However, some infections are caused by bacteria and will require antibiotics. It can be difficult to tell the difference between a viral or bacterial infection. If you are concerned about the sore throat, your child should be examined by your family doctor. Your doctor will check your child’s neck, throat, ears and chest, and may do a throat swab. This will help your doctor decide how to treat the sore throat.
Throat swabs are done to determine if a particular type of bacteria – Group A Streptococcus (GAS) – is the cause of a sore throat. Unfortunately, we cannot tell by symptoms alone whether this bacteria is present. Studies show that, at best, doctors can only tell the difference between a bacterial or viral infection half of the time. This is no better than flipping a coin.
As well, up to 20 per cent of children may have GAS as part of the natural bacteria in their bodies. As these children (known as carriers) do not get sore throats or other symptoms, they will not benefit from antibiotics.
Doctors will usually only do a throat swab if two of these symptoms are present.
• Fever greater than 38 C
• Minimal cough
• Tenderness along the neck
• Swelling or discharge from the tonsils
Unnecessarily treating sore throats with antibiotics can lead to antibiotic resistance. To identify those who actually need antibiotics, doctors must decide which sore throats should be swabbed. Symptoms that suggest strep throat include:
Generally, doctors will only do a throat swab if two or more of these symptoms are present. Antibiotics are usually not prescribed unless a throat swab comes back positive for GAS.
If a sore throat is caused by GAS, then a 10-day course of antibiotics will be prescribed. Usually penicillin is used, but other antibiotics are available in the case of an allergy. Although GAS infections will get better on their own, antibiotics can improve symptoms of infection sooner (typically one day earlier than without antibiotics). Antibiotics also lower the risk of passing GAS to others. They can also prevent rare but serious illnesses, such as rheumatic fever.
Although antibiotics are not always appropriate, other treatments can be tried to soothe symptoms of sore throat. Acetaminophen or ibuprofen may help for pain. The package will show the amount to give, based on your child’s weight. Gargling with salt water, sucking on throat lozenges, sipping warm liquids such as soup or tea with honey, and using a humidifier may also give temporary relief. As with any illness, make sure your child is eating and drinking well. Most sore throats do get better after a week. The goal is to relieve symptoms until the body heals on its own.
Cough suppressants are generally not recommended. Coughing is one way the body tries to clear an infection. Although suppressants may give temporary relief, they could make infections worse in the long term. As well, rare but serious side effects can occur when using cough suppressants. Health Canada advises that cough suppressants should not be used in children under age six.
In the past, it was very common to remove tonsils. This is no longer done as often, because the surgery can cause serious bleeding that can be difficult to stop. Although there is debate about who needs their tonsils removed, children with frequent throat infections are thought to benefit from this surgery. An ears, nose and throat (ENT) specialist should help to decide whether removing the tonsils is appropriate.
Most sore throats caused by viruses are not severe infections. However, mononucleosis (known as ‘mono’ or ‘the kissing disease’) is an exception. This serious infection is caused by the Epstein-Barr virus. Symptoms include fever, fatigue, persistent sore throat (usually lasting one to three weeks), swollen glands (in the neck, and even in the groin), and an enlarged liver or spleen. It is diagnosed with a blood test. If your child’s sore throat does not improve after a week, ask your doctor about testing for this disease.
While mononucleosis will get better with time, care must be taken to avoid damaging the liver or spleen. If your child has mono, contact sports should be avoided until the spleen and liver are back to normal. Your doctor can determine when it is safe to start again. Mononucleosis is also very contagious. Avoid any activities where saliva can be exchanged, such as sharing drinks, kissing, or using the same lip gloss.
When it comes to your child’s health, it is always better to see a doctor if you are concerned. However, certain symptoms may indicate that your child needs immediate medical attention. These include continuing symptoms that do not improve after a week, any problems with breathing or swallowing, severe throat pain, or the presence of blood.
Although sore throats are common in children, it is hard to know whether a virus or bacteria is the cause. Since antibiotics only treat bacterial infections, a throat swab is needed to determine if they should be used. However, not every child with a sore throat needs a swab. Your doctor can decide whether or not this is appropriate.
Even without treatment, most sore throats improve on their own. Focus on treating the symptoms. If you are concerned, seek medical attention. It is better to have your child assessed sooner rather than later.