Understanding And Treating Your Child’s Sore Throat

Second only to the stomach ache, sore throats are one of the most common ailments in pediatrics. Sometimes a sore throat is accompanied by other symptoms, and sometimes it’s the only one, but a day doesn’t go by in pediatric practice without treating at least one sore throat.

Because there are so many childhood illnesses that can trigger sore throats, I’m here to break down some of these conditions and provide guidance to better prepare you for the next time your child has throat pain.

Sore Throat Symptoms

In order to know what to do when your child has a sore throat, let’s start by learning more about some of the most common causes of sore throats, or pediatric pharyngitis. When a child gets a sore throat, it’s almost always a symptom of something else.

Viral Sore Throat Causes

The Common Cold

Almost all sore throats are caused by viruses. I know most parents and patients coming to see me for a solution don’t really want to hear that, but it’s true! Viral pharyngitis is regularly a symptom of adenovirus, rhinovirus, coronavirus, RSV, or other cold viruses. Those medical names are just a few of the viruses that cause what most people call the common cold.

A cold usually starts when your child wakes up with a yucky feeling and a scratchy throat. By the next day it can be a full blown cold sore with a runny nose, sore throat, sneezing, pain with swallowing, and coughing. Cold symptoms get worse slowly, and it can take 1-2 weeks to recover fully, or longer if the cold leads to a sinus infection.

The good news about sore throats caused by viruses is this: almost always, with a little loving care at home, the virus will resolve on its own. Supportive care from mom and dad and extra rest is the solution when your child has a viral sore throat.

Influenza

Influenza (not the stomach flu, but actual influenza) is another viral infection that can cause a sore throat.

If you are unsure if your child’s symptoms or sore throat point to influenza or a run-of-the-mill cold, I have a quick guide to influenza vs the common cold to help you learn the differences between these illnesses.

Again, usually bed rest and lots of fluids are adequate treatment for influenza, but sometimes your child may need an antiviral medication like Tamiflu. Body aches and high fevers are the herald symptoms of influenza, and children’s acetaminophen or ibuprofen usually help with the discomfort as their body fights this yucky viral infection.

Mononucleosis

You might have heard mononucleosis referred to as “the kissing disease” or simply, mono. Mononucleosis is caused by the Epstein-Barr virus (EBV) and mainly affects high school and college students. Symptoms include a high fever, fatigue, swollen lymph glands, and a sore throat.

Mono is rarely serious and usually goes away after one to two months. During this time, your child will need extra rest. Occasionally, mono can cause enlargement of the liver and/or spleen. If this happens, your child will have to limit sports participation and some physical activity until the infection resolves. If you are concerned your child has mono, take him or her to your pediatric provider for further testing.

Remember: Viruses don’t respond to antibiotics, so your pediatric care provider won’t prescribe an antibiotic for a cold, the flu, or mono.

Bacterial Sore Throat Causes

Strep Throat

Strep throat is caused by Group A Streptococcus bacteria that causes inflammation and pain in the throat. While strep throat can affect both children and adults, it is most common in children ages 5-15.

Other Strep Throat Symptoms

• Fever
• Sore, red throat, sometimes with white patches
• Swollen lymph nodes in the neck
• Trouble swallowing
• Headache
• Nausea or vomiting

Strep throat is diagnosed by a simple swab test. If strep is present, your pediatric healthcare provider will prescribe antibiotics for your child. After your child has been on antibiotics for 24 hours, they are no longer contagious and should begin feeling better. As long as no fever is present after the 24 hours have passed, a child may return to school or daycare at this time.

Diphtheria

Diphtheria is caused by the Corynebacterium diphtheria bacteria. It’s a serious bacterial infection that affects the mucous membranes of the throat and nose.

Other Diphtheria Symptoms

• Thick, gray coating on the throat and tonsils
• Fever
• Chills
• Swollen glands in the neck
• Loud, barking cough
• Bluish skin

Thankfully, Diphtheria is very rare because it is easily prevented by vaccinations. It is part of the DTaP vaccine given to children in a series of five shots from ages 2 months to 6 years. Booster shots are also recommended around age 12, and again in adulthood.

Whooping Cough

Whooping cough is caused by the Bordetella pertussis bacteria. It causes terrible, uncontrollable coughing that can make it difficult to breathe. Whooping cough symptoms start out mimicking the common cold, with a runny nose, cough, and fever. The dry, persistent cough developer within two weeks, and in young children often has a “whoop” sound.

