Strep Throat: Everything You Need to Know
Strep throat can be a common rite of passage for parents of young children. Let’s chat more about it!
what to know
Streptococcal pharyngitis (strep throat) is acute inflammation and infection of the back of the throat. It most commonly happens from a bacteria called Streptococcus pyogenes. It is transmitted by respiratory secretions, and the incubation period is 24-72 hours.
In school-aged and older children, strep throat often present with symptoms like fever, sore throat, headache (usually in the front of the head). It can sometimes look a little different - some children have abdominal pain & vomiting. Children younger than 3 years old may have runny nose, nasal discharge, or congestion.
You can look for clues like: redness in the back of the throat, white patches, pinpoint red dots (called palatal petechiae), and bigger lymph nodes just under the angle of the jaw.
Though it’s more rare, some kids may develop something called scarlet fever. Scarlet fever is a rash that happens through something called toxin-mediated release, where Streptococcus pyogenes bacteria releases an exotoxin that causes a local inflammatory response on the skin. It is more common in older children (5 years old and older). Typically, the rash will develop after a 2-5 day incubation period of symptoms mentioned above. Here’s what you may see (and here are some photos if that helps!):
small (1-2mm) bumps on a red/darker skin color base
sandpaper like (feels rough, like a ‘sunburn with goose bumps’)
it starts on the trunk and spreads to the extremities
it’s more pronounced in skin folds and flexural surfaces (like the elbows)
typically lasts for 4 days to a week.
you may see peeling as it starts to resolve, first at the head and trunk and then to the other areas over 2-6 weeks
Some children can get a diaper rash from strep called perianal strep. This rash is pretty classic if you know what to look for (more photos for you!). We can test for it with a swab of the skin or by clinical exam. It is treated with antibiotics. It has:
a very well-demarcated sharp circle around the anus
typically bright red
can have local swelling
itching
possible pain with bowel movements
if you suspect strep…
If you suspect strep throat in your child (older than 3 years old), you should talk with your care team about getting a rapid strep test done. This is a Q-tip like swab in the back of the throat - the rapid antigen detection test is 90-99% specific and can give you results within a few minutes.
Here’s a neat tool that can help you too. We use a clinical scoring system called the Centor Score Clinical Criteria (ACP, CDC, AAFP) when deciding whether or not to get a swab for strep throat (in additional to our clinical exam). You can use it too if you’re in the moment with your own child trying to decide if you need to get tested:
4 Criteria:
Absence of cough (1 point)
swollen and tender anterior cervical lymph nodes (1 point)
temperature greater than 100.4F (1 point)
tonsillar swelling or exudates (white patches) (1 point)
age: 3-14 years old (1 point)
*If your child scores: 4 or higher: high risk of strep throat, 2-3: test for strep using a rapid antigen test or throat culture, 0 or 1: lower likelihood of strep throat.
Most children with untreated strep throat will get better within a week or so. We treat strep throat with antibiotics because of the effect it can have on the heart (rheumatic heart disease) and kidneys (poststreptococcal glomerulonephritis). It is important to treat it to prevent these serious complications. We also want to make sure that there are no direct complications of an untreated bacterial illness in the body, like spread into the bloodstream, infected lymph nodes, etc.
If your child is younger than 3 years old, the guidelines are slightly different. Data shows that children this age are much less likely to experience secondary complications from strep throat. As such, infectious disease experts recommend only testing a child younger than this age if they have symptoms AND have a direct known contact with strep throat (i.e. a family member or close contact in childcare). Chat with your care team, who knows you and your child best, for more if you’re in this situation.
what to do
The good news is that symptoms can improve very quickly after starting antibiotics. Your job in the meantime is to help your child stay 1) comfortable and 2) hydrated.
Focus on fluids. Cool fluids can help with hydration as well as pain by reducing inflammation. Things like popsicles, smoothies, pedialyte, or regular water and drinks can help a lot. Your child can just take small sips at at time as they’re able regularly through the day. Here are some things that we use at home for the boys when we need to focus on hydration.
Use medication as needed. Strep throat can be very painful. If your child is really struggling, you can try a dose of children’s ibuprofen or tylenol (some studies say that ibuprofen is marginally more helpful than tylenol) for pain.
Honey (**kids older than 1 year old) can help with congestion and sore throat. We add it into water with some lemon. These honey sticks are fun and make it easy too!
Salt water gargles. If your child is game, these can help a lot!
when to call your pediatrician
worsening sore throat
fever that persists more than 48 hours after antibiotics
drooling
change in voice
inability to swallow
with any questions or concerns
