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Clinical Reference Systems: Pediatric Advisor 10.0
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Sore Throat (Pharyngitis)

DESCRIPTION

  • Your child complains of having a sore throat.
  • Children too young to talk may have a sore throat if they refuse to eat or begin to cry during feedings.
  • When examined with a light, the throat is bright red.

CAUSE

Most sore throats are caused by viruses and are part of a cold. About 10% of sore throats are caused by strep bacteria. A throat culture or rapid strep test is the only way to know whether a sore throat is caused by strep bacteria or a virus. Without treatment, a strep throat can have some rare but serious complications.

For more information on strep infections, see Strep Throat Infection.

Tonsillitis (temporary swelling and redness of the tonsils) is usually present with any throat infection, viral or bacterial. The presence of tonsillitis does not have any special meaning.

Children who sleep with their mouths open often wake up in the morning with a dry mouth and sore throat. It feels better within an hour of having something to drink. Use a humidifier to help prevent this problem.

Children with a postnasal drip from draining sinuses often have a sore throat from clearing their throat often.

EXPECTED COURSE

Sore throats caused by viral illnesses usually last 3 or 4 days.

Strep throat responds well to penicillin or other antibiotics. After a child has been taking medication for strep for 24 hours, strep is no longer contagious. Your child can then return to day care or school if his fever is gone and he's feeling better.

HOME CARE

  1. Local pain relief

    Children over age 1 can sip warm chicken broth or apple juice. Children over age 4 can suck on hard candy (butterscotch seems to be a soothing flavor) or lollipops.

  2. Diet

    Swollen tonsils can make some foods hard to swallow. Provide your child with a diet of soft foods for a few days if he prefers it.

  3. Fever and pain relief

    Give your child acetaminophen or ibuprofen for the sore throat or for a fever over 102 degrees F (39 degrees C).

  4. Common mistakes in treating sore throat
    • Avoid expensive throat sprays or throat lozenges. Not only are they no more effective than hard candy, but many also contain an ingredient (benzocaine) that may cause an allergic reaction.
    • Do not use leftover antibiotics from siblings or friends. Leftover antibiotics should be thrown out because they deteriorate faster than other drugs. Also, antibiotics help only strep throats. They have no effect on viruses, and they can cause harm. They also make it difficult to find out what is wrong if your child becomes sicker.

  5. Rapid strep tests

    Rapid strep tests are helpful only when their results are positive. If they are negative, a throat culture should be performed to pick up the 20% of strep infections that the rapid tests miss. Avoid rapid strep tests performed in shopping malls or at home because they tend to be inaccurate.

CALL YOUR CHILD'S PHYSICIAN IMMEDIATELY IF:

  • Your child is drooling or having great difficulty swallowing.
  • Your child is having difficulty breathing.
  • Your child is acting very sick.

CALL YOUR CHILD'S PHYSICIAN DURING OFFICE HOURS:

  • To make an appointment for a throat culture for any other child who has had a sore throat for more than 24 hours (especially if the child also has a fever).

    Exception: A throat culture is probably not necessary if your child's throat is just mildly sore AND the main symptom is croup, hoarseness, or a cough. Throat cultures are recommended for all other cases of sore throats because of an increased rate of acute rheumatic fever since 1987. Rheumatic fever is a complication of strep infections that can lead to permanent damage to the valves of the heart. The throat culture is not urgent, however, since treating a strep infection within 7 days of when it begins can prevent rheumatic fever.


Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.
Copyright 1999 Clinical Reference Systems