Strep Throat & Children – Causes, Signs and symptoms

Strep Throat Children


Strep throat is an infection caused by group A streptococci bacteria. These bacteria can cause inflammation and infection in a variety of areas throughout the body, including the respiratory system, skin and vital organs.

A strep throat infection can be transmitted by kissing, coughing, sneezing or touching contaminated surfaces. Symptoms usually appear within five days of exposure to the bacteria and include a sore throat, fever, swollen neck glands and tonsils. Symptoms tend to begin suddenly and are usually more severe than those experienced with viral infections. Coughing and a runny nose are not signs of strep throat.

Most cases of strep throat occur in children between the ages of 5 and 15 years. Strep throat rarely occurs in infants and toddlers. Children who spend time in crowded environments (e.g., daycare facilities, school) or who live in northern areas of the United States face an increased risk of developing strep throat.

Parents who suspect their child has strep throat should consult their child’s pediatrician. A physical examination and medical history may be performed, although the only way to identify the presence of strep throat is with a throat culture and/or rapid strep test (test that is similar to a throat culture, except with faster results).

Children with strep throat are treated with antibiotics. This kills the bacteria that causes infection, limits the spread of infection to others, and prevents serious medical conditions that may occur if an untreated infection spreads throughout the body. Children remain contagious for at least a day after beginning treatment. While children are recuperating from infection, parents can help make recovery as comfortable as possible.

It may be impossible to completely avoid people carrying the bacteria that cause strep throat. Some people may carry the bacteria but never develop an infection themselves and will not display any symptoms. Perhaps the best way to prevent infection is to practice good hygiene (e.g., handwashing with soap and water). Replacing a child’s toothbrush after infections is a good way to prevent the recurrence of infection.

About strep throat

Strep throat is a bacterial infection that causes inflammation within the throat. It affects the pharynx (back of the throat) and tonsils (two oval-shaped tissue masses located inside the mouth, at either side of the throat). Sometimes, the adenoids (tissue mass located behind the nose in the upper throat) may also become swollen and infected.

The bacteria that cause strep throat are from a class of bacteria called group A streptococci (strep). Most often, a person develops strep throat after exposure to a person already infected with the bacteria. Other times, the bacteria can live harmlessly in the nose or throat for some time without causing infection, and can then be triggered due to stress or immune system dysfunction, resulting in infection. 

Strep throat occurs most often in children between 5 years and 15 years old, although it may affect people of all ages. Approximately 15 percent of sore throats in children are due to strep throat, according to the American Academy of Family Physicians.

Untreated strep throat can spread to other areas of the body and lead to serious medical conditions. However, these complications are rare in the United States, since prompt and effective treatment is delivered in most cases of strep throat. These complications include:

  • Rheumatic fever. A severe inflammatory disease that causes joint pain and may cause permanent heart problems. Rheumatic fever occurs approximately 18 days after an episode of strep throat, according to the National Institutes of Health(NIH). It most often affects children.

  • Glomerulonephritis. Inflammation of the kidneys that may lead to kidney failure. This condition may occur after an untreated case of strep throat, although it occurs more often after a strep infection of the skin.

  • Sydenham’s chorea. Sometimes follows rheumatic fever. This disorder involves uncontrolled, jerking movements of the muscles in the torso, arms and legs.

In rare cases, strep throat can result in the development of obsessive-compulsive disorder (OCD) in some children. This mental health condition is characterized by recurrent, persistent thoughts that patients cannot control (obsessions) and/or an uncontrollable urge to perform certain actions over and over (compulsions). Such cases are known as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), and their cause is unknown.

There are many different strains of strep bacteria, which can cause a number of different types of illnesses. In addition to strep throat, strep bacteria can cause inflammation and infection in other areas of the body, such as:

  • Ear, nose and throat problems. This includes tonsillitis, sinusitis and otitis media. These infections may accompany strep throat.

  • Skin infections. The strep bacteria can also infect the skin, causing impetigo, cellulitis and erysipelas (inflammation in upper layers of the skin). The Centers for Disease Control and Prevention (CDC) estimates that over 10 million cases of strep-caused skin and throat infections occur every year. In some children, cellulitis infection may develop in the rectum (streptococcal perianal cellulitis) or vagina (streptococcal vaginitis).

  • Scarlet fever, an infectious disease that may occur in children following a strep throat infection. It can cause a bright red rash, sore throat and fever.

  • Severe, invasive infections. These include bacteremia (infection that enters the bloodstream), streptococcal toxic shock syndrome (causes blood pressure to drop and vital organs to fail) and necrotizing fasciitis (flesh-eating disease). These infections can be fatal. An estimated 9,000 invasive infections occur annually in the United States, according to the CDC.

