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The parent’s guide to strep throat in kids

Endless coughs and sneezes, runny noses, and unexplained itchy bumps—kids seem to be a magnet for germs. In our parent’s guide to childhood illnesses, we talk about the symptoms and treatments for the most common conditions. Read the full series here.

What is strep throat? | Symptoms | Complications | Diagnosis | Treatments | Prevention | Recurrent strep throat infections

“My throat hurts.” 

When your child says this, it’s likely your mind immediately jumps straight to strep throat. While it is not the only potential reason for a sore throat, it is common—and worrisome. With treatment it’s rarely serious, but strep throat in kids usually means time off school or day care, a trip to the doctor, and a round of antibiotics. In other words, it’s not fun for anyone involved.

What is strep throat?

Strep throat is an infection caused by a type of bacteria called group A streptococcus. This bacteria is responsible for 20% to 30% of all sore throats.

“Strep throat is very contagious,” says Soma Mandal, MD, a board-certified internist at Summit Medical Group in Berkeley Heights, New Jersey. “Typically, the bacteria spreads through sneezing and coughing.” It can also be spread by the sharing of personal items such as cups and utensils with someone who has strep throat.

Anyone can catch strep throat, but it’s more common in children. “Kids and teenagers are more prone to it, since they go to school with larger groups,” Dr. Mandal says. It is most common in ages 5 to 15 years old and rare in children less than 3 years old.

Parents can absolutely catch strep throat from their children, so take care to avoid exposure while caring for a child with strep throat. With antibiotic treatment, strep throat in kids is usually contagious for 24 to 48 hours.

“Strep throat will usually resolve without antibiotics within seven to 10 days, but there is increased risk of other conditions (like rheumatic fever) and a person stays contiguous for two to three weeks,” says Toni Brayer, MD, FACP, an internal medicine physician in San Francisco.

Strep throat symptoms in children

Symptoms of strep throat can be mild or severe. They typically appear three to five days after exposure to the bacteria.

The most common symptoms of strep throat are:

  • Fever that may begin suddenly and is often the highest on the second day
  • Chills
  • Red, sore throat that may have white patches or pus
  • Throat pain when swallowing
  • Swollen, tender neck lymph nodes

Other symptoms can include:

  • Red, swollen, bumpy tongue with enlarged tastebuds (called strawberry tongue)
  • Tiny red spots on the back roof of the mouth
  • Headache, irritability, or fussiness
  • Sleeping more than usual
  • Poor appetite, nausea, or vomiting, particularly in younger children
  • Stomach pain
  • Scarlatina (scarlet fever)—a red rash on the body that feels rough like sandpaper and may appear 12 to 48 hours after the first symptoms

Some or all symptoms may be present with strep throat.

If your child has runny nose, cough, congestion, itchy eyes, muscle or body aches, or other cold symptoms, then it is not likely to be strep throat.

Is strep throat serious?

“The goal of treatment is to prevent complications,” says Dr. Mandal. If strep throat is left untreated potential long-term complications include:

  • Acute rheumatic fever (a disease that can affect the heart, joints, brain, and skin)
  • Poststreptococcal reactive arthritis (an inflammatory condition that causes joint pain and swelling)
  • Scarlet fever (a rash that accompanies a strep infection along with strep throat symptoms)
  • Streptococcal toxic shock syndrome (a rare but serious bacterial infection)
  • Acute glomerulonephritis (a type of kidney disease)
  • Pediatric autoimmune neuropsychiatric disorder (a neurological and psychiatric condition)

Because most cases of strep throat are treated with antibiotics before they progress, these complications are rare. Older children can often clear the infection without antibiotics without these complications.

What should I do if my child has strep throat?

If your child is showing signs of strep throat, make an appointment or call a healthcare provider, typically a family doctor or pediatrician, ideally within the first one to two days of illness. “It is best to start the antibiotics within the first 48 hours of illness to reduce the symptoms and healing time,” says Dr. Brayer.

The healthcare provider will do a physical exam that includes looking inside the child’s throat, feeling the child’s neck, and asking questions about the child’s symptoms and health information. If strep is suspected, the healthcare provider will likely order strep tests. If there are signs of a viral or respiratory illness, it is not recommended to do strep testing. Also, testing is not recommended for children under the age of 3 years old or for adults.

