Follow these tips when giving fever medicine to a normally healthy child:

  • Don’t give ibuprofen to children younger than 6 months old. Also don’t give ibuprofen to an older child who is vomiting constantly and is dehydrated.

  • Read the label before giving fever medicine. This is to make sure that you are giving the right dose. The dose should be right for your child’s age and weight.

  • If your child is taking other medicine, check the list of ingredients. Look for acetaminophen or ibuprofen. If the medicine contains either of these, tell your child’s healthcare provider before giving your child the medicine. This is to prevent a possible overdose.

  • If your child is younger than 2 years, talk with your child’s healthcare provider before giving any medicines to find out the right medicine to use and how much to give.

  • Don’t give aspirin (or medicine that contains aspirin) to a child younger than age 19 unless directed by your child’s provider. Taking aspirin can put your child at risk for Reye syndrome. This is a rare but very serious disorder. It most often affects the brain and the liver.

    Note: Don't give your child any other medicine without first asking your child's healthcare provider, especially the first time.

General care

  • Keep your child home from school or day care until the provider tells you if your child has strep throat. Strep throat is very contagious. 

If strep throat is confirmed

  • The healthcare provider will prescribe antibiotics. Follow all instructions for giving this medicine to your child. Make sure your child takes the medicine as directed until it's gone. You should not have any left over.

  • Limit your child's contact with others until he or she is no longer contagious. This is 24 hours after starting antibiotics or as advised by your child’s provider. 

  • Tell people who may have had contact with your child about his or her illness. This may include school officials and daycare center workers.

  • Wash your hands with clean, running water and soap before and after caring for your child. This is to help prevent the spread of infection. Others should do the same.

  • Give your child plenty of time to rest.

  • Encourage your child to drink liquids.

  • Older children may prefer ice chips, cold drinks, frozen desserts, or ice pops.

  • Older children may also like warm chicken soup or drinks with lemon and honey. Don’t give honey to a child younger than 1 year old.

  • Don’t force your child to eat. If your child feels like eating, don’t give him or her salty or spicy foods. These can irritate the throat.

  • Older children may gargle with warm salt water to ease throat pain. Have your child spit out the gargle afterward and not swallow it. 

Follow-up care

Follow up with your child’s healthcare provider, or as directed.

When to seek medical advice

Call your child's healthcare provider right away if any of these occur:

  • Fever (see "Fever and children," below)

  • Symptoms don’t get better after taking prescribed medicine or seem to be getting worse

  • New or worsening ear pain, sinus pain, or headache

  • Painful lumps in the back of neck

  • Lymph nodes are getting larger 

  • Your child can’t swallow liquids, has lots of drooling, or can’t open his or her mouth wide because of throat pain

  • Signs of dehydration. These include very dark urine or no urine, sunken eyes, and dizziness.

  • Noisy breathing

  • Muffled voice

  • New rash

Call 911

Call 911 if your child has any of these:

  • Fever (see "Fever and children" below)

  • Trouble breathing

  • Confusion

  • Feeling drowsy or having trouble waking up

  • Unresponsive

  • Fainting or loss of consciousness

  • Fast (rapid) heart rate

  • Seizure

  • Stiff neck

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

  • Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

  • Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

  • Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

  • Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

  • Mouth (oral). Don’t use a thermometer in your child’s mouth until he or she is at least 4 years old.

Use the rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell him or her which type you used.

Below are guidelines to know if your young child has a fever. Your child’s healthcare provider may give you different numbers for your child. Follow your provider’s specific instructions.

Fever readings for a baby under 3 months old:

  • First, ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead: 100.4°F (38°C) or higher

  • Armpit: 99°F (37.2°C) or higher

Fever readings for a child age 3 months to 36 months (3 years):

  • Rectal, forehead, or ear: 102°F (38.9°C) or higher

  • Armpit: 101°F (38.3°C) or higher

Call the healthcare provider in these cases:

  • Repeated temperature of 104°F (40°C) or higher in a child of any age

  • Fever of 100.4° F (38° C) or higher in baby younger than 3 months

  • Fever that lasts more than 24 hours in a child under age 2

  • Fever that lasts for 3 days in a child age 2 or older

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