Sore throat is one of the most common reasons children see a doctor. The good news: most sore throats are caused by viruses, get better on their own within a week, and do not need antibiotics. This guide explains what causes sore throats, how to care for your child at home, when strep throat may be the culprit, and the warning signs that mean you should call your child's doctor or seek urgent care.
What causes a sore throat?
Most sore throats are viral. Common cold viruses and other respiratory viruses cause the majority of sore throats in children. These often come along with a runny nose, cough, hoarse voice, red or watery eyes, or diarrhea. Viral sore throats cannot be treated with antibiotics and usually improve on their own.
Strep throat is the most common bacterial cause. "Strep throat" is caused by a bacterium called group A streptococcus. It accounts for roughly 1 in 4 to 1 in 3 sore throats in school-aged children and is most common between ages 5 and 15. It is uncommon in children younger than 3 years. Strep throat is important to identify because it can be treated with antibiotics and, when needed, treatment helps prevent rare complications.
Other causes include mononucleosis ("mono," from the Epstein-Barr virus, more common in teens), hand-foot-and-mouth disease, and irritation from very dry air or postnasal drip.
Viral sore throat vs. strep throat
No single symptom can tell the two apart for certain, but some patterns are helpful:
More likely strep throat:
- Sudden sore throat with pain on swallowing
- Fever
- Red, swollen tonsils, sometimes with white or yellow patches
- Swollen, tender glands in the front of the neck
- Headache, stomachache, nausea, or vomiting
- A fine, sandpaper-like rash (scarlet fever)
- No cough
More likely a virus:
- Cough
- Runny or stuffy nose
- Hoarse voice
- Red, watery eyes
- Mouth sores or ulcers
- Diarrhea
Because these overlap, the only reliable way to diagnose strep is a throat swab test done by your child's doctor.
How strep throat is diagnosed
If your child's symptoms suggest strep, the doctor will do a quick throat swab (a rapid strep test). If it is positive, strep is confirmed. If the rapid test is negative in a child, doctors usually send a second swab for a throat culture or a more sensitive test, because rapid tests can miss some cases in children.
Testing is generally not recommended when a child clearly has viral symptoms (like cough, runny nose, and red eyes), or for children under 3 years old unless there are special risk factors, such as an older sibling with strep.
Caring for your child at home
For most sore throats, comfort care is the main treatment:
- Pain and fever relief: Acetaminophen or ibuprofen, dosed by weight, can ease throat pain and fever. Follow the label or your doctor's guidance, and do not give ibuprofen to infants under 6 months without medical advice.
- Fluids: Offer plenty of liquids. Cold drinks, ice pops, and smooth foods are often easier to swallow.
- Soothing options: Warm liquids (like broth or warm water with honey) can be comforting. Honey should not be given to children under 1 year of age. Older children can try gargling warm salt water or sucking on throat lozenges or hard candy (only for children old enough to do so safely without choking).
- Rest and humidity: Rest and a cool-mist humidifier can help.
- Avoid aspirin in children and teens because of the risk of a rare but serious condition called Reye syndrome.
When are antibiotics needed?
Antibiotics only help sore throats caused by bacteria, mainly strep throat, and are prescribed only after a positive strep test. They do nothing for viral sore throats, and using them when they are not needed can cause side effects and antibiotic resistance.
When strep is confirmed, penicillin or amoxicillin is the usual first choice; children with a penicillin allergy have other options. If your child is prescribed antibiotics, give the full course as directed, even after they feel better. Children with strep can usually return to school after 12 to 24 hours on antibiotics and once fever-free.
When to call the doctor or seek urgent care
Contact your child's doctor if your child has a sore throat plus any of the following:
- Sore throat lasting more than about a week, or getting worse instead of better
- Fever that is high, persistent, or returns after going away
- A rash
- Symptoms of strep (fever, painful swallowing, swollen neck glands) without cold symptoms
Seek care right away (call your doctor urgently or go to the emergency department) if your child has:
- Difficulty breathing or noisy, high-pitched breathing
- Trouble swallowing, or drooling because they cannot swallow
- Difficulty opening the mouth, or a muffled "hot potato" voice
- Severe pain on one side of the throat, or a stiff or swollen neck
- Signs of dehydration (very little urine, no tears, dry mouth, unusual sleepiness)
- Difficulty waking, or a child who seems very ill
These can be signs of a more serious problem that needs prompt evaluation.
Preventing the spread
Sore throat infections spread easily. Teach your child to wash hands often, cover coughs and sneezes, and avoid sharing cups and utensils. Replace your child's toothbrush after they have been on antibiotics for strep for a day or two.