Other Whooping Cough Symptoms

• Vomiting
• Blue or purple skin around the mouth
• Dehydration
• Fever
• Breathing difficulties

Whooping cough is also called pertussis, and like diphtheria, is easily prevented by vaccination. In fact, the whooping cough vaccine is the “P” in the DTaP that also prevents diphtheria (the T is for tetanus).

Other Common Sore Throats Causes

Kids can have sore throats without a virus or bacteria attacking them. Here are a few other sore throat causes.

Allergies & Postnasal Drip

Allergies are a very common cause of sore throat in children. In addition to colds and influenza, kids can get postnasal drip from exposure to allergens or other irritants.  Postnasal drip happens when you have an excess of mucus accumulating in the back of your throat. That mucus and drainage causes irritation and pain to the back of the throat.

If you think your child is suffering from allergies, your pediatric care provider can perform allergy tests to pinpoint exact allergen triggers. Your pediatric care provider may also recommend a trial of an over-the-counter allergy medicine like Children’s Benadryl or an antihistamine like Children’s Claritin or Zyrtec.

Sleeping With Mouth Open

Children who sleep with their mouths open can experience a dry mouth and sore throat upon waking in the morning. A cool mist humidifier can help.

Cigarette Smoke

Breathing in second-hand smoke can trigger persistent sore throats. Cigarette smoke effects can be much more serious than a sore throat long-term, so it is important to limit your child’s exposure to cigarette smoke completely.

Gastroesophageal Reflux

Gastroesophageal reflux is a digestive condition that happens when stomach acid flows up into the esophagus. In addition to heartburn, nausea, and hoarseness, reflux can also cause sore throats. Your pediatric care provider will most likely treat reflux by a change in diet or antacid medication.

When Should I Call The Nurse About A Sore Throat?

Most sore throats are viral and will resolve themselves after 4 or 5 days, but there are times when you should visit your pediatric healthcare provider.

Call your pediatric healthcare provider immediately if your child has a sore throat and:

• Your child is drooling, spitting, or having a great difficulty swallowing (call 911)
• Your child is having difficulty breathing (call 911)
• Severe Pain
• Your child can’t fully open her mouth
• Your child acts very sick

Call your pediatric healthcare provider within 24 hours if your child has a sore throat and:

• Persistent fever
• Abdominal pain, nausea or vomiting
• Your child had recent contact with a person who had strep throat
• Your child has a sunburned-looking rash
• You see large yellow or white spots on the tonsils while looking at them with a light

What About Tonsillitis?

Tonsillitis is an inflammation and swelling of the tonsils. It is usually present with any throat infection, including both bacterial and viral infections. The presence of tonsillitis doesn’t have any special meaning.

In the past, doctors removed children’s tonsils if they presented with strep throat or tonsillitis a few times in one year. We now know that tonsils are an important part of the immune system, so tonsillectomies are reserved for only serious cases, usually only after repeated, persistent strep infections or enlarged tonsils that cause upper airway obstruction or sleep apnea.

Sore Throat Remedies At Home

If your child’s sore throat is not caused by a bacterial infection, you will not be given antibiotics. Remember, this isn’t a bad thing, it’s just not necessary and it won’t help! Antibiotics are only effective with bacterial infections, not viral infections.

Here are a few sore throat remedies you can try at home:

1. Give your child plenty of clear fluids. Water is best, but you can also offer them a flat soft drink (like 7Up).
2. Gargling with warm salt water (1 teaspoon of salt in 8 ounces of water) can help to alleviate the pain.
3. Give your child a soft diet with foods that are easy to swallow while they have a sore throat. Milkshakes, Jell-O and popsicles are a big hit with my patients. In older children, sometimes sucking on a hard candy (like butterscotch) can help sore throats as well.
4. Children’s acetaminophen or ibuprofen can help with throat discomfort and fevers above 102 degrees. If your child does have a fever, remember that is a good sign that their body is fighting the infection that is causing the sore throat. For more info on helping a feverish child, go here.
5. Run a humidifier. Sometimes extra moisture helps with dry throat pain.
6. Rest – encourage lots of extra rest!

As always, a little extra love and cuddles can go a long way when your child isn’t feeling well. Be sure to practice good hand washing and try to keep contact with other family members at a minimum to reduce the chance of spreading infections.

Author: Dani Stringer, MSN, CPNP, PMHS – founder of KidNurse and MomNurse Academy