Definition:

• The child complains of a sore throat.
• In children too young to talk, a sore throat may be suspected 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 due to the strep bacteria. A throat culture or rapid strep test is the only way to distinguish strep pharyngitis from viral pharyngitis. Without treatment, a strep throat can have some rare but serious complications. 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 in the morning with a dry mouth and sore throat. It clears 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 frequent throat clearing.

Expected Course:

Sore throats with viral illnesses usually last 3 or 4 days. Strep throat responds well to penicillin. After taking the medication for 24 hours, your child is no longer contagious and can return to day care or school if the fever is gone and he is feeling better.

Home Care:

Local Pain Relief - Children over 8 years of age can gargle with warm salt water (1/4 teaspoon of salt per glass). Children over 4 years of age can suck on hard candy (butterscotch seems to be a soothing flavor) or lollipops as often as necessary. Children over age 1 can sip warm chicken broth or warm apple juice.

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

Fever - Acetaminophen or ibuprofen may be given for a few days if your child has a fever over 102'F (39oC) or a great deal of throat discomfort.

Common Mistakes in Treating Sore Throat:

Avoid expensive throat sprays or throat lozenges. Not only are they no more effective than hard candy, but they also may contain an ingredient (benzocaine) that may cause a drug reaction.

Avoid using leftover antibiotics from siblings or friends. These should be thrown out because they deteriorate faster than other drugs. Unfortunately, antibiotics only help 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 OUR OFFICE

IMMEDIATELY if:

• Your child is drooling, spitting, or having great difficulty in swallowing.
• Breathing becomes difficult.
• Your child is acting very sick.

DURING REGULAR HOURS:

• To make an appointment for a throat culture for any other child with a sore throat present for more than 24 hours.
• (Exception: If the sore throat is very mild and the main symptom is croup, hoarseness, or a cough, a throat culture is probably not needed. Throat cultures are recommended for all other sore throats because a resurgence of acute rheumatic fever began in 1987. Rheumatic fever is a complication of strep infections that can lead to permanent damage to the valves of the heart.)
• If a fever lasts more than 3 days.
• If you have other questions or concerns.
  

Adapted from Instructions for Pediatric Patients by Barton Schmitt (2nd edition, 1999) with permission from the author.

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