Strep Throat Infection

Is this your child's symptom?

• Your child was diagnosed with a Strep throat infection
• A doctor has told you your child probably has Strep throat or
• Your child has a positive Strep test
• Your child is taking an antibiotic for Strep throat and you have questions
• You are worried that the fever or sore throat is not getting better fast enough

Symptoms of Strep Throat Infection

• Pain, discomfort or raw feeling of the throat
• Pain is made worse when swallows
• Children less than 2 years of age usually can't complain about a sore throat. A young child who does not want favorite foods may have a sore throat. They may also start to cry during feedings.
• Other symptoms include sore throat, fever, headache, stomach pain, nausea and vomiting.
• Cough, hoarseness, red eyes, and runny nose are not seen with Strep throat. These symptoms point more to a viral cause.
• Scarlet fever rash (fine, red, sandpaper-like rash) is highly suggestive of Strep throat.
• If you look at the throat with a light, it will be bright red. The tonsil will be red and swollen, often covered with pus.
• Peak age: 5 to 15 years old. Not common under 2 years old unless sibling has Strep.

Cause of Strep Throat

• Group A Strep is the only common bacterial cause of a throat infection. The medical name is Strep pharyngitis.
• It accounts for 20% of sore throats with fever.
• Any infection of the throat usually also involves the tonsils. The medical name is Strep tonsillitis.

Diagnosis of Strep Throat

• Diagnosis can be confirmed by a Strep test on a sample of throat secretions.
• There is no risk from waiting until a Strep test can be done.
• If your child has cold symptoms too, a Strep test is usually not needed.

Prevention of Spread to Others

• Good hand washing can prevent spread of infection.

When to Call for Strep Throat Infection

Call 911 Now

• Severe trouble breathing (struggling for each breath, can barely speak or cry)
• Fainted or too weak to stand
• Purple or blood-colored spots or dots on skin with fever
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Trouble breathing, but not severe
• Great trouble swallowing fluids or spit
• Stiff neck or can't move neck like normal
• Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
• Fever higher than 104° F (40° C)
• Will not drink or drinks very little for more than 8 hours
• Can't open mouth all the way
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Urine is pink or tea (brown) color
• Taking antibiotic more than 24 hours, and sore throat pain is severe. The pain is not better 2 hours after taking pain medicines.
• Taking antibiotic more than 48 hours and fever still there or comes back
• Taking antibiotic more than 3 days and other Strep symptoms not better
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• You have other questions or concerns

Self Care at Home

• Strep throat infection on antibiotic with no other problems

Care Advice for a Strep Throat Infection

What You Should Know About Strep Throat:

• Strep causes 20% of throat and tonsil infections in school age children.
• Viral infections cause the rest.
• Strep throat is easy to treat with an antibiotic.
• Complications are rare.
• Here is some care advice that should help.

Antibiotic by Mouth:

• Strep infections need a prescription for an antibiotic.
• The antibiotic will kill the bacteria that are causing the Strep throat infection.
• Give the antibiotic as directed.
• Try not to forget any of the doses.
• Give the antibiotic until it is gone. Reason: to stop the Strep infection from flaring up again.

Sore Throat Pain Relief:

• Age over 1 year. Can sip warm fluids such as chicken broth or apple juice. Some children prefer cold foods such as popsicles or ice cream.
• Age over 6 years. Can also suck on hard candy or lollipops. Butterscotch seems to help.
• Age over 8 years. Can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed.
• Medicated throat sprays or lozenges are generally not helpful.

Pain Medicine:

• To help with the pain, give an acetaminophen product (such as Tylenol).
• Another choice is an ibuprofen product (such as Advil).
• Use as needed.

Fever Medicine:

• For fevers higher than 102° F (39° C), give an acetaminophen product (such as Tylenol).
• Another choice is an ibuprofen product (such as Advil).
• Note: fevers less than 102° F (39° C) are important for fighting infections.
• For all fevers: keep your child well hydrated. Give lots of cold fluids.

Fluids and Soft Diet:

• Try to get your child to drink adequate fluids.
• Goal: keep your child well hydrated.
• Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
• Solids. Offer a soft diet. Also avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: fluid intake is much more important than eating any solids.
• Swollen tonsils can make some solid foods hard to swallow. Cut food into smaller pieces.

What to Expect:

• Strep throat responds quickly to antibiotics.
• The fever is usually gone by 24 hours.
• The sore throat starts to feel better by 48 hours.

Return to School:

• Your child can return to school after the fever is gone.
• Your child should feel well enough to join in normal activities.
• Children with Strep throat need to be taking an antibiotic for at least 12 hours.

Call Your Doctor If:

• Trouble breathing or drooling occurs
• Dehydration suspected
• Fever lasts more than 2 days after starting antibiotics
• Sore throat lasts more than 3 days after starting antibiotics
• You think your child needs to be seen
• Your child becomes worse

Remember! Contact your doctor if you or your child develop any "Contact Your Doctor" symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 05/01/2025

Last Revised: 03/04/2025

Copyright 2000-2025 Schmitt Pediatric Guidelines LLC.