Risk factors and causes of strep throat

Strep throat is caused by group A beta-hemolytic streptococci bacteria (also known as streptococcus pyogenes). A person develops strep throat after coming into contact with the bacteria in the saliva or nasal discharge of an infected person. This can occur during kissing, sneezing or coughing, or touching contaminated surfaces and then touching one’s own mouth, nose or eyes.

When strep throat recurs after treatment within a household, a carrier (person who carries the bacteria but displays no symptoms of infection) may be the cause. Occasionally, the strep bacteria may not have been entirely eliminated from a person’s body, even after antibiotic treatment.

Factors that may increase a person’s risk of strep throat include:

  • Age. Children between the ages of 5 and 15 years are at highest risk for strep throat. Strep throat rarely occurs in infants and toddlers.
  • Crowded environments. Anyone spending time in crowded environments, such as school, playgrounds and daycare facilities is at an increased risk of catching infectious diseases, such as strep throat.
  • Spring, fall months. Strep throat occurs most often during the spring and fall months.
  • Poor hygiene. Anyone who fails to practice good hygiene (e.g., handwashing with soap and water) is at an increased risk of developing bacterial infections, such as strep throat.
  • Northern regions. Strep infections are more common in the northern areas of the United States, rather than in the southern areas.

Signs and symptoms of strep throat

Signs and symptoms of strep throat usually appear within five days of being exposed to the bacteria that causes strep throat. However, it may be difficult to know whether a person is infected since some people are carriers – they carry the bacteria, yet never display any symptoms of infection themselves. When strep throat symptoms recur in a child, it may indicate an untreated bacterial infection or recurring contact with a carrier (e.g., at home, school, in daycare settings).

Parents who suspect their child has strep throat should seek immediate medical attention, since their child will need to be treated with antibiotics. Symptoms of strep throat are generally more severe and begin more suddenly than viral infections of the throat (e.g., a cold, the flu). In addition, prolonged or high fever, breathing problems or significant difficulty swallowing also indicate a medical emergency that requires immediate attention.

Common symptoms of strep throat in children age 4 years and older include:

  • Sore throat
  • Sudden, high fever (higher than 102 degrees Fahrenheit or 38.9 degrees Celsius)
  • Swollen lymph nodes (glands) in the neck
  • Red, swollen tonsils (tissue located inside the mouth, at either side of the throat)
  • White spots or coating of the tonsils (may also be yellow or gray in color)
  • Abdominal pain
  • Headache
  • Difficulty swallowing
  • Loss of appetite
  • Nausea and vomiting

Symptoms may vary when strep throat occurs in young children. Signs of strep throat in infants include:

  • Low-grade fever (under 102 degrees Fahrenheit or 38.9 degrees Celsius)
  • Thick and bloody nasal discharge

Signs of strep throat in toddlers include:

  • Low-grade fever (under 102 degrees Fahrenheit or 38.9 degrees Celsius)
  • Thick and bloody nasal discharge
  • Increased irritability
  • Sleeplessness
  • Loss of appetite
  • Swollen neck glands

The presence of any of the following may indicate a child has a viral infection, and NOT strep throat:

  • Runny nose
  • Coughing
  • Hoarseness
  • Red eyes

If a child develops a skin rash shortly (often 24 to 48 hours) after the strep throat symptoms begin, it may indicate scarlet fever. A rash accompanied by swelling of the joints or shortness of breath after a strep infection, may indicate rheumatic fever (inflammatory complication of strep throat that can result in heart problems). Parents who notice these symptoms should seek immediate medical attention for their child.

Diagnosis methods for strep throat

Parents who suspect their child may have strep throat should consult their child’s pediatrician. They may also be referred to an ear, nose and throat specialist.

A physical examination should include a visual inspection of a child’s throat. A tongue depressor may be used to enable clear viewing of the back of the throat. A medical history may be compiled, which can include questions about the frequency of throat infections in the child.

Strep throat cannot be diagnosed strictly by symptoms and physical examination. The only way to identify the presence of strep throat is through the following diagnostic tests:

  • Rapid strep test (also called the rapid antigen test). A physician will swab the back of the child’s throat for a tissue sample. This can be analyzed and results are typically available in minutes. It can detect the strep bacteria in 75 to 85 percent of strep throat cases, according to the American Academy of Family Physicians (AAFP).

  • Throat culture. A physician swabs the child’s throat (similar to the method used for the rapid strep test) and the tissue sample is then sent to a laboratory for analysis. Results are generally not available for at least a day or two.

Generally, both tests are performed, particularly if the rapid strep test is negative. The rapid strep test allows treatment to begin immediately (if strep throat is detected) and the throat culture is used to confirm this result. Occasionally, the throat culture (a more sensitive test) may detect a strep throat infection that was missed during the rapid strep test. 

