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
- 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.
- 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.
- 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).
- 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.
- 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.
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