Does Your Child Have Strep Throat?

How to Tell If Your Child Has Strep Throat

We often hear a lot about colds and the flu. But there’s another common illness called strep throat that doesn’t get quite as much attention. Stanford Medicine Children’s Health — Pediatrics in Berkeley pediatrician Katya Gerwein, MD, explains how to distinguish strep throat from other similar illnesses. She also discusses this in a HealthTalks podcast.

What is strep throat?

Most of the time, sore throats (like the kind you get when you have a cold) are caused by a virus. However, strep throat is different because it is an infection caused by bacteria called group A Streptococcus (group A strep). Strep throat is very contagious and can easily be spread by contact with a person who has the infection, or by saliva spread from coughing and sneezing.

“It’s spread by respiratory droplets mostly,” Dr. Gerwein explained. “So, you cough, or you sneeze into your hand, and then you touch something, and then somebody else touches it. It’s basically the same way that you transmit a cold.”

Strep throat is usually diagnosed using a rapid test that quickly checks for the presence of streptococcal bacteria using a throat swab. Results are ready within 10 minutes, and the test is highly accurate, Dr. Gerwein said.

Who is at risk for strep throat?

According to the Centers for Disease Control and Prevention (CDC), children 5 to 15 years of age are the most at risk for strep throat. It tends to spread in places with lots of kids, like schools or day care centers. The good news is that strep is very rare for children under 3 years of age.

“Kids under the age of 3 almost never get strep. It’s almost unheard of,” Dr. Gerwein said. “We don’t know why; it’s one of the mysteries of medicine. So, if your kid is under 3, they probably don’t have strep.”

Strep throat symptoms vs. cold or flu

“The symptoms of strep that you would want to be more alert for are a kid who has a sore throat, but no runny nose or cough.” Dr. Gerwein said that symptoms of a strep throat infection almost always include some sore throat (although there are rare exceptions). There may or may not also be fever, redness in the back of the throat, swollen tonsils, white patches or pus on tonsils, small red spots on the roof of the mouth (petechiae) and/or swelling of lymph nodes in the front of the neck, vomiting, belly pain, or a pink rash.

Dr. Gerwein explained that one way to rule out strep versus a cold or flu is whether the child has nasal symptoms or a cough, as those are rarely seen in strep throat infections.

“The thing about strep is that it doesn’t come with a runny nose or cough. You could have a slight tickle in your throat from the phlegm. But, if you really have a lot of runny nose, sneezing, or stuffy nose, and you have a lot of coughing like you would get with a cold, then it’s not strep,” she said. “You can get some voice changes, but it doesn’t get hoarse. So, if you have that hoarse voice that you get with laryngitis, it’s not strep. Those are just easy ways to rule out a lot of what people worry about.”

Treating strep throat

According to Dr. Gerwein, most kids with strep will start to feel better in three to five days without antibiotics. Yet, strep throat is often treated with antibiotics to prevent potential complications and get kids back to school sooner.

“The main reason we’re treating strep is to prevent complications like rheumatic fever, which is exceedingly rare. Even though rheumatic fever is rare, it is very serious, and it is more likely in kids. So, in pediatrics, we tend to treat just because you don’t want to take that chance,” she said. “If you get rheumatic fever, it’s irreversible. Also, if you take the antibiotics, you’re not contagious after 12 hours, so kids can go back to school, and that is another advantage.”

If you’re still unsure if your child has strep or another illness, it’s never a bad idea to check in with your child’s pediatrician. “We want people to know we’re always happy to see their kids,” Dr. Gerwein said. “We just don’t want parents to worry unnecessarily.”

For more advice from Dr. Gerwein, check out Getting Back on Track: The Importance of Immunizations and COVID-19 and Influenza: A Q&A With Drs. Roshni Mathew and Katya Gerwein. Or learn more about strep throat: “Pharyngitis and Tonsillitis in Children.”