A new diagnostic test has been developed that uses DNA technology, called the rapid DNA test. It provides results within a few hours, and may be more sensitive than the rapid antigen test. Parents should consult with the physician about the availability of this test.

Family members who are not currently displaying symptoms of strep throat will sometimes receive a rapid strep test and throat culture to help determine if they are carriers.

Treatment options for strep throat

Antibiotics are required to treat strep throat in children, even though the infection usually clears within a week. Antibiotics are necessary to kill the bacteria, limit the spread of infection and prevent medical complications.

Antibiotics may be provided in pill, liquid or injectable form. Children with strep throat should begin to feel better – and parents will typically notice a reduction of symptoms – within a day or two of beginning antibiotic treatment. Parents should ensure their child takes the complete course of antibiotics prescribed. Failure to be treated with antibiotics, or failure to take the entire course of treatment, may increase the risk of serious medical complications (e.g., rheumatic fever, glomerulonephritis). Failure to complete treatment may also lead to the development of antibiotic-resistant bacteria.

Children with strep throat may continue to be contagious for at least one day after beginning antibiotic treatment. Children should not return to school until they have taken antibiotics for at least one day, the fever is gone and they feel better. Antibiotic treatment limits the spread of infection but does not prevent strep throat from recurring in a particular child. Children who are not treated with antibiotics may be contagious for weeks after an infection.

If a child who has tested positive for strep throat does not respond to antibiotic treatment, it may be because that child is a carrier (carries the bacteria in the body but never develops an infection). The existing condition may also not be strep throat at all, but a viral infection. A way to confirm this is to test the child for strep throat when signs of infection are no longer present. A healthy, asymptomatic child who tests positive for strep throat is considered a carrier. It is not usually necessary to treat carriers.

Parents of children with strep throat can help manage their child’s symptoms. This includes ensuring the child gets plenty of rest and nourishment. Adequate fluid intake (e.g., water, juice, broth) can help prevent dehydration that can occur when children are sick. In addition, certain over-the-counter pain medications (e.g., acetaminophen, ibuprofen) can help reduce the fever and pain associated with strep throat. Parents should never give aspirin to children or adolescents since it may increase the risk of Reye syndrome, a potentially fatal condition.

Additional methods that may comfort a child with strep throat include:

  • Gargle with warm salt water
  • Drink cool or warm liquids
  • Eat soft foods (e.g., soup, popsicles)

Parents should avoid giving the child acidic products (e.g., orange juice, lemonade), since they may sting the throat. Environments that include cigarette smoke or fumes from paint or cleaning products should also be avoided, since these may irritate an already sore throat. In addition, parents should consult their child’s pediatrician about whether throat lozenges or throat sprays may help. Lozenges can pose a choking hazard for young children, and some lozenges may aggravate the symptoms of strep throat. Throat sprays are sometimes recommended for symptomatic relief in children 6 years and older.

Although rare, a tonsillectomy is sometimes recommended for children with repeated episodes of strep throat (e.g., more than five episodes in one year). Parents should consult their child’s pediatrician to weigh the benefits and risks of this type of surgery.

Prevention methods for strep throat

Strep throat is a bacterial infection that can be easily spread. The infection can be acquired anywhere that people congregate, such as at home, at school or in daycare facilities. 

The best way to prevent strep throat is to avoid exposure to the bacteria that cause strep throat. These bacteria can be transmitted by saliva or nasal discharge from an infected person. However, it may be difficult to completely avoid infected people since some people can be carriers – they may carry and transmit the bacteria, but display no symptoms of infection themselves.

Methods that can help prevent the spread of strep throat include:

  • Wash hands frequently
  • Cover mouth and nose when coughing or sneezing
  • Immediately dispose of used tissue
  • Avoid touching eyes, nose or mouth
  • Avoid sharing eating utensils, food or any items that may spread germs
  • Replace toothbrush after infections

Questions for your doctor about strep throat

Preparing questions in advance can help patients and parents have more meaningful discussions with physicians regarding their or their child’s treatment options. The following questions related to strep throat may be helpful:

  1. My child has a sore throat. How can I tell if it’s strep throat?
  2. What type of treatment will my child need for strep throat?
  3. How long will my child have to take antibiotics?
  4. What can I do to make my child comfortable at home while he/she recuperates from strep throat?
  5. Do you recommend specific over-the-counter pain relievers for my child? What are their side effects? Are there any I should avoid giving my child?
  6. What change in symptoms should I report to you?
  7. Are other household members at risk of contracting strep throat from my child?
  8. For how long will my child be contagious?
  9. When do you recommend that my child return to school, or resume normal activities?
  10. How can I reduce the likelihood my child catches strep throat (or another infection) while at daycare or in school?
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