“Doctors can either take a throat culture by swabbing the throat with a sterile swab and send it to the lab, which delays the diagnosis by about 24 to 48 hours, or they can do a rapid strep antigen swab test right in the office and get an immediate result,” Dr. Brayer says. “If that rapid strep test is negative, but the symptoms point to strep, they may send a culture to the lab for confirmation anyway.”

Treatments for strep throat in kids

Strep throat can go away without antibiotics, especially in older children, but untreated strep throat puts the child at greater risk of more serious complications and increases the time the child is contagious.

Strep throat is typically treated with a 10-day course of antibiotics, usually penicillin or amoxicillin. Sometimes the provider will opt to treat the child with one (intramuscular) shot of penicillin. If the child has an allergy to penicillin or amoxicillin, other antibiotics, such as cephalosporins, can be tried. It is important to take the entire course of antibiotics, even once symptoms are gone.

In addition to antibiotic treatment, some things that can help make the child feel better and promote healing include:

  • Administer over-the-counter (OTC) medications, such as Advil, Motrin (ibuprofen), or Tylenol (acetaminophen) for pain relief and fever reduction. Do not give a child aspirin as this can result in a rare but serious condition called Reye’s syndrome.
  • Encourage fluids to prevent dehydration.
  • (Ginger ale is a popular choice, but water is the best option. Avoid acidic drinks such as orange juice and other citrus drinks.)
  • Offer warm liquids, such as caffeine-free lemon tea, and adding honey (for children over age 2).
  • Offer frozen ice treats such as popsicles, or throat lozenges for older children and teens. Avoid giving them to young children because they can choke on them.
  • Gargle with salt water for children who are over age 6 (and are able to spit instead of swallow).
  • Use a cool-mist vaporizer or humidifier to help with dryness and soothe a sore throat. Always use cool-mist, never warm or hot.
  • Provide soft, easy to swallow foods for the child to eat.
  • Encourage the child to get lots of rest.

RELATED: 25 sore throat remedies

How to prevent strep throat in kids

As with all contagious illnesses, good hygiene goes a long way to prevent the spread of strep throat. To help prevent strep throat spreading from infected individuals to healthy ones:

  • Encourage proper and frequent handwashing (for everyone!)
  • Teach your child to cover all sneezes or coughs. Ideally, a tissue should be used. If one isn’t available, sneezing or coughing into a shirtsleeve will do. Don’t sneeze or cough into hands (if kids use their hands, have them wash their hands.)
  • Keep an infected child’s eating utensils, dishes, and drinking glasses separate from the rest of the family’s. Wash them in hot, soapy water after each use.
  • Make sure an infected child doesn’t share food, drinks, napkins, handkerchiefs, toys, or towels with other family members or anyone else. This is a good habit to get into even when everyone is healthy to help prevent catching illnesses from others.
  • Toss your child’s toothbrush after the antibiotic treatment starts and the child is no longer contagious. Replace with a new one.

School-age children with strep throat should stay home from school. “Children are very contagious when they are ill with strep throat,” says Dr. Brayer. “They can return to school when they no longer have a fever and have taken antibiotics for at least 24 hours and feel well. Remember that is a full 24 hours.”

Dr. Mandal recommends keeping children home from school for even longer. “If a child is diagnosed with strep throat, they should remain at home until they have been on antibiotics for at least 48 hours,” says Dr. Mandal. “This would prevent the spread of strep to other children.”

Can strep throat recur?

Anyone can catch strep throat again throughout their lives, but some children experience recurrent strep throat, which involves being diagnosed with strep throat more than seven times in a single year. This is often treated by a tonsillectomy (the removal of the child’s tonsils.) It is important that strep throat is verified with lab testing (rapid strep or throat culture) to avoid unnecessary antibiotics and procedures. For some children, strep infections continue after surgery. This can be caused by:

  • Antibiotic resistance: Stopping antibiotics before the end of treatment can cause the bacteria to develop a resistance to the drug, making the antibiotics less effective.
  • Weakened immune system: This can make your child more susceptible to disease, including strep throat.
  • Hidden carrier: Some people are asymptomatic carriers of the strep bacteria. It’s possible the child is in regular close contact with a strep carrier.
  • Reinfection from dental tools: Failing to replace a child’s toothbrush and properly disinfecting the adjacent objects such as the toothbrush holder can reintroduce the strep bacteria.

Strep throat is a common and unpleasant illness in children that can also spread to adults. Left untreated, it can have serious complications. Thankfully, with a course of antibiotics, good hygiene, and some good old-fashioned TLC, kids with strep throat usually feel better within a few days, and fully recover in about 10 days.