Children's Hospital Colorado

Strep Throat Infection

Urgent or Emergency Care?

If you believe your child needs immediate attention and you have concerns for a life-threatening emergency, call 911. Not sure what counts as urgent and what's an emergency when your child is sick or injured? When it can't wait, know where to take your kids.

Help Me Decide

  • 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.

Call 911 Now

  • Severe trouble breathing (struggling for each breath, can barely speak or cry)
  • Fainted or too weak to stand
  • You think your child has a life-threatening emergency

Go to ER Now

  • Can't swallow any fluids and new onset drooling

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 over 8 hours, dark urine, very dry mouth and no tears)
  • Purple or blood-colored spots or dots on skin
  • Fever over 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

Call 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

Call Doctor During Office Hours

  • You have other questions or concerns

Self Care at Home

  • Strep throat infection on antibiotic with no complications

Care Advice for a Strep Throat Infection

  1. 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.
  2. 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.
  3. Sore Throat Pain Relief:
    • Age over 1 year. Can sip warm fluids such as chicken broth or apple juice.
    • 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.
  4. 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.
  5. Fever Medicine:
    • For fevers above 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.
  6. 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.
  7. 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.
  8. 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 24 hours.
  9. 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

Disclaimer

The information contained in these topics is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition. Nothing contained in these topics is intended to be used for medical diagnosis or treatment.

  • Not a Substitute - The information and materials in Pediatric HouseCalls Symptom Checker should not be used as a substitute for the care and knowledge that your physician can provide to you.
  • Supplement - The information and materials presented here in Pediatric HouseCalls Symptom Checker are meant to supplement the information that you obtain from your physician. If there is a disagreement between the information presented herein and what your physician has told you -- it is more likely that your physician is correct. He or she has the benefit of knowing your child's medical problems.
  • Limitations - You should recognize that the information and materials presented here in Pediatric HouseCalls Symptom Checker have the following limitations, in comparison to being examined by your own physician:
    • You can have a conversation with your child's doctor.
    • Your child's doctor can perform a physical examination and any necessary tests.
    • Your child could have an underlying medical problem that requires a physician to detect.
    • If your child is taking medications, they could influence how he experiences various symptoms.

If you think that your child is having a medical emergency, call 911 or the number for the local emergency ambulance service NOW!

And when in doubt, call your child's doctor NOW or go to the closest emergency department.

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Copyright 2000-2018. Schmitt Pediatric Guidelines LLC.

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