Parenting Advice From Your Physicians at Kaiser Permanente

When our kids were little, I used to tease my best friend. Whenever her kids had even the slightest tickle in their throats, she would make an appointment to get them a strep throat test. One time the test was positive, and her daughter needed an antibiotic to get better, so after that, each sore throat was tested. Those poor kids really had a lot of throat swabs! Now I understand better why she wanted all those tests.

Kids get sore throats all the time! Most of the time, the cause is a virus— COVID, influenza, RSV, or many of the other cold or upper respiratory viruses. And none of them need prescription medication to treat the sore throat.

Sometimes though, a sore throat is due to an illness caused by the Streptococcus bacterium—and this infection needs to be treated with an antibiotic.

Strep throat (also called strep pharyngitis or tonsillitis) is most common in kids 5 to 15 and usually starts suddenly. An infected person can unknowingly pass the infection on to others even before symptoms appear.

It can cause a child to have fever, achiness, nausea, vomiting, abdominal pain, along with the tell-tale sore throat. The back of their throat will look very red and may have red speckles and a white coating on the tonsils. When a child has this infection, they usually have enlarged and tender lymph nodes in the front of their neck and may have a red, rough rash.

Kids usually don’t have much cough, congestion, or runny noses—these often indicate the presence of a viral infection. Viruses can also cause red eyes with discharge, sores, blisters, or ulcers in a child’s mouth, lips or palms, and sores—but strep pharyngitis does not. The symptoms of strep throat usually get better in 3 to 5 days—even if untreated.

If strep throat gets better on its own, do we really need to treat it with an antibiotic? Yes—definitely! The antibiotics are given not only to help a child feel better sooner but also—most importantly— to prevent some of the possible long-term consequences of a Streptococcus infection, including rheumatic heart disease and kidney disease. And for this reason, it’s important to finish taking all of the prescribed antibiotic even when your child starts to feel better. Also, antibiotics prevent spreading the infection to others—an infected person is contagious until they take antibiotics for 24 hours.

So, how’s a parent to know if a child complaining of a sore throat has a common cold or the less common but treatable strep throat? We can use a swab to test the back of their throat, but contrary to my bestie’s thinking, not every kiddo with a sore throat needs a swab!

Usually, a test is unnecessary if the child also has a runny nose, nasal congestion, cough, mouth sores, or rash on palms and soles. Strep pharyngitis is quite contagious, so your child is more likely to have it if they’ve had close contact with an infected person. The best way to decide if a test is needed is to talk with your pediatrician.