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Sore throat

Sore throat refers to any painful sensation in the throat (pharyngitis) or surrounding areas.

Most children with pharyngitis have easily treated infections or infections that will resolve on their own, but a few serious disorders can be present.

What are the causes of sore throat in children?

  • Pharyngitis usually results from contact with a person who has the infection.
  • Viral infections are the most common cause of pharyngitis in children.
  • Strep throat is caused by a bacterium called Streptococcus pyogene or group A streptococci.
  • Strep throat is most common among school-aged children and adolescents
  • Its important to be able to tell between a sore throat from a virus or strep because strep infections need to be treated with antibiotics

Common causes of sore throat:

  • Viral infection
  • Strep throat
  • Non-strep bacteria
  • Infectious mononucleosis (Mono) – most common in adolescents
  • Irritation (e.g., allergies)

Life-threatening causes of sore throat


  • Epiglottitis-  rare, but serious inflammation of the epiglottis, a flap of tissue in the back of the throat-  occurs most often in children 2 – 4 years of age
  • Retropharyngeal abscess- accumulation of pus in an area behind the esophagus (the swallowing tube)- usually occurs in children less than 4 years of age
  • Peritonsillar abscess- accumulation of pus within the tonsils-  most common in adolescents
  • Severe tonsillitis with infectious mononucleosis

How long will it take my child to become ill after being exposed to someone else with pharyngitis?

  • Remember, just because your child is exposed to an ill person does not necessarily mean they too will become ill.
  • But if your child is to become ill, it will depend on the type of infection:1. For viral pharyngitis, on average, an infected child will become ill 2 – 10 days after being exposed.- although for Mononucleosis, it can take 30 – 50 days

    2. For Strep throat, an infected child will become ill 2 – 5 days after being exposed.

What are the signs and symptoms for the common causes of throat infections (pharyngitis) in children?

  • Fever
  • Sore throat
  • Decreased appetite
  • Swollen glands in the neck (in some cases)
  • White patches of pus on the tonsils (in some cases)
  • For viral throat infections:o  typically, children also have a cold at the same timeo  with the Coxsackie virus, your child may have one or more
    blisters in their throat
  • For Strep throat:-  children over 3 years of age with strep are often more ill; they
    may have an extremely painful throat and fever over 102
    degrees Fahrenheit (38.9 degrees Celsius)-  the child may also experience headache andabdominal pain-  the child is less likely to have cough and runny nose (unless
    they are less than 3 years of age)-  the child may develop scarlet fever for which a red,
    sandpaper-like rash develops
    (see photos scarlet fever and scarlet fever 2)-  in some cases the child will develop a strawberry appearance
    to their tongue (see photo of strawberry tongue)

What are some clues that my child’s sore throat may be the result of a more serious disorder?

  • Drooling
  • Difficulty swallowing
  • Difficulty opening their mouth
  • Difficulty speaking
  • Stiff neck
  • Stridor – raspy, harsh sound when breathing in
  • Your child looks extremely ill

How can strep throat be diagnosed?

  • The doctor cannot make a definite diagnosis of strep just based on your child’s symptoms and the examination of your child’s throat
  • A rapid strep test can easily be performed in which results can be available in minutes, depending how busy the laboratory is
  • If the rapid strep test is negative, the laboratory will run a strep culture in which the results will be made available within 1 – 2 days
  • Pharyngitis is presumed to be from a virus if the rapid strep test and strep culture are negative

What is the treatment for pharyngitis?

  • plenty of rest and fluids (avoid acidic juices that may irritate the throat)
  • gargle with salt water
  • ice pops, ice chips, or ice cream
  • acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)

For Strep throat:

  • antibiotics are needed to avoid some rare complications such as rheumatic fever, a disease that affects the joints and the heart
  • antibiotics should not be prescribed unless the diagnosis is confirmed through lab testing- in cases that are very suggestive of strep throat (e.g., scarlet
    fever present), the ER doc may elect to start antibiotics with
    follow up with your pediatrician
  • because antibiotics only minimally shorten the course of strep throat, it is not absolutely necessary to give these drugs right away before confirming the diagnosis
  • an antibiotic can be given as a one time injection or medication by mouth for 10 days
  • if your child is given the oral medication, its very important that they take it for the full 10-day course, as prescribed, even if the symptoms get better or go away in order to prevent strep from spreading to other areas of the body

How long will my child be sick with pharyngitis?

  • On average, for an uncomplicated pharyngitis your child should get better in 2 – 5 days.

When can my child return to daycare or school?

  • Children with Strep throat should not return to school or daycare until they’ve been taking antibiotic treatment for at least 24 hours
  • Students awaiting results of a strep culture who are not receiving antibiotic therapy may attend school unless they have fever
  • For viral pharyngitis, it will depend on how quickly your child’s symptoms go away, especially their fever

When should I call my pediatrician concerning a sore throat in my child?

  • You should your pediatrician if your child’s sore throat with or without fever has not improved within 2 days or is worsening.
  • Call immediately for any of the clues for possible serious illness as listed above.

How can pharyngitis be prevented?

  • Frequent hand washing is recommended to decrease the chance of becoming infected. Click on how to prevent infection for more details.