Last updated on May 6, 2021.
Is your child complaining of a scratchy and sore throat? It could be strep throat. While a vast majority of sore throat is caused by viruses, strep throat is a bacterial infection. About 20% to 30% of children with a sore throat actually have strep throat. Here is everything you need to know about strep throat, reviewed by pediatrician Dr. Eddie Cheung.
What is strep throat?
Strep throat (streptococcal pharyngitis) is an acute and painful inflammation of the throat due to a bacterium called Group A Streptococcus. It is a contagious yet mild and benign illness that lasts for around 7 days. Strep throat affects people of all ages, but most cases are in children and adolescents aged 5 to 15. It is uncommon in kids under 3 and in adults.
Your child’s doctor can check and confirm the diagnosis by swabbing the back of the throat for a rapid antigen detection test to look for the presence of strep bacteria. If the result comes back as negative, a throat culture will be performed.
Our immune system can usually fight off strep throat without complications. Although they are not common, there is still a risk. Some complications include kidney inflammation, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections and middle ear inflammation. Acute rheumatic fever is another serious complication that results in the inflammation of the joints or heart, and rash.
As strep throat is contagious, your child should be on antibiotics for at least 24 hours and have no fever when returning to school.
Incubation period: 2-5 days.
Infectious period: At least 24 hours after commencing antibiotic treatment.
How is strep throat transmitted?
Group A Streptococcus can be passed from person to person through respiratory droplets during coughing or sneezing. It can also be spread by sharing food or drinks, or touching surfaces infected with respiratory droplets from patients.
Signs and symptoms of strep throat
The onset is very sudden. Your child will usually get a sore throat accompanied by any of the following signs and symptoms. They develop in 2-5 days after bacterial exposure and usually go away in 3-5 days.
- Fever (temperature >100.4°F or 38°C)
- Severe pain in the throat
- Enlarged red tonsils
- Swollen tender lymph nodes in the front neck
- White or yellow patches in the back or sides of the throat
- Small red spots appear on the roof of the mouth
- Abdominal pain
- Nausea or vomiting
- Skin rash that starts in the groin and the armpit, and then spreads to the trunk and limbs
As mentioned, strep throat in children younger than 3 years old is rare. However, if they get it, they may experience
- Runny or stuffy nose
- Slight fever (< 101°F or 38.3°C)
- Painful enlarged lymph nodes in the neck
Infants (aged 1 year or below) may show
- Poor appetite
- Slight fever (< 101°F or 38.3°C)
When should you see a doctor?
You will need to see a doctor to get some antibiotics to treat strep throat.
If your child is experiencing a sore throat with any of the following conditions, seek medical care as soon as possible.
- Breathing difficulties
- Troubles with swallowing, eating or drinking
- Excessive drooling
- Difficulties opening the mouth
- Persistent fever
- Chill or shivery
- Swelling or stiffness of the neck
You should also call your GP if you are concerned about the illness, if your child has a weakened immune system or if their symptoms do not improve after 2 days of antibiotic treatment.
How is strep throat treated?
Most of the time, sore throats do not require medications or other treatments as they will get better within a week.
- Oral antibiotics: e.g. penicillin, amoxicillin and cephalexin. Your doctor will only prescribe them when there is a positive diagnostic test result. You should make sure the course is completed as instructed to prevent transmission and possible antibiotic resistance.
- Pain medications: e.g. paracetamol and ibuprofen. Children under 18 years should not take aspirin as it can lead to Reye’s syndrome.
Other management options:
- Drink plenty of fluids to stay hydrated.
- Avoid foods and drinks that can irritate a sore throat, e.g. hot, acidic or spicy ones.
- Gargle with warm salt water to reduce throat pain.
- Get enough rest for a better immune system.
- Eat foods that are easy to swallow, e.g. soups and yogurt.
- Suck on lozenges or hard candies.
Good hygiene is the key to reducing likelihood of developing infections. Follow these tips to prevent getting strep throat and spreading it to others.
- Clean your hands with soap and water or alcohol-based hand sanitizer properly and regularly, especially after sneezing, coughing or touching frequently-contacted surfaces such as doorknobs, before cooking or eating, or being around with an infected person.
- Cough or sneeze into a disposable tissue, the crook of the arm or the upper sleeve. Do not cover your mouth and nose with your hands.
- Do not share food, drinks or personal items such as toothbrushes, handkerchiefs or towels.
- Use hot water and soap to wash your child’s eating utensils, glasses and dishes separately. The washed items are safe for others to use.
Dr. Eddie Cheung 張蔚賢醫生 is a specialist in paediatrics. He received his paediatric training in Queen Mary Hospital and post-fellow paediatric cardiology training in Grantham Hospital/ Queen Mary Hospital. He is a Fellow of the Hong Kong College of Cardiology, the Vice President of Hong Kong Society of Paediatric Cardiology and Consultant of Hong Kong Association of Cleft Lip and Palate. He is currently working as Director of Paediatric Centre of HK Medical Consultants and serves as Infection Control Officer at the Hong Kong Adventist Hospital.