What Should You Do When Your Child Has a Sore Throat?
A sore throat can show up fast.
One minute your child is eating dinner or getting ready for school, and the next they are saying, “It hurts to swallow.” As a parent, your mind may immediately jump to questions: Is it strep? Is it a cold? Do they need antibiotics? Should they stay home from school? Should I call the doctor now or wait?
The good news is that many sore throats in children are caused by viruses and improve with rest, fluids, and supportive care. But some sore throats need testing or treatment, especially when strep throat is a possibility.
At Rush Memorial Hospital, we know parents want clear answers without guessing. Here is what to look for, what you can do at home, and when your child should be seen.
What usually causes a sore throat in children?
A sore throat is a symptom, not a diagnosis. It can happen for several reasons.
The most common causes include:
- Viral infections, such as colds or flu-like illnesses
- Strep throat, which is caused by group A strep bacteria
- Allergies or postnasal drainage
- Dry air
- Irritation from smoke or pollution
- Mouth breathing during sleep
- Acid reflux
- Tonsil inflammation
Viruses cause many sore throats, especially when symptoms include a runny nose, cough, sneezing, hoarseness, or watery eyes. Antibiotics do not treat viruses.
Strep throat is different. It’s a bacterial infection of the throat and tonsils. According to the CDC, healthcare providers can do a quick test to see whether a sore throat is caused by strep, and antibiotics can help people with strep throat feel better faster.
How can I tell if my child might have strep throat?
You cannot know for sure just by looking. A strep test is usually needed.
That said, strep throat often looks different from a typical cold. The American Academy of Pediatrics recommends calling your pediatrician if your child has a sore throat with fever and swollen glands, especially without a runny nose or cough.
Signs that may point toward strep include:
- Sudden sore throat
- Fever
- Pain with swallowing
- Swollen glands in the neck
- Red or swollen tonsils
- White patches or streaks on the tonsils
- Headache
- Stomachache, nausea, or vomiting
- Fine red rash, which can happen with scarlet fever
Signs that often point more toward a virus include cough, runny nose, hoarseness, pink eye, or diarrhea. Viral sore throats can still feel miserable, but they usually do not need antibiotics.
Should I look in my child’s throat?
You can, but don’t rely on what you see to make the decision.
Some children with strep have very red tonsils or white patches. Others don’t. Some children with viral infections can also have red, irritated throats. Looking can give you helpful information, but it does not replace a provider exam or strep test.
Also, don’t force the exam if your child is gagging, scared, or having trouble breathing or swallowing. Comfort and safety come first.
When should I call the doctor?
Call your child’s healthcare provider if your child has a sore throat with:
- Fever
- Swollen glands in the neck
- No cough or runny nose
- White patches on the tonsils
- Rash
- Headache or stomachache with throat pain
- Exposure to someone with confirmed strep throat
- Symptoms that are not improving after a few days
- Symptoms that are getting worse
The CDC recommends seeing a healthcare provider for sore throat symptoms because testing may be needed for strep.
When is a sore throat an emergency?
Most sore throats are not emergencies. But some symptoms need immediate attention.
Seek urgent or emergency care if your child has:
- Trouble breathing
- Drooling because they cannot swallow
- Severe trouble swallowing
- Blue lips or extreme sleepiness
- Signs of dehydration, such as very little urine, no tears, dry mouth, or dizziness
- Stiff neck
- Severe pain on one side of the throat
- Trouble opening the mouth
- Neck swelling
- A muffled “hot potato” voice
- A rash with serious illness symptoms
- Your child looks very sick or you are seriously concerned
Parents know their children. If something feels wrong, it is appropriate to seek care.
Does my child need a strep test?
Maybe. Your provider will decide based on symptoms, age, exam findings, and possible exposure.
A rapid strep test involves swabbing the throat and can show quickly whether group A strep bacteria are likely causing the illness. A throat culture takes longer but may find infections that a rapid test misses. For children and teens, the CDC says a throat culture is important after a negative rapid strep test when strep is still suspected.
This is why it is important not to start leftover antibiotics or someone else’s prescription. The right treatment depends on the right diagnosis.
Why not just give antibiotics to be safe?
It may feel like antibiotics are the fastest way to help, but they only work for bacterial infections like strep throat. They don’t help viral sore throats.
Using antibiotics when they aren’t needed can cause side effects, such as diarrhea, rash, or allergic reactions. It can also contribute to antibiotic resistance, which makes infections harder to treat in the future.
If your child tests positive for strep, antibiotics are important. If the test is negative and the cause is likely viral, supportive care is usually the best treatment.
What can I do at home to help my child feel better?
For many sore throats, comfort care makes a big difference.
Try these steps:
- Encourage fluids. Small, frequent sips are fine.
- Offer soft foods, such as soup, applesauce, yogurt, smoothies, or popsicles.
- Use age-appropriate pain or fever medicine as directed.
- Run a cool-mist humidifier if the air is dry.
- Encourage rest.
- For older children, warm saltwater gargles may help.
- Avoid smoke, strong odors, and other irritants.
Do not give honey to children under 1 year old. For older children, honey may soothe throat irritation, especially if coughing is also present.
If your child is refusing fluids, has fewer wet diapers or trips to the bathroom, or seems unusually tired, call your provider.
Should my child stay home from school or daycare?
It depends on symptoms and the cause.
Your child should generally stay home if they have a fever, feel too sick to participate, are vomiting, have diarrhea, or need more care than the school or daycare can provide.
If your child has confirmed strep throat, the CDC says they should stay home from school, daycare, or work until they are fever-free and have been on appropriate antibiotics for at least 12 to 24 hours.
Even when symptoms are mild, encourage good handwashing, covering coughs and sneezes, and not sharing cups, utensils, or water bottles.
How long should a sore throat last?
A mild sore throat from a virus often improves over a few days. Strep throat may also improve quickly once antibiotics are started, but your child should finish the full antibiotic course exactly as prescribed.
Call your provider if symptoms are not improving, are worsening, or return after seeming to get better. Also call if your child develops new symptoms such as rash, ear pain, dehydration, breathing trouble, or severe fatigue.
FAQ: Children and Sore Throats
How do I know if my child’s sore throat is strep?
You usually cannot know for sure without a test. Strep is more likely when a sore throat comes on suddenly with fever, swollen neck glands, pain with swallowing, and no cough or runny nose. A healthcare provider can decide whether a strep test is needed.
Can my child have strep without a fever?
Yes, it is possible, though fever is common. If your child has a significant sore throat, swollen glands, exposure to strep, or symptoms that are not improving, call your provider for guidance.
Do antibiotics help every sore throat?
No. Antibiotics only treat bacterial infections, such as strep throat. They do not work for viral sore throats caused by colds or similar illnesses.
What can I give my child for throat pain?
Fluids, soft foods, rest, and age-appropriate pain or fever medicine may help. Follow dosing instructions carefully. Do not give aspirin to children, and do not give honey to babies under 1 year old.
When can my child go back to school after strep throat?
Children with strep should stay home until they are fever-free and have been taking appropriate antibiotics for at least 12 to 24 hours, according to CDC guidance.
When should I seek urgent care for a sore throat?
Seek urgent care if your child has trouble breathing, drooling, severe trouble swallowing, signs of dehydration, stiff neck, severe one-sided throat pain, trouble opening the mouth, or looks very sick.
Medical Disclaimer
This blog is for general informational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Always follow guidance from your healthcare provider. If you think you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately.