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  • Sore Throat

    Definition

    • Pain, discomfort or raw feeling of the throat
    • Made worse when swallows
    • Rare symptom before 2 years old
    • Not caused by an injury to the throat

    Causes

    • Colds (URIs). Most sore throats are part of a cold. In fact, a sore throat may be the only symptom for the first 24 hours.
    • Viral pharyngitis. Some viruses cause a sore throat without nasal symptoms.
    • Strep pharyngitis. Group A Strep is the most common bacterial cause. It accounts for 20% of persistent sore throats. Only these need an antibiotic.

    Strep Throat

    • Symptoms include sore throat, fever, headache, stomach pain, nausea and vomiting.
    • Cough, hoarseness, red eyes, and runny nose are usually not seen with Strep throat. These symptoms point more to a viral cause.
    • Scarlet fever rash (fine, red, sandpaper-like rash) is highly suggestive of Strep throat.
    • Peak age: 5 to 15 years old. Not common under 2 years old unless sibling has Strep.
    • Diagnosis should be confirmed by a Strep test before starting treatment. There is no risk to your child to delay treatment until a Strep test can be done.
    • Standard treatment is with antibiotics by mouth.

    Symptoms in Infants and Toddlers

    • Children less than 2 years of age usually don’t complain about a sore throat. A young child who does not want favorite foods may have a sore throat. They may also start to cry during feedings. Their symptoms are usually better covered using DRINKING FLUIDS -DECREASED guide.

    Return to School

    • Your child can return to school after the fever is gone. Your child should feel well enough to join in normal activities.
    • Also, children with Strep throat need to be taking an antibiotic for 24 hours.

    When to Call Us for Sore Throat

    Call 911 Now (your child may need an ambulance) If:

    • Severe trouble breathing (struggling for each breath, can barely speak or cry)
    • You think your child has a life-threatening emergency

    Call Us Now (night or day) If:

    • Your child looks or acts very sick
    • Trouble breathing, but not severe
    • Great trouble swallowing fluids or spit
    • New drooling
    • Stiff neck
    • Dehydration suspected. (No urine in over 8 hours, dark urine, very dry mouth and no tears)
    • Purple or blood-colored spots or dots on skin
    • Weak immune system. (Such as sickle cell disease, HIV, cancer, organ transplant, taking oral steroids)
    • Fever over 104° F (40° C)
    • You think your child needs to be seen urgently

    Call Us Within 24 Hours (between 9 am and 4 pm) If:

    • You think your child needs to be seen, but not urgently. (OR needs a Strep test)
    • Sore throat pain is severe and not improved 2 hours after taking ibuprofen
    • Large lymph nodes in the neck
    • Pink rash that’s widespread
    • Earache or sinus pain (not just congestion)
    • Fever lasts more than 3 days
    • Fever returns after gone for more than 24 hours
    • Age under 2 years
    • Close contact to a person with Strep within last 7 days
    • Sores on the skin

    Call Us During Weekday Office Hours If:

    • You have other questions or concerns
    • Sore throat is the main symptom and lasts more than 48 hours
    • Sore throat with cold/cough symptoms lasts more than 5 days

    Parent Care at Home If:

    • Viral throat infection suspected

    Care Advice for Sore Throat

    What You Should Know:

    • Most sore throats are just part of a cold and caused by a virus.
    • A cough, hoarse voice or nasal discharge points to a cold as the cause.
    • Here is some care advice that should help.

    Sore Throat Pain Relief:

    • Age over 1 year. Can sip warm fluids such as chicken broth or apple juice.
    • Age over 6 years. Can also suck on hard candy or lollipops. Butterscotch seems to help.
    • Age over 8 years. Can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed.
    • Medicated throat sprays or lozenges are generally not helpful.

    Pain Medicine:

    • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed. See Dose Table.

    Fever:

    • For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. See Dose Table. Note: Lower fevers are important for fighting infections.
    • For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.

    Fluids and Soft Diet:

    • Try to get your child to drink adequate fluids.
    • Goal: Keep your child well hydrated.
    • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
    • Solids. Offer a soft diet. Also avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: Fluid intake is much more important than eating any solids.
    • Swollen tonsils can make some solid foods hard to swallow.

    Return to School:

    • Your child can return to school after the fever is gone. Your child should feel well enough to join in normal activities.
    • Also, children with Strep throat need to be taking an antibiotic for 24 hours.

    What to Expect:

    • Most often, sore throats with a viral illness last 4 or 5 days.

    Call Your Doctor If:

    • Sore throat is the main symptom and lasts more than 48 hours
    • Sore throat with a cold lasts more than 5 days
    • Fever lasts more than 3 days
    • Your child becomes worse

    Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

    Author and Senior Reviewer: Barton D. Schmitt, M.D.
    Copyright 1994-2013 Barton D. Schmitt, M.D.

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