"Strep throat," also known as strep pharyngitis, is an infection of the back of the throat (pharynx) caused by specific bacteria called Group A Streptococcus (strep). The tonsils often are involved as well and this condition then sometimes is called tonsillitis. As the throat becomes more red and irritated, it becomes very sore. In addition, strep infections may cause fever, headache, swollen glands in the neck, belly (abdominal) pain, vomiting and a red rash known as scarlet fever.
Strep throat can occur in any age child at any time of the year, but most commonly it is seen in school-aged children and adolescents during the winter and early spring.
In some patients, who usually have not been treated, strep throat may lead to ear infections (otitis media), sinus infections (sinusitis), or collections of pus (abscesses) around the tonsils or in the lymph nodes in the back of the throat or neck. Untreated strep throat also can lead to rheumatic fever, a serious condition that affects the joints and heart. In rare cases, even with treatment, strep throat can cause a kidney problem known as acute glomerulonephritis in which there is swelling of the hands and feet, blood in the urine making it dark-colored, and high blood pressure.
Symptoms of strep throat may include:
- Sore throat, often severe
- Painful swallowing
- Bad breath
- Tender, swollen glands in the neck
- Nausea, vomiting, belly pain
- Red rash that feels rough like sandpaper
- White spots on the tonsils or in the back of the throat
- Coating of the tongue that looks like the outside of a strawberry
Strep throat usually does not cause:
- Runny nose
To know if there is strep throat, the doctor will:
- Check your child’s temperature, since strep throat often causes fever.
- Look inside your child’s throat with a light. A child with strep throat may have red, swollen tonsils, a red bumpy tongue that looks like the outside of a strawberry, and white or yellowish spots in the back of the throat.
- Touch the back of the throat with a culture swab to check for strep. The results usually are available within 24 hours. A rapid test may be available that can give results within one hour; however, if the rapid test is negative, a culture usually still is necessary.
If your child does have strep throat, the doctor will:
- Prescribe an antibiotic.
- Strep throat must be treated with an appropriate antibiotic to prevent rheumatic fever, a serious condition that affects the joints and the heart. Antibiotics can prevent rheumatic fever, as long as they are started within nine days of the initial symptoms.
- Early treatment, within 24 to 48 hours of developing symptoms, may help your child feel better sooner and will stop the spread of the disease faster. However, waiting slightly longer may help your child’s body build up its immunity, which may decrease the chance of getting strep throat again.
- Recommend ways to ease the pain.
- Discuss the things you should watch for at home.
- Tell you if your child should be seen again. Usually no follow-up visit is required if your child is feeling better. It also is not necessary to repeat the throat culture after completing treatment for strep throat unless your child again develops symptoms of strep throat.
- Be sure your child takes the antibiotic by mouth exactly as directed.
- Check with your pharmacist to see whether the antibiotic should be taken on an empty stomach or with food.
- Finish all of the antibiotic, even if your child is feeling much better after starting the medicine.
- Some over-the-counter medicines may be helpful:
- For pain and fever, try acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).
- Cough drops that contain menthol feel cool and can make the throat feel better, but these only should be used for children over age 4 years because younger children could choke on them.
- Herbal cough drops made with horehound, licorice root or slippery elm bark can be soothing for a sore throat.
- These over-the-counter medicines usually are not helpful:
- Cold and allergy medicines, such as decongestants (for example, pseudoephedrine or Sudafed) and antihistamines (for example, diphenhydramine or Benadryl), do not treat strep throat, rarely help with throat pain, and can have unwanted side effects.
- Certain over-the-counter medicines should not be used unless directed by your doctor:
- Throat sprays and cough drops that contain an anesthetic, such as benzocaine (Cepacol) or phenol (Cepastat, Chloraseptic), can help to numb any throat pain. However, the tongue and other parts of the mouth can become numb as well. Therefore, these throat sprays and cough drops are best used only with a doctor’s permission and direction.
- Never give your child aspirin or any products containing aspirin because it has been associated with Reye’s syndrome, a serious illness that affects the liver and brain.
- Other things you and your child can do that may help your child feel better:
- Drink lots of liquids — warm (broth, apple juice, lemonade or tea) or cool (milk shakes, gelatin desserts, flavored ices) — to soothe the throat and prevent dehydration.
- Add some honey to warm liquids to help soothe your child’s sore throat. Do not give honey to infants under 1 year of age because it can cause botulism.
- Children older than 4 years of age can suck on hard candies or lollipops.
- Children who are able to do so can gargle with warm salt water (1/2 teaspoon of salt in 8 to16 ounces warm water).
- Do not smoke around your child because it will irritate the throat more.
- Use a cool-mist vaporizer (a humidifier) in your child’s room. Make sure to clean it according to the manufacturer’s instructions every few days.
- Call the doctor if your child:
- Is getting worse.
- Is having trouble breathing.
- Cannot swallow or open the mouth all the way.
- Is not drinking and has not made urine in six to eight hours.
- Seems too sleepy (lethargic) at times when he usually would be awake and active.
- Continues to have fever or pain two to three days after being seen by a doctor.
- Has dark-colored (like cola or blood) urine.
- Has swelling of the hands or feet.
- Gets a new rash.
- Prevent other episodes of strep throat by:
- Taking all of the antibiotic as prescribed.
- Teaching your child to wash his or her hands regularly.
Check with your school or day care regarding specific policies about returning after illness. Strep throat is contagious (spread from person to person). Most often, children with strep throat can go back to school or day care after they have been on antibiotics for at least 24 hours and no longer have fever over 101°F.
If your child needs to take a dose of antibiotic or other medicine during the school day, it can be helpful to ask your pharmacist to put the medicine into two different labeled containers. That way you can send one to school or day care and leave the other at home. Also be sure to fill out any necessary forms, including a note from your doctor with specific instructions for giving the medicine.